Acne in transgender patients: disease management and treatment recommendations from a group of experts on acne

Abstract

In transmen (women to men), the testosterone (T) therapy used to support the masculinizing process may cause acne. Conversely, in transwomen (men to women), feminising hormones may reduce acne but cause skin dryness and irritation which may be further exacerbated if mild acne persists, requiring topical treatments. Gonadotropin-releasing hormone analogues suppress endogenous sex hormones, thus avoiding the onset of acne in prepubertal individuals. To identify the specific issues of acne in transgender patients and propose suitable medical care for dermatologists. A group of five experts on acne reviewed and discussed 68 publications regarding the issue of acne in transgender patients. Key words included "acne+transgender", "acne+transgender+treatment", "transgender+skin diseases+treatment", "transmen+acne+treatment," and "transwomen+acne+treatment". The gender affirming process in transgender patients requires a multidisciplinary approach involving endocrinologists, psychiatrists, cardiologists and dermatologists, especially if the hormonal treatment causes or worsens acne. Treatment of "transgender" acne differs from "classic" acne treatment. The administration of masculinizing hormones frequently causes moderate to severe acne which requires the administration of oral treatments involving specific conditions of use and, conversely, the use of feminising hormones reduces the risk of more severe forms of acne. However, mild to moderate acne may persist, requiring topical treatments that may further increase skin dryness and irritation. The risk of relapse after stopping treatment may be very high and justifies a maintenance topical treatment. The use of ceramide-enriched emollients is mandatory in all patients. The treatment of "transgender" acne may be challenging, however, efficacious treatment options exist.

Keywords: acne; isotretinoin; oestrogens; retinoids; spironolactone; transfeminine; transgender; transmasculine.