This inflammatory cascade typically leads to the formation of inflammatory acne lesions, including papules, infected pustules, or nodules.[1] If the inflammatory reaction is severe, the follicle can break into the deeper layers of the dermis and subcutaneous tissue and cause the formation of deep nodules.[1][66][67] Involvement of AP-1 in the aforementioned inflammatory cascade leads to activation of matrix metalloproteinases, which contribute to local tissue destruction and scar formation.[44]
Combined oral contraceptive pills contain progesterone and estrogen and help to balance out the levels of testosterone in the body12 One obvious effect of this is birth control, but dermatologists have also found it very useful for treating hormonal acne. Testosterone doesn’t directly cause acne, but when hormone levels fluctuate and testosterone increases above its baseline level, it can lead to increased acne for some. This is because increases in testosterone and other androgens leads to an increase in sebum production, which can cause more clogged pores and more p. acnes bacteria, leading to blackheads, whiteheads, pimples, or even cysts.
Hormonal activity, such as occurs during menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens causes the skin follicle glands to grow larger and make more oily sebum.[12] Several hormones have been linked to acne, including the androgens testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA); high levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) have also been associated with worsened acne.[41] Both androgens and IGF-1 seem to be essential for acne to occur, as acne does not develop in individuals with complete androgen insensitivity syndrome (CAIS) or Laron syndrome (insensitivity to GH, resulting in very low IGF-1 levels).[42][43]
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