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

Welcome to this week’s Midlife Minute. Today I’m answering listeners’ questions related to acne, melasma, and neurotoxins. Stay tuned for more! IN THIS EPISODE, YOU WILL LEARN: Why acne is usually hormonal even when blood work looks normal The mechanism that lies behind the connection between sugar, dairy, and acne The circumstances where blood testing is warranted for acne How women can have acne and completely normal-looking labs and regular cycles, and still have PMOS-level hormone activity occurring The value of screening for PMOS rather than just treating the skin How melasma differs from acne Two factors that cause melasma when both are present Can Botox trigger autoimmune disease or cause autoimmune flares? How to reduce the risk of problems when using Botox Connect with Cynthia Thurlow Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to support@cynthiathurlow.com Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow. Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Reference List: Acne, Melasma, and Neurotoxins Acne References A1. Elhassan YS, Hawley JM, Cussen L, et al. Society for Endocrinology Clinical Practice Guideline for the Evaluation of Androgen Excess in Women. Clinical Endocrinology. 2025. A2. Bienenfeld A, Azarchi S, Lo Sicco K, et al. Androgens in Women: Androgen-Mediated Skin Disease and Patient Evaluation. Journal of the American Academy of Dermatology. 2019. A3. Briganti S, Flori E, Mastrofrancesco A, Ottaviani M. Acne as an altered dermato-endocrine response problem. Experimental Dermatology. 2020. A4. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology. 2024. A5. Moradi Tuchayi S, Makrantonaki E, Ganceviciene R, et al. Acne vulgaris. Nature Reviews Disease Primers. 2015. (Sentinel reference for acne pathophysiology) A6. Liu YT, Wang YW, Tu C, et al. Recommendations for managing adult acne and adolescent acne based on an epidemiological study conducted in China. Scientific Reports. 2024. A7. Xia J, Ding L, Liu G. Metabolic syndrome and dermatological diseases: association and treatment. Nutrition & Metabolism. 2025. A8. Cussen L, McDonnell T, Bennett G, et al. Approach to androgen excess in women: Clinical and biochemical insights. Clinical Endocrinology. 2022. A9. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental Dermatology. 2009. A10. Chang J, Nock MR, Cohen JM, Bunick CG. Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States. PLoS One. 2022. A11. Rao Y, Lei Z, Chen S, et al. Differential plasma proteome analysis reveals key proteins associated with insulin resistance in acne vulgaris patients. Scientific Reports. 2025. A12. Roster K, Fleshner L, Karatas TB, et al. Menopause and Common Dermatoses: A Systematic Review. American Journal of Clinical Dermatology. 2026. (Shared reference, also cited in melasma section) A13. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris. The Journal of the American Medical Association. 2021. A14. Costa CS, Bagatin E, Yang Z, et al. Systemic pharmacological treatments for acne: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 2021. A15. Hebert A, Thiboutot D, Stein Gold L, et al. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatology. 2020. A16. Zaenglein AL. Acne Vulgaris. The New England Journal of Medicine. 2018. A17. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology and Metabolism. 2023. A18. Yesiladali M, Unluhizarci K, Attar E, Kelestimur F. Where are we in the diagnosis and treatment of hirsutism? A narrative review. Reviews in Endocrine & Metabolic Disorders. 2026. A19. Committee on Practice Bulletins, Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstetrics and Gynecology. 2018. A20. Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2018. (See full list of references at https: https://www.cynthiathurlow.com/.