When it comes to solving issues related to our skin and hair, we often look for external solutions. But what if the solution was internal all along? What if paying attention to our hormones was the fix all along for chronic symptoms?

The skin and hair often serve as the window to our health. Which means if our hormones are off kilter, they bear the brunt. Your hormones can have a big impact on your skin and hair at any age, and not just during your period. And understanding the connection can make all the difference, say medical experts.

We’re all too familiar with the blotchy blemishes and flare-ups we face with the hormonal variations associated with our menstrual cycles. “Because of hormonal changes, your skin can become either drier or oilier,” says Dr Iryna Shatokhina, specialist endocrinologist, Medcare Women & Children Hospital. “Oestrogen goes high and low at different phases of the menstrual cycle. This affects texture and thickness and fluid balance of the skin. Fluctuations in hormonal levels can cause acne and oily hair, and progesterone plays a big role in this process by closing skin pores and inducing sebum oversecretion.”

Hormones play a major role

But our hormones affect our quality of life far beyond the skin and hair, controlling a host of bodily functions. They regulate different processes such as our emotions, appetite, thought processes, metabolism, reproductive cycle and body temperature, says Dr Shatokhina. “Hormonal changes can dramatically impact our emotions. Oestrogen regulates serotonin, dopamine, epi- and nor epinephrine, which are involved in mood regulation. Shifting levels of estrogen are associated with mood swings and irritability. Decreased levels of estrogen can lower levels of serotonin, responsible for mood swings, fatigue, depression, concentration difficulties. Elevated levels of estrogen along with low levels of progesterone are again linked with depression, anxiety, irritability and fatigue. Low levels of androgens DHEA and DHEA –S are linked with depression.”

Which means a hormonal imbalance can cause unpleasant symptoms that range from weight gain, mood swings, insomnia and sweating, to skin changes, excessive hair growth and fertility issues with irregular periods. Which also means what’s going on beneath the surface could cause massive hair and skin woes if anything is out of alignment. Dr Shatokhina says from an endocrine point of view the main skin concern she sees UAE residents for are acne and hyperpigmentation. “And the common hair problems of hair thickening and loss can be due to vitamin D deficiency or hormonal imbalance as well. Hirsutism is also an unwanted common problem for female residents and basically related to hormonal or genetic factors.”

Our hormones affect our quality of life far beyond the skin and hair, controlling a host of bodily functions and regulating different processes such as our emotions, appetite, thought processes, metabolism, reproductive cycle and body temperature, says Dr Shatokhina
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Dr Natalia Spierings, a consultant dermatologist at Kings College Hospital, Dubai, says hormones are responsible for all the skin changes of puberty (hair growth on the face and body, acne vulgaris) and then again as we age (hair loss, loss of elasticity in skin as we age). “Melasma, which is patches of hyperpigmentation on the face, is thought to be due to oestrogen,” she says. “The culprit hormones are the sex hormones and the main one is androgens – very abundant in men and less so in women. But hormonal balance is also vital and this shifts and changes throughout life. Cortisol (the stress hormone released from the adrenal glands) is also known to affect skin barrier function and can predispose to various skin problems – from eczema to acne vulgaris.”

Dr Spierings most commonly sees UAE residents come to her with issues such as acne vulgaris, oily skin and enlarged pores as well as female-pattern hair loss. At the same time, she stresses that the majority of healthy men and women do not have a hormonal ‘imbalance’ accounting for any skin issues.

“Hormones are important for skin health and are the root of some skin problems but testing levels of hormones randomly is unnecessary in 99 per cent of patients. The only one worth mentioning is the hormonal imbalance seen in patients with polycystic ovarian syndrome (PCOS), in which women get increased hair growth on the face in a male pattern (hirsutism), hair thinning specifically at the front and sides of the scalp as well as acne vulgaris. There is usually no other condition in dermatology requiring hormones to be checked. To confirm a diagnosis of PCOS I generally refer my patients to an endocrinologist.”

Polycystic ovarian syndrome (PCOS), one of the most common endocrine disorders globally, affects how a woman’s ovaries work.

Excess of androgens stimulate sebaceous glands in skin to pump out oil, a factor that leads to the development of acne, says Dr Shatokhina. This is a common problem for patients with PCOS. “Women who have higher levels of androgens are more likely to have acne, as well as excess hair growth and female pattern hair loss. Estrogen plays a prominent role in overall skin health. Oestrogen is associated with increased collagen production, skin thickness, skin hydration with hyaluronic acid production, and that helps the skin to stay smooth and firm. Progesterone stimulates the production of sebum or the oil glands in the skin. It can cause the skin to swell, and compress the look of pores.

“If you or your family member have the above mentioned symptoms I would highly recommended  visiting an endocrinologist and dermatologist to rule out any endocrine condition before visiting a cosmetologist. The main blood tests are based on clinical findings and symptoms of the patient and can include insulin resistance testing, thyroid function tests, glucose and vitamin D status evaluation.”

Lifestyle changes and treatments

So, what can you do to feel your best inside out?

Dr Spierings says aside from generally living a healthful lifestyle – “don’t smoke, stay out of the sun, get adequate restful sleep and eat a well-balanced diet low in sugar and junk food" – there are no specific diet or lifestyle changes to make for any skin or hair issues, whether the issues are due to hormones or not. Diet has virtually nothing to do with skin disease.

“Keep it simple. Vaseline is the best facial moisturiser available and also probably the cheapest! Aside from a specific targeted prescription treatment for a specific skin problem, cosmetic skincare products are generally unnecessary for most people. That said, in the UAE, daily sunscreen use should be encouraged, of course!

“Treatment will always depend on the diagnosis.”

Endocrinologist Dr Iryna Shatokhina usually recommends her patients to choose complex carbohydrates such as fibre-filled fruits and berries, vegetables, whole grains, and plant proteins like beans and nuts. “Avoid or limit processed and fatty foods, caffeine, salty foods, artificial sweeteners and alcohol. Drinking alcohol can dehydrate your skin and can make you look flaky and unhealthy. Drinking enough water and staying well hydrated is key.”

Many UAE residents come to Dr Spierings with issues such as acne vulgaris, oily skin and enlarged pores as well as female-pattern hair loss
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A lifestyle modification she stands firmly behind is getting a full night’s sleep of about 7-8 hours. “This will optimise the secretion of our hormones, especially growth hormone, also responsible for collagen production keeping our skin young and fresh.”

Like Dr Spierings, she believes it is important to remember that wearing sunscreen daily will protect your skin from premature ageing. “For women with oily skin it is better to apply only non-comedogenic products to reduce risk of clogged pores.”

Don't forget to clean skin twice a day

Particular attention should be taken to cleaning the skin twice a day and avoiding heavy everyday make-up with foundation.

“A good option is to use skincare products for treating acne just before your period to avoid unpleasant acne. If only dietary changes and preventive skincare are not sufficient for keeping your skin in good condition the doctor might prescribe oral medications that can work from the inside out to balance your hormones and help your skin. Common options for hormonal acne treatment include oral contraceptives, supplements and anti-androgen drugs.”

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