Understanding Hormones and Your Skin

“How to achieve beautiful, supple and young-looking skin”. You almost can’t avoid it - splashed on magazine covers, reported in newspapers and marketed on television and radio, the message to improve our skin would appear paramount to how we and others view our looks.
How does our skin age?  Skin aging is influenced by:

* Genetic differences
* Hormonal changes, e.g. estrogen and thyroxin
* Chronic sun exposure
* Wind, pollution

Blame it on hormones

Hormones are mostly to blame for skin changes as we age. Hormones are chemical messengers produced in organs such as the ovaries, adrenal glands, and thyroid glands, and all have an effect on other tissues.

Much of the reason why our skin begins to suffer is primarily due to hormones — and there is a massive industry manufacturing products to try to alleviate the results of these hormonal changes, notably as women reach menopause in their 40s and 50s.

As menopause occurs, estrogen is reduced and while it has a direct effect on thinning bones, it also creates significant changes in the skin. Women find:

* their skin becomes drier with increased wrinkles
* skin becomes more fragile, loses some of its elasticity, and is looser because the production of collagen is reduced
* older skin appears paler as the lack of estrogen reduces the number of blood vessels in the skin
* menopause also causes a reduction in the level of testosterone but not as significant a drop as in estrogen

Hormones and dry skin

Another hormone we have is thyroxin, produced by the thyroid gland, which influences skin appearance. Too much thyroxin shows a warm, smooth, sweaty, flushed skin. Under-activity of thyroxin produces a dry, coarse thickening of skin with reduced ability to sweat.

Hormones affect acne

The oil glands of the skin are in part controlled by the level and activity of the hormone testosterone in the skin. Testosterone is required to produce acne. This outcome can be seen in conditions such as polycystic ovary syndrome, which produce some elevation in testosterone, which in turn causes increased facial hair, irregular periods and acne. It has also been found that some birth control pills can block testosterone skin reactors to improve some of the consequences of increasing hormone levels. (See Acne Guide for more acne information)
Thinning hair

Hair will thin after menopause. In some women, genetic factors produce significant thinning. Abnormalities in the level of a thyroid hormone, in addition to the amount of iron stored in the body, can influence the volume of hair.

Estrogen encourages hair to stay in its growing phase (Anagen hair). This is seen in the significant thickening of hair towards the end of pregnancy. After menopause, however, the lower estrogen amount allows the scalp hair to grow towards the falling out stage (Telogen hair).
HRT and skin

Post menopausal women will notice that unlike their scalp, facial hairs increase. This is thought to be because estrogen — which opposes the effect of testosterone — drops relatively more after menopause than testosterone.

Hormone replacement therapy (HRT) has been used over the last 20 years to combat the signs of aging. HRT can promote a fuller-looking skin because the skin then becomes thicker with less loss of subcutaneous fat. Thinning and drying of vaginal surfaces is also minimized. This can also be achieved by using topical estrogen. The use of estrogen creams has been shown to maintain the elasticity and fullness of skin after menopause, although at this time it is not used extensively because of concerns about side effects and the variability of absorption into the body.

See your doctor or dermatologist to determine which solutions best suits your experience with aging skin.

By Richard Thomas, MD

Acne Treatment: Women Pinpoint the Trigger

From the occasional pimple during times of stress to the familiar breakouts before menses, acne affects almost all women at some time in their lives.

While acne commonly develops during the preteen and early teen years, it can also arise in young adulthood and persist for years. Studies show women feel more frustrated by acne than men do—adult women even more so than teenage girls. Why? Dealing with a chronic disorder typically associated with puberty can lead to great frustration. But don’t despair if you have acne, effective treatment is available.

How acne happens

Your skin is studded with thousands of oil glands that produce sebum to moisturize and enhance the skin’s ability to act as a protective barrier. Sebum within each gland is carried to the surface through pores. The highest density of oil glands is found on your face, especially at the nose, forehead and mid-cheek areas. The largest oil glands are found on the back and mid-chest. This explains in part why acne appears mostly on the face, chest and back.

But what actually causes acne is still unknown. Researchers suspect hormones play a role in pore blockage and increased oil production. A blockage creates the build-up of oil within the pore to form blemishes such as blackheads and whiteheads. “Zits” appear when acne bacteria multiply within the blocked pore, resulting in inflamed red bumps or pustules. Some of these large sacs of oil may rupture leading to large red lumps (also called nodules).

Unfortunately, you may inherit acne-prone skin—particularly the type susceptible to the more severe, scarring forms of the condition.

Prevention

For some patients acne can be aggravated by:

* Thick, pore-blocking creams
* Clothing, hats, helmets or pads that retain sweat or moisture
* Long hair that brushes the skin on your back, neck, and face
* Hair gels and sprays where they may touch your skin
* Sleeping on damp hair

While diet has not been conclusively shown to be an acne trigger, some women may notice certain foods aggravate their skin. Try excluding these foods for two or three weeks and see if your skin improves.

Treatment

Fortunately, therapy can reduce acne, minimize the risk of scars and improve your skin’s appearance. Treatment begins with discovering your acne triggers and learning what treatments will help you control the condition. Choosing cosmetics appropriate for your skin is important, too.

Acne treatment ranges from cleansers, topical gels and creams for mild acne to antibiotic or hormonal pills for moderate cases. Accutane may be prescribed for severe cases. Acne staining can be treated with exfoliating creams and facials while scarring may require the use of fillers, dermabrasion or laser treatments. Full compliance with a treatment program is the key to success.

About the author:
Jerry K. L. Tan, MD, FRCPC is an Adjunct Professor, Faculty of Medicine, University of Western Ontario, Windsor, Canada. He is also Director, Acne Research and Treatment Centre, Windsor, Canada. Dr. Tan’s area of specialty: acne and rosacea.

Combination Skin Care

Combination skin is characterized by a mixture of oiliness and dryness. Typically, the oily areas tend to be the T-zone, consisting of the forehead, nose and chin. The cheeks are normal to dry. The degrees of oiliness and dryness can vary. Pores may be larger in the oily areas - with pimples, blackheads and breakouts sometimes occurring - and dry areas may feel rough and irritated. The “tissue test” can help you determine if you have combination skin. Take a tissue and hold/press it against your face. If there is oil on the tissue where it touched your T-zone, but no oil where the tissue touched your cheeks, you most likely have combination skin.

Many factors can cause combination skin, including hormones, age, genetics, the way in which lipids are organized in our skin and even the weather. Hormonal changes can lead to changes in skin’s oiliness or dryness. Teens and young adults tend to have oilier skin, especially in the T-zone, but with age, hormones change and the oil production may decrease (but unfortunately, acne is still an issue for many adults). Also, hormones change due to menstruation and the birth control pill, which can make skin oilier in certain areas. Lipids also play a role in combination skin: These proteins affect skin’s softness and feel. When lipids aren’t evenly spread throughout the skin, certain areas will feel drier and rougher, while other areas may feel soft but oily or greasy. The organization of lipids in skin is due to genetics and hormones. Finally, weather can exacerbate combination skin. Dry cold weather can cause skin to dry out and become irritated. Conversely, hot humid weather can increase oil production. This can affect your T-zone as well as your cheeks.

Combination skin requires special care to balance the oily and dry areas of the face. Proper cleansing, treatment, moisturizing and sun protection are all necessary. People with combination skin often have difficulty finding a cleanser that works for their unique skin needs. Formulas designed for oily skin may leave combination skin too dry, especially in the cheeks, while formulas designed for dry skin may leave combination skin greasy, especially in the T-zone. It’s best to avoid products that are either too drying or too rich. Instead, use a foaming or gel cleanser to get rid of dirt and oil without causing irritation or dryness. A cleanser to try is one that removes excess oil and impurities while still being gentle and not drying out skin.
You should also exfoliate your skin regularly to remove dry, dead, rough skin cells. These cells may be particularly prominent on your cheeks. They can flake off and block pores, causing blemishes and blackheads. Try a product that might include papaya and pineapple juice, olive derivatives and Ginkgo Biloba.

Treatment products are another important skincare component, helping to balance your skin. One treatment to try is one which moisturizes dry areas but prevents excess oil, especially in the T-zone. This product also contains antioxidants to prevent aging. Another type of treatment is a mask, and you’ll find an array of products for every skin type. Some experts advise using a hydrating/moisturizing mask on dry areas (cheeks) and a deep-cleaning clay mask on oily areas (T-zone). While using two different masks is certainly an option, you can also use a mask specifically designed for combination skin. If you suffer from breakouts, which may occur around the T-zone, use acne treatment products with salicylic acid. For problem skin, try a blemish serum or a spot treatment.

Combination skin needs balance, and part of that balance means moisturizing your skin. Moisturizing is especially important for drier areas of the face, but your entire face needs moisture. Some experts suggest using separate moisturizers - a lightweight one for the T-zone and a deeper one for cheeks. You may choose to use separate moisturizers, but you can also use a single moisturizer designed for combination skin. Try a lotion that balances skin with witch hazel and aloe extract to help skin stay soft. Pay careful attention to dry areas, as they may require more frequent moisturizing than oily areas. Generally, experts recommend moisturizing dry areas twice a day and moisturizing oily areas once a day. Keep in mind that your individual skin has unique needs, so you might want to adjust your moisturizer - how often you use it, where you need it and how much you need.

Sun Protection; like all other skin types, combination skin needs protection from the sun. UVA and UVB rays can damage skin, so use oil-free sunblock all over your face daily (and on any other exposed areas). Try an oil-free sunlotion or sunblock because it protects your skin from UV rays and won’t make skin greasy.

Natural treatments such as aromatherapy oils, home-made exfoliants and masks may help treat =your combination skin. For example, try mixing essential oils like chamomile, lavender and ylang ylang (just a few drops) together with your oil-free moisturizer. These ingredients have antibacterial properties and may help to rid skin of dirt or bacteria. However, if your skin is sensitive or easily irritated, or if you are pregnant, you shouldn’t use these essential oils.

Exfoliating treatments can be made at home by mixing and grinding nuts, seeds or oatmeal along with water. These will slough off dead, dry skin cells - especially common around the cheeks. You can add citrus peels from fruit - like orange or grapefruit - to the mix and apply it to the oily-zone.To make a mask for dry areas, use ingredients like yogurt, mashed bananas or avocados to moisturize. On oilier areas, try pureed strawberries and apples.

Hormonal Treatment of Acne

Hormonal treatments, including oral contraceptives, have long been recognized by dermatologists to be an effective treatment option for women who have acne, no matter how severe.

Acne is thought to be initiated by the effect of masculinising hormones called “androgens” on oil glands that, during puberty, enlarge and become increasingly sensitive. This results in excessive oil secretion and blockage of pores, which leads to the initial non-inflamed spots of acne (whiteheads and blackheads). As the acne bacteria (Propionibacterium acnes) proliferate, the oil-rich environment in the pores leads to inflammation which becomes visibly apparent as red pimples, pustules and lumps.

Hormonal therapy for acne is, therefore, meant to interrupt this initial phase of this cascading sequence of acne development. Such preparations include oral contraceptives such as Diane-35®, Tri-Cyclen®, Alesse®, and Yasmin®; and a non-contraceptive anti-androgen, spironolactone.

Androgens that play a part in causing acne include 5-dihydrodrotestosterone (DHT), testosterone (T), androstenedione (A), and dehydroepiandrosterone-sulfate (DHEA-S). The production of these androgens from ovaries and adrenal glands is mediated by gonadotrophins. Levels of testosterone are inversely related to levels of sex hormone binding globulin (SHBG), so that if T increases, SHBG decreases and when T is reduced, SHBG increases.

Polycystic ovarian syndrome is a condition found in women who have very high androgen and testosterone levels. Symptoms include obesity, infertility, scalp hair loss, increased facial and body hair, irregular periods, acne and elevated blood insulin levels. This condition affects 5-10% of women in their reproductive years. Clinical evaluation and blood testing can be performed to diagnose this disorder. In addition to exercise and weight control, hormonal therapy is often helpful in this condition.
Oral Contraceptives (OCs)

OCs, which contain estrogen and progestins, directly affect how much androgen your body produces and can therefore impact acne. Possible ways that estrogens may be working to improve acne include:

* Decreased production of adrenal (DHEA-S) and ovarian androgens (A, T);
* Inhibition of the enzyme 5-alpha-reductase, which leads to a reduction of DHT levels;
* SHBG increase, which reduces levels of T.

Progestins vary in their androgenic or testosterone-like activity and may, therefore, have variable effects on acne. Progestins with the lowest androgenic activity are more appropriate in the treatment of acne and other disoders caused by increased androgen levels (desogestrel, norgestimate). Alternatively, cyproterone acetate – an antiandrogenic progesterone derivative - may be combined with the estrogen component.

Currently available OCs such as Diane-35®, Tri-Cyclen®, Alesse®, and Yasmin® contain progestins with minimal androgenic or anti-androgenic activity, providing an important therapeutic option for women with acne. Their proven effectiveness and long-term safety profile supports their use in various grades of acne in females:

* as additional therapy with topical agents for women who have mild, non-scarring acne and who desire oral contraception;
* as primary therapy in moderate, non-scarring acne in combination with topical therapy and systemic antibiotics;
* in scarring and severe inflammatory acne as one of two preferred methods of contraception in patients treated with systemic isotretinoin.

Clinical studies in acne patients treated with Tricyclen and Alesse show that acne spots were reduced by 40-50% over a course of 6 months. The extent of improvement may be greater with Diane-35 as patients in a Canadian acne survey generally considered Diane-35â to be more effective for treating acne than Tricyclenâ. Side effects common to all oral contraceptive preparations included breast tenderness, headache, and nausea. These were typically mild and tended to resolve by the second cycle. A newly approved oral contraceptive in Canada, Yasminâ, has been shown to be as effective as Diane-35â for treating acne.
Spironolactone

Spironolactone, a synthetic steroid, is an anti-androgen that binds to the body’s androgen receptors, thus blocking the androgens from binding to the cell receptors, inhibits 5-alpha-reductase enzyme activity and reduces androgen biosynthesis. Small studies using this agent for treating acne have been shown to be effective with few side effects, but larger studies are needed for confirmation.

About the author:
Dr. Jerry K. L. Tan, MD, FRCPC: Adjunct Professor, Faculty of Medicine, University of Western Ontario, Windsor, Canada. Director, Acne Research and Treatment Centre, Windsor, Canada. Area of specialty: acne and rosacea.

Proactive Acne Treatment

Despite the thousands of products available for acne treatment today, the most proactive thing you can do is take good care of your skin – first.

Acne control is a goal for every adolescent or adult that has suffered from the ravages of this unsightly, stressful and physically painful condition. When the first signs of acne appear, take action to fight the malady right from the beginning. Early and proactive treatment stands a better chance of being successful. Often, early action means the difference between scarring and additional mental distress and a successful alleviation of the acne symptoms with no sign of scarring.

Understand the cause

Successful acne control is a matter of working with known causes of the condition and changing the dynamics to reduce the negative impact of the acne. Beginning the process early is more likely to be successful in reducing the breakouts. For example, it is now known that acne symptoms appear when there is a malfunction of the oil-producing glands at the base of the hair follicles. The cause is probably related to hormonal production, so treatment that begins early can focus on these two aspects. Hormone treatment takes time to work so early treatment is better than delaying.

Reduce physical scarring

Extensive scarring can be the result of acne pimples or inflammation coupled with the high chance of infection from the break in the skin surface. Obviously, acne control that actively fights the conditions that lead to physical scarring has a better chance of preventing such scars. The successful key is early intervention, before there is time to build up pockets of infection under the skin. Since it is now known that acne is not the result of unclean skin, depending upon cleansing for prevention of scarring may not be enough.

Prevent emotional turmoil

The impact of disfiguring and painful outbreaks of acne symptoms on the precarious emotional outlook of an adolescent is easy to remember even if you are long out of your teens. There can be almost irreparable damage done to the self esteem of the teenager. Early and emphatic acne control recognizes that dealing with the symptoms early provides less opportunity for the negative personal view to take hold in the mind of the individual with acne. Being told simply that he or she will outgrow acne symptoms does not solve the immediate drain on confidence.

Reduce the outbreaks

Early and active treatment of the acne symptoms is more likely to be successful in reducing the permanent impact of the condition. Acne control consists of treating the physical and emotional symptoms effectively so that they do not continue. This can consist of basic maintenance; getting proper rest, drinking lots of water, eating healthy clean food and cleansing your face each night and morning.

Skin Changes Through Pregnancy

Chloasma or the “Mask of Pregnancy” can cause blotchy discoloration on your face and splashes of darkened skin that may appear on the forehead, nose, and cheeks in a mask-like configuration on some pregnant women — more often in dark-skinned women.

What causes chloasma?  Those annoying pregnancy hormones are showing up again, causing hyperpigmentation on many parts of your body. You might have noticed your freckles and moles are darker now, there’s probably a dark line down the center of your abdomen (the linea nigra), and your areolas might be a deeper shade as well.  Dark-skinned women usually notice such hyperpigmentation more, but light-skinned women aren’t off the hook completely — they too will get their fair share of darkening skin, though it may not be as noticeable.

Despite have clear skin most of their lives, many women find another “new experience” awaiting them once they discover a pregnancy. The beginning stages can be small and unnoticeable pimples - usually showing around the jaw line or forehead due to hormonal fluctuations.

Three main factors contribute to acne: increased oil production, clogged pores, and a bacteria called P acnes. First, oil causes the dead skin cells to stick together, leading to a clogged pore, which is called a blackhead or a whitehead. Bacteria then moves into the pore, producing inflammation, which manifests as redness and pus. Addressing acne requires medications or treatments that decrease oil secretion, unclog pores, and kill bacteria.

As the pregnancy progresses, the acne will worsen. It is at this point, many women may frantically search for cures in their local drugstore or try home remedies. Perhaps they feel overwhelmed by the choices or confused by the long list of ingredients and decide to give up finding a solution. In some cases, the acne can grow to included pigmented or “age” spots as well.

All of these changes typically last the duration of the pregnancy and are due to hormonal changes and increased oil production, resulting in acne, while higher estrogen levels will activate skin color cells to make dark spots. This occurrence is so common in pregnancy that it’s been given the name “mask of pregnancy.” Sun exposure will exacerbate the issue further without a good sunscreen or sun protection.

Like many others, when facial skin suddenly becomes oily, the first reaction is to take away all moisture or anything ‘greasy’ that can increase the feel of oil on the skin layer.

Never fear, these again are temporary problems with easy fixes. First, stop using anything oil-based and switch to gel-based or water based sunscreens and moisturizers for the time being. Treat your skin as if it were previously an acne-prone, pigmented type and finally ask your doctor or dermatologist for a baby-safe acne treatment if the situation is really uncomfortable. Your skin should return to its previous condition soon after your baby is born.

•  In the meantime - Eat foods that contain folic acid (you’ll also get plenty in your prenatal supplement), since studies have shown that a folate deficiency can be related to hyperpigmentation. Good choices include green leafy vegetables, oranges, whole-wheat bread, and whole-grain cereal.

•  Stay out of the sun as much as possible and wear a sunscreen of at least SPF 15 (sunlight can also intensify hyperpigmentation). A hat and long sleeves are a good idea if you’re fair-skinned, headed to the beach, or have a historically sensitive complexion.

•  If you like, use a good concealer to cover particularly pesky spots, but skip bleaches or other chemically based lightening treatments until after you give birth. Refrain from using peels or lasers as well, as they could interfer with the chemical balance of the fetus.

Acne Terms and Causes