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A Balancing Act: Hormones and the Skin

Throughout her life, a woman may blame many things on her hormones: unpredictable emotions, weight gain and even changes in her skin, hair and nails.//

These changes occur as the levels of hormones in the body increase and decrease, or if any abnormalities in hormone levels occur. A dermatologist can provide treatment options which can address the changes that occur during a woman’s lifetime.

Speaking today at ACADEMY ’06, the American Academy of Dermatology’s summer scientific meeting, dermatologist Margaret E. Parsons, M.D., F.A.A.D., assistant clinical professor at the University of California at Davis in Sacramento, Calif.,discussed how the fluctuations in hormones can affect the skin, hair and nails.

Puberty and Hormones
Acne typically first appears during adolescence and can persist well into adulthood. The cause of acne is most often linked to androgens, which are the hormones that stimulate the sebaceous – or oil – glands in the skin. When the sebaceous glands are over-stimulated by androgens, acne flare-ups can occur.

For women affected by acne, especially those in the early-to-mid twenties and older, oral contraceptives (OCPs) can be an effective part of their acne treatment plan in conjunction with other therapies. Current oral contraceptives help decrease androgen levels, and therefore decrease acne.

In addition, a dermatologist may prescribe oral medications or topical creams, gels, or lotions with vitamin A derivatives, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria.

“Although new acne treatments are developed every day, a cure for acne has not yet been developed. As such, many patients choose to self-treat or experiment with unconventional treatments,” stated Dr. Parsons. “Yet many of these treatments are based on anecdotal observations and have not been rigorously tested by science. A visit to a dermatologist is the best way to determine why acne is appearing or flaring, and how hormones influence these break outs.

Mid-Life and Hormones
As a woman enters her child-bearing years, many hormonal changes can occur, especially during pregnancy. The estrogen-related change of pregnancy that is most noticeable is melasma, also known as the “mask of pregnancy.” This benign condition is attributed to an overproduction of melanin, a natural substance in the body that gives color to the hair, skin and eyes. Treatment options available from a dermatologist include topical prescriptions for hydroquinone, retinoids, azeleic acid or hydroxy-acids. A combination of these products may be used to enhance efficacy. No treatment of melasma is complete without the daily, year-round use of a broad-spectrum sunscreen – one that protects against both ultraviolet A and ultraviolet B rays – with a Sun Protection Factor (SPF) of 30 or higher to prevent the further darkening of the skin, recommends Dr. Parsons.

While pregnant, most women experience a thickening of the hair, called telogen effluvium. Three months after delivery, some women will experience thinning of the hair, called telogen efflivium. Hair growth will subsequently return to its normal growth. Nails also are affected by the hormonal changes of pregnancy with most women experiencing increased nail growth, although some may notice a softening of the nails.

During the child-bearing years, many women experience a pattern of acne on the lower face, especially along the chin. “Adult acne is believed to have a strong hormonal connection,” stated Dr. Parsons. “This pattern of acne responds well to oral contraceptive therapy in conjunction with other topical and oral treatments.” A medication that may be prescribed along with an oral contraceptive is spironolactone, an anti-androgen. Spironolactone prevents excessive oil production by blocking androgen receptors and decreasing androgen production in both the ovaries and adrenal glands. T he result is fewer acne flares.

Menopause and Hormones
During menopausal years, several hormonal changes occur. The estrogen level in the body begins to lower and women will begin to notice a thinning of their skin and loss of elasticity. The skin also becomes drier during these years as the oil glands in the skin become less active. At this point in life, Dr. Parsons recommends that a skin care regimen include a prescription retinoid, either tretinoin or tazarotene, or an over-the-counter product such as retinol or alpha-hydroxy acids.

Women also may want to visit the dermatologist during this time, especially if they experience “hot flashes” which can flare rosacea. In addition, the stress of sleeplessness during this time can flare skin conditions such as atopic dermatitis and psoriasis.

Hair and Hormones
As women age, hair also is affected by the changing levels of hormones. Some women may experience a pattern of hair loss known as androgenetic alopecia, in which hair thins on the vertex or top of their head and hair becomes finer in texture. Women retain their hairline better than men with this type of alopecia, which is primarily genetic. This type of female hair loss is primarily treated with topical minoxidil and other therapies including oral medications which can affect androgen levels, such as oral contraceptives and spironolactone.

Fluctuations in androgens also can cause hirsutism, a condition characterized by excessive growth of hair on the female face and body. Male-like patterns of hair may appear on the upper lip and chin, and more hair growth than usual may be seen on the arms and legs and even the chest and groin area. Hirsutism can be treated with topical treatments as well as many modes of hair removal including waxing, shaving and laser treatments.

If a woman has hirsutism, acne and irregular periods, polycystic ovary syndrome is a condition that is often considered. This con dition can be treated initially with oral contraceptives, but also with other oral medications, such as spironolactone and other anti-androgen medications. A blood test at a physician’s office can determine the cause of these symptoms and the best treatment option.

“Changing levels of hormones can have an impact on the skin, hair and nails that can be physically and emotionally challenging,” commented Dr. Parsons. “That’s why it’s important to consult with a dermatologist who can identify problem areas and recommend treatments that will keep the skin, hair and nails healthy no matter what a woman’s stage of life.”


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