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Hormones and the Skin: the Role Hormones Play as We Age

Many people say that aging is just a state of mind. However, many dermatologists will tell you that aging can be affected by your hormone levels. Whether low or high, your hormones affect your skin, hair and nails as you age. //

Speaking today at the American Academy of Dermatology’s (Academy) SKIN Academy, dermatologist Debra Jaliman, MD, FAAD, an assistant clinical professor at Mt. Sinai School of Medicine in New York, NY, discussed how hormones levels in your 20s, 30s, 40s and beyond can affect a woman’s skin.

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

Young Adulthood
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 OCPs 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.

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, such as eflornithine cream, as well as many modes of hair removal including waxing, shaving and laser treatments.

Dr. Jaliman emphasized that acne with hirsutism could indicate a more serious medical condition for which acne is just one symptom. “When persistent acne is accompanied by hirsutism and hair loss or thinning hair, it could signal increased androgen production common in conditions such as polycystic ovaries and adrenal hyperplasia,” said Dr. Jaliman. “In addition, women with hormonal acne also may experience irregular menstrual cycles, obesity, infertility or diabetes. It’s vitally important for these women to consult with their physician, as a blood test can determine the cause of these symptoms and the best treatment option.”

Pregnancy
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 or over-the-counter products containing hydroquinone, or prescriptions for retinoids, azeleic acid or hydroxy-acids. In-office procedures, such as the use of lasers and peels, can be used after pregnancy to remove the pigment. 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. Jaliman.

While pregnant, most women experience a thickening of the hair. Three to six months after delivery, some women will experience hair loss and thi nning, called telogen effluvium. This temporary shedding can be sudden and very alarming to some women, according to Dr. Jaliman. However, hair growth will subsequently return to normal approximately four to six months following pregnancy. Nails also are affected by the hormonal changes of pregnancy with most women experiencing brittle nails, although some may be diagnosed with distal onycholysis, a separation of the nail plate from the underlying nail bed.

Menopause
As a woman enters menopause, 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.

"As we age, the skin often becomes drier and more sensitive than it was during adolescence and our 20s and 30s," stated Dr. Jaliman. "At this point in life, I would recommend a skin care regimen including a prescription retinoid, either tretinoin or tazarotene, or over-the-counter products such as retinol, alpha-hydroxy acids, antioxidants or peptides."

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 treated with topical minoxidil and other therapies including oral medications which can block the effect of androgens, such as hormone replacement therapy and spironolactone.

"As you age, making slight modifications to your daily skin and body care regimen can go a long way in improving the appearance of your skin, hair and nails," said Dr. Jaliman. "Your dermatologist is the best source of information when choosing skin, hair and nail products that can enhance your appearance no matter what your age."

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