Are acne and alopecia related?

We review all the key aspects of the frequent and little-known association between acne and alopecia.

Both acne and alopecia are very common conditions that affect people of all ages and genders. The phrase "At my age, and I still have acne..." is so typical. Many of these patients also experience a varying degree of alopecia.

Acne and alopecia can appear together because they share the same cause. Do you want to know why and what treatment options exist? Don't miss the rest of the post!

Acne is caused by alterations in the sebaceous glands, typically appearing in areas with higher concentrations, such as the face, chest, and back. When sebum or oil production increases, the pores through which it exits can become superinfected and inflamed, leading to typical red pimples. These can be very superficial (less related to hormones) or deep and painful.

Alopecia is caused by an alteration in hair loss or thickness. The type of alopecia related to hormones is androgenetic alopecia, which causes hair to become progressively thinner.

As seen in the image, the hair follicle (which generates hair) and the sebaceous gland (which generates oil) are related structures. There are areas of the body, such as the head, where the most important portion is the hair follicle, and therefore tends to present alterations like alopecia, while in others, like the face, the sebaceous gland predominates, and acne is more common.

Both the sebaceous gland and the hair follicle respond simultaneously to androgens (hormones like testosterone or androstenedione); the oil gland by producing more oil (and acne) and the hair follicle by worsening its growth (and causing alopecia).

So, will acne always appear with alopecia?

NO!!!!

A person does not necessarily have to suffer from both simultaneously. They will be associated in individuals with a clear hormonal cause.

The association is more common in people over 20, and especially in women. In men, it is much more common after this age to only experience alopecia, although in this situation, it is common for them to have skin and scalp that are oilier than usual.

Women with polycystic ovary syndrome or hyperandrogenism of another cause will be those who most frequently present with the association of acne and alopecia.

Can alopecia treatment be helpful for acne?

When both alopecia and acne are of hormonal origin, the treatment will serve to treat both.

In women, the most effective drugs in this regard are antiandrogen drugs. Depending on the patient, they can be used in the form of contraceptives or as androgen receptor blockers (bicalutamide or spironolactone, for example). Additionally, other local treatments can be associated to enhance the result in each of the pathologies, such as retinoids for acne or minoxidil for alopecia.

In men, it is somewhat different, generally using androgen receptor blockers associated with acne treatment.

Should I see a doctor for treatment? Or can I buy it myself?

When you have acne or alopecia, and especially if you have both, I always recommend an evaluation by your specialist dermatologist. The type and severity of both acne and alopecia should be assessed, because although the conditions may seem similar, there are major differences. Furthermore, sometimes it can be associated with other types of hormonal problems that require more complex treatments. So, if in doubt, consult a doctor!