Ep. 655 Hormonal Acne, Melasma, and Botox Safety | Women's Health, Hormones, Acne

Cynthia Thurlow (0:00)

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Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Welcome to the latest Midlife Minute where I'm going to be answering listeners' questions. Today, they are focused on acne, melasma and neurotoxins. And so first question is from JC who mentions that her 18-year-old daughter has developed severe face and back acne over the past two years and suspects it's hormonal and or dietary and doesn't know where to start. And so it's really interesting. I think that there's a lot of prevailing perspectives on even young adult acne and we know that it almost always goes back to hormones, specifically androgens, which are precursors to testosterone, acting on the oil glands in our skin. And over 50% of women with acne actually have elevated androgens on a blood test. But plenty of women with normal appearing labs still get hormonal acne, sometimes around their cycles, sometimes when they're stressed. And that's because a lot of what's happening locally in the skin itself is not just in our bloodstream. Our skin can be more sensitive to a normal amount of a hormone or producing extra hormone on its own. And none of that can necessarily show up on a standard blood panel. What I think is interesting is that insulin definitely plays a role here. And why I think diet has a larger piece of the conversation. Certainly, this is something I've seen with one of my children who's super sensitive to dairy, sadly, because he really likes it. But when he eats a lot of dairy, it shows up in his face. He'll start getting some back acne, some facial acne. And when he eliminates dairy from his diet, he tends to have pretty clear skin. So I think that this other piece of the conversation about insulin and a related hormone called IGF-1.

When insulin runs high, it makes our skin more sensitive to androgens. And it turns off a natural break on that sensitivity. And it directly revs up oil production all at once. So all these things are happening simultaneously. And that's the actual mechanism behind the sugar and dairy connection to acne. It is not a myth. This is actually what I found in the research when I went to look all this up to be able to speak to it very authentically and from a research perspective. And there's a striking data point that proves this. People with a rare genetic condition called Laron syndrome can't make IGF-1 at all. And they don't get acne. That's how tightly linked this pathway is. So most acne doesn't require blood work. But the Society for Endocrinology put out an updated clinical practice guideline in 2025 laying out exactly when a workup is warranted. And I think this is relevant to this conversation because we got quite a few questions about acne. In fact, there are several I haven't even gotten to yet. An acne that's treatment resistant, that showed up suddenly or looks atypical, or that's showing up alongside irregular periods, excess facial hair, dark, velvety patches of skin, or hair thinning. That guideline is specific about what to actually order to. Ask for testosterone, run by a method called LC-MS.

Specifically, the standard immunoassay most labs run isn't accurate at the low levels typical in women. Surprise, surprise. So you can get a fairly falsely reassuring number using this other method. A full panel also includes DHEA slash S. And so this is the sulfated version of DHEA, an adrenal related androgen, which screens for a rare adrenal condition that mimics PCOS almost perfectly. And if you're on birth control, the guideline is clear that you need to be off of it for at least three months before testing. Since the pill, the oral contraceptive skews the numbers and the results. Now, I know with a younger person, the thought of going off contraception if they're sexually active is probably not ideal. But if someone is having any of these concerning symptoms, the same guideline also lays out red flag thresholds, not just talk to your doctor vagueness.