Case Report: Managing Hormonal Acne in a 39-Year-Old Female in Houston and Katy, Texas
Acne is one of the most common dermatologic concerns we see at our practice in Houston and Katy, Texas. This case highlights the complexities of managing adult female acne, especially when hormones, diet, and underlying health conditions play a role.
Patient Background
A 39-year-old female returned for follow-up evaluation of acne affecting her face. She had previously completed a six-month course of isotretinoin (Accutane/Absorica) and had also tried spironolactone in the past. While Accutane helped initially, her acne recurred.
The patient currently has a Mirena® IUD, which may contribute to hormonal acne. She also noted that her breakouts worsened with dairy, sugar, and processed foods. Additionally, she reported concerns about hair loss and possible hormonal imbalance, raising suspicion for PCOS (polycystic ovarian syndrome).
Clinical Examination
A full skin examination was performed, including the scalp, face, neck, chest, back, and extremities. Findings included:
Inflammatory papules and pustules
Comedonal papules
Evidence of ongoing active acne
Treatment Plan
After reviewing her history and concerns, a comprehensive treatment strategy was created:
Spironolactone (50 mg twice daily): Restarted to address hormonal acne by reducing the effect of androgens on the oil glands.
Topical Tretinoin 0.025% cream: Prescribed for nightly use to improve cell turnover, reduce clogged pores, and minimize scarring.
Benzoyl Peroxide Wash: To reduce acne-causing bacteria and inflammation.
Moisturizers and Sunscreen: Recommended non-comedogenic brands such as CeraVe, Cetaphil, EltaMD UV Clear, and La Roche-Posay.
Lifestyle Counseling: Patient was advised to limit dairy, sugar, and processed foods that may trigger breakouts.
Laboratory testing was ordered to evaluate endocrine function and rule out PCOS or other hormonal imbalances.
Counseling and Expectations
We discussed the chronic nature of acne and the importance of long-term management. The patient was informed that:
Results may take 2–3 months to achieve 60–80% improvement.
Acne can recur, and adjustments may be needed over time.
Possible side effects of spironolactone include dizziness, breast tenderness, and menstrual irregularities.
Tretinoin should be applied at night to dry skin to minimize irritation.
The patient agreed with the plan and will return in three months for follow-up.
Why This Case Matters
This case illustrates that acne is not just a teenage problem—it is a chronic condition that can affect women well into adulthood. Hormones, birth control, diet, and genetics often play a role. By combining oral and topical therapies with lifestyle adjustments, patients can achieve clearer, healthier skin.
At our dermatology practice in Houston and Katy, Texas, we specialize in personalized acne treatments tailored to each patient’s unique needs.
