How to prevent hormonal breakouts that happen despite BC?

June 5, 2017 8:03 AM

Been using birth control for years because of acne. Acne is gone, but hormonal forehead breakouts persist. What does this mean and how do I stop them?

I, a woman in her mid-20s, have been using birth control for 8 years because of severe acne on the cheek and jaw area. My skin cleared up in a year and was practically perfect until 2 years ago. I then started getting breakouts on my forehead 2 weeks before my period - not like the red acne I used to have elsewhere on my face, but tiny pimples that can’t be squeezed as nothing will come out. There are dozens of them on my forehead. :(

These breakouts disappear completely 2-3 days after my period begins and I again have perfect skin for a short while. My BC is this, it's the strongest anti-acne BC where I currently live. I don’t want to go off BC because I'm certain that severe acne would return. But I'm unhappy that I'm on strong BC and my forehead is still a mess most of the time.

Has this happened to you? What did you do? Does this mean that my BC is not working? Is there anything I can "supplement" my BC with so I won't get these breakouts?

posted by frantumaglia to Health & Fitness (10 answers total)

Hormones aren't the only cause/treatment for acne. See a dermatologist (try to schedule the visit for when the eruptions are present, but you can also take close photographs with your phone to show them) so you can get a better drill-down on what it actually is and what the treatment might be.

In my experience, the eruptions you describe aren't actually acne in the blocked-pore sense, and are more like a recurring rash (and self-perpetuating, as it'll spread if you're not careful about touching it and other parts of your face). I cannot remember the name of what I was prescribed, but it was a cream in a tiny tube that I had to use for a few months (along with a specific cleansing/moisturizing regimen that I think was mostly designed to just not irritate it worse) to get it to a) go away b) stop spreading.

I also have rosacea, which isn't really curable, but there are so many forms of it you might as well let a dermatologist decide if that's what yours is.
posted by Lyn Never at 8:14 AM on June 5, 2017

Different things seem to work for everyone for acne. None of the standard treatments worked for me, but slathering honey on my face did. It also goes away if I’m swimming in salt water daily, which suggests that a saltwater rinse might help me too.

(Perhaps tangentially, I wouldn’t assume that your severe acne would return if you went off birth control; you may have aged out of the worst of it. So if you don't like the pills it could be worth experimenting.)
posted by metasarah at 8:27 AM on June 5, 2017 [1 favorite]

What you're describing sounds like closed comedones. Alternating between a BHA and AHA gel in addition to my usual cleansing and moisturizing generally gets rid of mine (also seemingly hormonal), but I agree that this is something to see a dermatologist about, just in case.
posted by mcfighty at 8:29 AM on June 5, 2017

You often need multiple treatments to control acne. I am on BCP and I also use the following treatments. My suggestion is to pick one at a time and use it for 2 months to see if it improves matters.

Wash with 2% salicylic acid morning, and evening after makeup removal. Leave on for 2 mins before rinsing.

Benzoyl peroxide topical treatment, which you must leave untouched for at least 30 minutes after applying. Leaving it on is the key to successful treatment. Get the lowest percentage you can find. Start by trying it morning and evening if you can, otherwise just evening. If it irritates or overdries, try Cetaphil moisturizing lotion left to sink in for 15mins before you apply. Also if the percentage strength is too high try mixing it with the moisturizer to dilute.

A coal tar shampoo without silicones - I think Capasal is the best. It could be that the location of the acne has something to do with your shampoo, but in that case you might be getting acne on your scalp so IDK.

I would wonder if your hair treatmentts or styling products were maybe getting on your forehead somehow, if all else fails.

I also make sure to wash TWICE with Cetaphil cleanser in the evening plus a rinse. That seemed to be necessary to get fully clean.
posted by tel3path at 8:44 AM on June 5, 2017

Honestly - get what you have that is residual tested to see if it's something else. I have been having these shitty breakouts that do not respond to anything at-bloody-all and my doctor took a biopsy and it turns out it's rosacea. You may have something else going on, and if treating it like acne isn't solving it, getting a biopsy and a ruling from a pathologist isn't out of line in the least.
posted by Medieval Maven at 9:52 AM on June 5, 2017

Personally, I was fed up with period symptoms so I started skipping my period completely - I just skipped the "blanks" in every pack. I can't speak specifically to acne.
posted by AppleTurnover at 10:33 AM on June 5, 2017

Salicylic acid ("acne pads") and AHA/glycolic acid will help open those blocked pores.

Vitamin D may also help; chronically activated T cells will express vitamin D receptors, and will "stand down" if those receptors are engaged. Keratinocytes around pores may hyperproliferate and block the pore in response to lots of stuff including pro-inflammatory cytokines and stress-related hormones. Vitamin D will help prevent/tamp down the hyperproliferation.

Most people don't have enough circulating vitamin D (especially during winter); 1000 - 2000 IU per day is a very safe oral dose. Jamiesons is a high quality brand. At the very least, make sure its vitamin D3 (cholecalciferol) and check the expiry date.

Instead of squeezing them, perhaps consider a wire-loop blackhead* remover - just be careful to be gentle otherwise you may rupture the blocked pore resulting in infection/inflammation.

*color ranges from beige all the way to dark brown, depending on the degree of oxidation
posted by porpoise at 10:43 AM on June 5, 2017

Spironolactone is another option for hormonal acne. It's a little bit different from OCPs (it won't work as birth control) but it's very similar to the active ingredient in Yasmin and a few other OCPs, drospirenone.
posted by treehorn+bunny at 5:57 PM on June 5, 2017

This is why I take BC continuously--I don't get my period at all so I don't break out at that time of the month. Some docs will let you put a note on your prescription that says "take continuously" so you don't do the skip week.
posted by chaiminda at 3:45 AM on June 6, 2017

I was also going to suggest you try "stacking" your birth control so you don't get a period. You just start the next pack immediately, no week off (or no placebos).
posted by Violet Hour at 1:21 PM on June 6, 2017