A large percentage of our female clients starting in our clearing program have a past history of visiting a dermatologist and starting on birth control therapy to help control their acne. While this is one tool in the toolbox for helping female hormonal acne, many come in on a birth control therapy that is working against them and not for them. There are different categories of birth control that can both help acne or make it worse and often it is very difficult for us to clear acne if it is being aggravted, made worse by the wrong type of birth control.
Acne is mostly a hormonal condition, which is why it often starts in puberty. As the male hormones in the body, androgens, rise they turn on the oil gland and also cause a rapid increase in the amount of dead skin cells being shed that both clog up the pores and lead to bacteria overgrowth in the pore. Some oral birth control can help in two ways:
1. They suppress ovulation which can reduce androgens, like testosterone, reducing oil production and the increased cell proliferation in the pore.
2. They also can help increase sex hormone binding globulin (SHBG) which is a protein made by the liver that binds to sex hormones like testosterone, dihydrotestosterone, and estradiol, making them inactive.
By doing this, oral birth control can help regulate the amount of these hormones available for the body to use. Together these two effects decrease the amount of excess circulating androgens in the bloodstream, which then lessens the internal acne aggravating factors that lead to acne, the over production of sebum and the increased cell proliferation in the pore. This can then help reduce acne lesions.
No, the right oral birth control that aids in reducing androgens through the two mechanisms takes time to work and begin to affect the skin. The clinical studies on certain beneficial birth control for acne shows approximately 6 months or more. One study shows at 6 months oral birth control shows the same efficacy as oral antibiotics at reducing acne lesions (https://pubmed.ncbi.nlm.nih.gov/24880665/).
When it comes to choosing the right birth control for acne, there are different things to think about. Not all birth control is helpful for acne and some can contribute to worsening of acne by increasing the amount of androgens in the body. All oral birth control are combination pills that contain both estrogen and progestin, female hormones, that work together as their mechanism of action. The estrogen component is generally beneficial for acne. But the progestin component can be either androgenic, meaning they can increase androgen activity in the body, worsening acne or they can be anti-androgenic, meaning they can reduce androgens in the body which can help to improve acne.
Norgestrel and Levonorgestrel are both progestins that have a androgenic effect increasing androgens in the body. If you are using birth control to manage acne, you may want to pick a birth control which does not contain these two progestins. Norethindrone, another progestin, also has some androgenic properties, but when paired with sufficient estrogen, the overall androgenic effect can be controlled, thus not contributing to acne. But studies are mixed with Norethindrone, so may not be the best option. With Norethindrone, it should be paired with at least 35mcg estrogen medication, Ethinyl Estradiol.
Oral birth control that contains anti-androgenic progestins or low androgenic progestin and higher dosage of estrogen are best to support acne clearing. Progestins Norgestimate, Norethindrone Acetate, Ethynodiol Diacetate are all relatively less andogenic and good options when paired with at least 35mcg estrogen medication, Ethinyl Estradiol. These would be in Ortho-Cyclen and Ortho Tri-Cyclen. However, higher estrogen can have many unwanted side effects such as weight gain and breast tenderness. The progestin Desogestrel has minimal androgenic properties and can be paired with a low dosage of estrogen, which can support acne and reduce the side effects of oral birth control that contain higher dosages of estrogen medication. Desogestrel paried with lower 20mcg of Ethinyl Estradiol can be found in the brand Yaz.
No. To clear acne, often you need both oral and topical clearing support. And remember, birth control can take 6 months or more of taking it before you begin to see improvement in your acne. And even then, often we see you need additional topical support to fully clear acne. Here is what you can do if you are not clearing on your birth control alone.
1. Cleanse: We start new inflamed acne clients on a super gentle cleanser that helps support the skin barrier and reduces any redness or irritation.
Face Reality Barrier Balance Creamy Cleanser
2. Tone: We start new inflamed acne clients on a hydrating toner to soothe and rejuvenate dehydrated skin.
Face Reality Moisture Balance Toner
Apply using a cotton round / pad
3. Correct: We start new inflamed acne clients on Face Reality Mandelic 8% Serum for normal skin and Face Reality Mandelic 5% Serum for dry or sensitive skin- begin use every other day.
Face Reality Mandelic 8% Serum
Face Reality Mandelic 5% Serum
Face Reality Glycolic 5% Serum
*At Week 2, begin mandelic serum daily
**At week 4, begin mandelic serum 2x per day, both AM and PM after moisture toner
***At week 6, start Glycolic 5% Serum in place of mandelic serum in PM after moisture toner
4. Hydrate: We start new inflamed acne clients on a hydrator to deeply hydrate and moisturize the skin.
5. Moisturize: We start new inflamed acne clients on a an acne safe moisturizer.
6. SPF: We start new inflamed acne clients on a an acne safe SPF
1. Cleanse: We start new inflamed acne clients on a super gentle cleanser that helps support the skin barrier and reduces any redness or irritation
Face Reality Barrier Balance Creamy Cleanser
2. Correct: The first two weeks, we start new inflamed acne clients on Face Reality Advanced Acne Med 2.5% for dry skin and Face Reality Acne Med 5% for normal or oily skin using the timing schedule below to allow skin to acclimate and avoid irritation and unnecessary dryness. DO NOT SPOT TREAT. Use a dime to nickel-sized amount over the ENTIRE acne-prone area, avoiding the eye area.
Face Reality Advanced Acne Med 5%
Face Reality Advanced Acne Med 2.5%
Timed Acne Med Schedule:
- First 3 days: apply all over for 15 minutes
- Days 4-6: apply all over for 30 minutes
- Days 7-9: apply all over for 1 hour
- Days 10-14: apply all over for 2 hours
3. Rinse off
4. Tone: We start new inflamed acne clients on a hydrating toner to soothe and rejuvenate dehydrated skin.
Face Reality Moisture Balance Toner
Apply using a cotton round / pad
5. Hydrate: We start new inflamed acne clients on a hydrator to deeply hydrate and moisturize the skin.
6. Moisturize: We start new inflamed acne clients on a an acne safe moisturizer.
Week 2+: At the end of week 2, begin Acne Med usage overnight after moisture toner and hydrabalance. Do not use moisturizer at night , in PM when starting acne med overnight. Cleanse, moisture toner, hydrabalance and then apply acne med last. Nothing should go over acne med the first 4-6 weeks. See our Inflamed Acne Blog Week 2-4 for more details.
*PM Routine: Make sure to add in correct serum in PM after moisture toner at week 4 and then move to Glycolic serum in place of mandelic serum in PM at week 6. See AM instructions. See our Inflamed Acne Blog Week 2-4 for more details.
1. Take a 2-3 day break from Mandelic Acid & Acne Med to give the skin time to heal. During this break, focus on hydration and barrier repair by using soothing products like HydraRemedy and a Face Reality Clearderma Moisturizer.
2. Once the skin feels comfortable and hydrated again, resume the regular routine as before.
520 Hillside Ave. Glen Ellyn, IL 60137
Call 630 - 488 - 6334 | Text 929-305-1465