Treating Acne in Male vs. Female Skin

Here’s How Male and Female Skin Differ and How You Should Treat Them Differently

Treating Acne in Male vs. Female Skin

Article Summary

Male hormones that are present in both males and females play a major role in how the skin develops and ultimately the development of acne, which explains why males as a whole are more prone to acne and tend to develop more severe cases. 

When it comes to acne treatment, hormonal treatments like oral contraceptives and anti-androgens are almost never prescribed to males, but can be effective in females. Also, there is some initial evidence showing that some topical acne medications might work slightly better in females compared to males.

Finally, since males develop facial hair, it can be harder to apply topical medications, so it is best for males who are applying topical medications to shave every day so that those medications can be evenly applied to the skin.

Male and female skin differ in ways that affect the development and treatment of acne.1 The main cause of these differences is a group of male hormones called androgens. Testosterone is the most well-known androgen. Everyone has both male and female hormones, but males have much higher levels of androgens than females do.

Androgens are responsible for many of the physical changes that happen during puberty. But they also affect other parts of the body, including the skin. Because of the effects of androgens, the skin of males and females is different.

Males have:

  • A thicker epidermis (top layer of skin)
  • Higher levels of sebum (skin oil)
  • Less skin elasticity
  • Higher skin blood content
  • More facial pores
  • Thinner subcutaneous tissues (the internal tissues directly under the skin)
  • More acidic skin

How Male Skin Is Different Than Female Skin
Female skin is the opposite:

How Female Skin Is Different than Male Skin
Since males tend to have higher levels of sebum, and higher levels of sebum tend to go hand in hand with more acne, this is an important reason why males tend to develop more acne than females. Females on the other hand have less acidic skin, which may provide a more ideal breeding ground for acne bacteria.

A 2006 study backs up these points.2


Male Hormones Play a Major Role in the Development of Acne

When it comes to acne, the role of androgen hormones (male hormones present in both males and females) should not be underestimated. In fact, humans do not develop acne unless they have testosterone in their blood. A 2005 study in Experimental Dermatology drives this point home:

Experimental Dermatology Journal

According to the authors of the study, “Several clinical observations point to a major role of androgens in the [development] of acne...[A]cne begins to develop [at the onset of puberty] when the adrenal gland starts to produce large quantities of…a precursor for testosterone.”3

These observations explain why acne tends to develop during puberty in both males and females, when production of testosterone increases, and why males, who end up producing much higher levels of testosterone, are more prone both to acne in general and to more severe acne.

In addition to the normal increase in androgens that comes with puberty and the differences in androgen levels between males and females, sometimes people of either gender can have abnormally high levels of androgens. Excessively high androgen levels are associated with:

  • Increased secretion of sebum (skin oil)
  • The development of severe acne in both males and females3

Generally speaking, it appears that both males and females with severe, persistent acne typically have higher blood levels of androgens than those without acne. They also have higher levels of androgens compared with people who have less severe acne.4,5

Pituitary Gland


Hormonal Treatments - Usually For Females Only

When acne is caused by abnormally high androgen production, estrogens and anti-androgens can help counteract the effects of these androgens. Doctors prescribe these two options far more often for female patients, since they can cause feminization in males, such as the growth of breast tissue.

Estrogens are female sex hormones. They work by reducing both the size of the glands that produce sebum and the amount of sebum that these glands produce.Estrogens are prescribed to only females in the form of oral contraceptives (birth control pills), and are effective in reducing androgen levels. For mild-to-moderate acne, contraceptives that contain mostly estrogen usually reduce acne, on average, by 60%. For more severe acne, or if there is no improvement with contraceptives containing mostly estrogen, switching to contraceptives that contain a type of hormone called progestogen may improve response. For acne that doesn’t improve with contraceptives alone, adding an anti-androgen medication is usually effective.6

Anti-androgens, such as spironolactone, are medications that block the effects of androgens, thus reducing the production of sebum. They are usually prescribed only to females, but their power to reduce acne has been shown in both females and males in clinical trials.3,7

According to one study, males and females with therapeutically resistant, severe, persistent acne, known as “cystic acne,” typically have abnormally high androgen levels and benefit from estrogen and/or anti-androgen treatment.8

Expand to read details of study 

The New England Journal of Medicine

In a 1983 study in The New England Journal of Medicine, males with cystic acne were given anti-androgens and females with cystic acne were given oral contraceptives and/or additional anti-androgens. The authors noted, “Of the patients treated for six months, 97 percent of the women and 81 percent of the men had resolution or marked improvement in their acne.”8


Anti-Androgens and Birth Control Pills



Some Acne Treatments May Work Better in Females 

Doctors can prescribe non-hormonal treatments to males and females without any risk of feminizing males. However, even non-hormonal treatments appear to sometimes work differently in males compared with females.

For instance, two studies that treated acne with a combination clindamycin phosphate/benzoyl peroxide gel found that this medication may be more effective in females.9,10


Another study looked at a topical anti-inflammatory acne medication called dapsone and found that it too worked better in females.11


A final study looked at the oral medication isotretinoin and showed no difference in efficacy between males and females.12

Expand to read details of study 

Journal of Clinical & Experimental Dermatology Research

A 2014 study in the Journal of Clinical & Experimental Dermatology Research, in which patients were treated with isotretinoin, a medication that is typically reserved for the most severe forms of acne, found no differences between male and female response to treatment. However, the authors noted that the females in this study had other conditions such as polycystic ovary syndrome, as well as less severe acne at the beginning of the study, which might have affected the study results.12


Facial Hair - It's Important to Shave Every Day If Applying Topical Medications

Males develop facial hair and facial hair can make it harder to apply topical acne medications. Even just a bit of stubble can make it difficult to apply medication evenly across the skin. The longer facial hair becomes, the more it grabs on to topical treatments and prevents those treatments from penetrating into the skin where they are needed. For this reason, it is best for males who are regularly applying topical acne treatments to shave every day. 

Another important reason to shave every day is to prevent irritation. The longer facial hair becomes, the more difficult it is to shave, which can lead to more irritation when shaving. Since irritation aggravates acne, this is another reason for males who are using topical treatments to shave every day. 

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Conclusion

The make-up of male and female skin differs, and each type responds differently to treatment. Hormonal treatments are far more commonly used for females than for males, and some non-hormonal treatments seem to work slightly better on female when compared to male skin. The exception being isotretinoin, which may treat both skin types equally.

The Experts at Acne.org

Our team of medical doctors, biology & chemistry PhDs, and acne experts work hand-in-hand with Dan (Acne.org founder) to provide the most complete information on all things acne. If you find any errors in this article, kindly use this Feedback Form and let us know.

References:

  1. Dao, H., Jr. & Kazin, R. A. Gender differences in skin: a review of the literature. Gend. Med. 4, 308–328 (2007).
  2. Kim, M. K. et al. Evaluation of gender difference in skin type and pH. J. Dermatol. Sci. 41, 153–156 (2006).
  3. Zouboulis, C. C. et al. What is the pathogenesis of acne? Exp. Dermatol. 14, 143–152 (2005).
  4. Zouboulis, C. C., Chen, W. C., Thornton, M. J., Qin, K. & Rosenfield, R. Sexual hormones in human skin. Horm. Metab. Res. 39, 85–95 (2007).
  5. Thiboutot, D., Gilliland, K., Light, J. & Lookingbill, D. Androgen metabolism in sebaceous glands from subjects with and without acne. Arch. Dermatol. 135, 1041–1045 (1999).
  6. Wiegratz, I. & Kuhl, H. Managing cutaneous manifestations of hyperandrogenic disorders: the role of oral contraceptives. Treat. Endocrinol. 1, 372–386 (2002).
  7. Sweeney, T. M., Szarnicki, R. J., Strauss, J. S. & Pochi, P. E. The effect of estrogen and androgen on the sebaceous gland turnover time. J. Invest. Dermatol. 53, 8–10 (1969).
  8. Marynick, S. P., Chakmakjian, Z. H., McCaffree, D. L. & Herndon, J. H., Jr. Androgen excess in cystic acne. N. Engl. J. Med. 308, 981–986 (1983).
  9. Harper, J. C. The efficacy and tolerability of a fixed combination clindamycin (1.2%) and benzoyl peroxide (3.75%) aqueous gel in patients with facial acne vulgaris: gender as a clinically relevant outcome variable. J. Drugs Dermatol. 14, 381–384 (2015).
  10. Harper, J. C. Gender as a clinically relevant outcome variable in acne: benefits of a fixed combination clindamycin phosphate (1.2%) and benzoyl peroxide (2.5%) aqueous gel. J. Drugs Dermatol. 11, 1440–1445 (2012).
  11. Tanghetti, E., Harper, J. C. & Oefelein, M. G. The efficacy and tolerability of dapsone 5% gel in female vs male patients with facial acne vulgaris: gender as a clinically relevant outcome variable. J. Drugs Dermatol. 11, 1417–1421 (2012).
  12. Pampena NS, et al. Gender Matter in Isotretinoin Therapy for Acne Vulgaris? A Retrospective Study. J. Clin. Exp. Dermatol. Res. 6, 3–7 (2015).
See More References

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