Hormones are intrinsically involved with maintenance of skin health such as collagen formation, lipid levels, elasticity, wound healing, moisture content and facial hair patterns. Skin is a site of hormone synthesis, activation and metabolism. A major cause of thin skin, wrinkles, and dryness is a deficiency of estrogen and progesterone in women and testosterone in men. On the other hand, too much androgen can result in oiliness, acne and either excess hair growth or hair loss. Excess estrogen can cause dark discoloration known as melasma.
Estrogens:
Skin is one of the main sites of estrogen action where is plays a role in maintaining moisture, preventing collagen breakdown and maintaining skin thickness. Facial skin has much higher concentrations of estrogen receptors than the rest of the body and therefore the effects of declining estrogen levels are more obvious on the face. High estrogen levels can cause melasma – a dark discoloration of the skin worsened by exposure to sunlight. Women who are pregnant or use oral contraceptives are particularly affected. Studies of Estrogen replacement have shown improvement in skin properties such as increased collagen content, thickness, elasticity and moisture. Estriol has anti-aging effects on the skin when applied topically. Estriol can be used alone or in combination with total body hormone replacement therapy.
Summary of Estrogen Benefits:
1. Greater epidermal and dermal thickness because of increased collagen production.
2. Reduction in wrinkles.
3. Better structure by improved elastin matrix.
4. Greater vascularization, i.e., more blood vessels to allow better oxygen and nutrient delivery to the skin.
5. Increase levels of hyaluronic acid, which is the primary substance in expensive fillers like Restylane, allows skin to retain water.
6. Inhibit excessive oil production and reduce acne.
7. Diminished facial hair.
8. Antioxidant action leading to reduction in cancer potential.
Androgens – Testosterone and Dheas:
Thinning of the skin can occur in people with androgen deficiency because there is less testosterone for conversion to estrogen via an enzyme in the skin (aromatase). Low testosterone in women and men is associated with thinning skin and reduced wound healing. Testosterone replacement in men increases protein production and skin thickness. In women, low testosterone and DHEAS that occurs with increasing age will also produce effects of low estrogen.
Skin problems associated with androgen excess occur in young people around the time of puberty at which time women experience androgen dominance prior to cycling and producing adequate amounts of estrogen and progesterone. In males at the time of puberty, excessive amounts of androgen lead to acne.
Progesterone:
Progesterone acts as a balancing agent, reducing the conversion of Testosterone to DHT, which is a powerful hormone that drives production of oil from sebaceous glands as well as hair on the body. Progesterone has been shown to improve skin thickness and elasticity.
Cortisol, Thyroid Hormones and Vitamin D:
Cortisol levels rise in times of stress and the increased levels lead to acne and rashes. Thyroid hormones can result in dryness, reduced oil production, pale skin color and rough, scaly skin. Some hair loss can also be seen in the underactive state. Overproducing of thyroid hormones such as in Graves Disease is associated with thickening of the skin, increase in skin pigmentation, redness and sweating. Vitamin D is essential for proper immune system function. If the immune system is impaired, condition such as psoriasis, acne and slow would healing occur. Vitamin D is involved in growth of the top skin layers, barrier function, and hair follicle cycles.
Hormone Containing Creams:
Estriol and/or Estrogen is compounded in low doses and applied via cream to the facial skin. These compounds can be applied to other areas of the body; however, they are specially formulated for face along with a daily skin care regimen that includes cleansing, Vitamin C, and sunblock. Hormone containing facial creams is applied once daily following cleansing and application of Vitamin C serum. Compounded facial products are obtained at a compounding pharmacy by prescription. These products may or may not be covered by your insurance. Please inquire with the Pharmacist regarding the general cost.