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Hormonal Skin

Skin Conditions | February 27, 2019 | Author: Naturopath

Skin conditions

Hormonal Skin

Skin outbreaks of pimples can afflict female as well as male during hormonal bursts at adolescence, females around their menstrual cycle and menopause, and sometimes in-between.  Break-outs can range from rashes of ‘blind’ pimples, blackheads (comedones), pustules (whiteheads) to full-blown painful, pustular cystic pimples, afflicting not only the face but often the neck, chest, upper arms and back. Individuals may be left with scaring after pimples have healed. This condition is often described as acne. Acne does not only show a physical effect, but also have an emotional and psychosocial component with sufferers feeling frustrated, embarrassed and anxious. Low self-esteem and depression can reduce quality of life.

The pathophysiology of a pimple

Pimples erupt from the pilosebaceous unit – a hair follicle and its sebaceous gland, caused by four main pathological reasons, often combined.

The effect of androgens upon the sebaceous glands increasing the amount of sebum produced. Sebum is a fat containing triglycerides, wax esters, squalene, and cholesterol used to lubricate and waterproof the skin. Androgens are male hormones.

Hyperkeratinisation – blogged hair follicles from impaired outer skin shedding (desquamation). Normally dead skin cells are pushed out of the follicle by the growing hair folicle, but in hyperkeratinisations this process is impaired. This is due to excess keratin which causes the dead cells to accumulate, bind together and form a clump forming a plug at the surface of the skin and preventing the flow of sebum. This is often referred to as keratosis pilaris. Keratin is the protein which produces skin cells.

Bacteria proliferation due to increase sebum production – most commonly the bacterium Propionibacterium acnes. Bacteria such as Propionibacterium acnes and Staphylococcus epidermidis are commonly found on the skin, but it is when there is an imbalance (a dysbiotic state) problems occur.

Inflammation – due to bacteria, and effecting the surrounding tissue causing swelling, heat and redness.

Who is at risk?

The pathophysiology of a pimpleDuring adolescence androgen levels increase which can explain why it is common to see acne in teenagers. If androgen levels are not increased a sensitivity to androgens might be responsible. This is indicated by an elevated level of 5 alpha-reductase. 5 alpha-reductases are enzymes responsible androgen metabolism. This may be the case in people who suffer from acne for years.

Pimples pre menstruation. Acne that appers in the second half of the cycle is often due to the variation of hormones at this time. In the first half of the cycle there is more oestrogen and in the second half  progesterone dominates. At the end of the cycle, before menstruation begins, both these hormones are at their lowest. Testoterone is found in females in small amounts and during the cycle remains constant. Testosterone is the main adrogen. Progesterone can cause an increase in sebum production, but also cause the skin to swell (become lovely and plump), this can then block sebaceous glands. Testosterone also causes sebum production to increase at this time and the result is often increased oil seen on surface of the skin. For some people with a dry skin this can actually be beneficial. Enter Propionibacterium acnes bacteria to take opportunity to increase its production. Keeping the skin clean using gentle soap, cleanser and water with out over stimulating is often the best way to manage this condition. Tea tree oil can help reduce bacteria.

During perimenopause/menopause. Often due to decreased oestrogen and increased androgens.

Hyperandrogenic disorders such as PCOS. Due to increased androgens.

Sensitivity to fatty acids. Propionibacterium acnes, the main bacteria found to be responsible for pustular acne, converts sebum to fatty acids. In some people with sensitivity to fatty acids an uncommon sever nodular acne can occur due to a sensitivity to fatty acids, increased due to bacteria.

Acne and stress.  Chronic, continual stress increases hormone levels, which can lead to an increase in oil production.

Naturopathic treatment

Supporting the organs of detoxification is a normal protocol in the naturopathic treatment of acne. Along with the skin, the bowel, liver and lymph systems are organs of elimination. This can simply mean addressing the diet ensuring it is wholesome with plenty of fibre and clean drinking water.

Herbs

Herbal medicine is aimed at increasing bile production and improving bowel function to help with the removal of waste; supporting liver function; and reduce excess circulating hormones.

Burdock (Arctium lappa), calendula (Calendula officinalis), cleavers (Gallium aparine), dandelion (Taraxacum officinalis) and yellow dock (Rumex crispus) are choices which can help with improving eliminatory function. Dandelion, flaxseed and yellow dock can assist if constipation is a problem.

Antimicrobials and anti-inflammatory applied topically and internally can help with pustules, swelling and redness.

Antimicrobials include: Echinacea spp., Oregon frape (Berberis aquifolium), lavender (Lavendula officinals) and tea tree (melaleuca alternifolia).

Anti-inflammatories include: licorice (Glycyrrhiza glabra) witch hazel (Hamamelis virginiana), chamomile (Matricaria recutita) and lavender (Lavendula officinals).

Hormonal modulation with chaste tree (Vitex agnus castus).

Emotional stress can have an influence on the health of the skin.

Addressing overwhelming stresses is important not only for the appearance of skin, but also for general wellbeing.

Take time to sort out priorities, to remove needless worry, and to put in place some relaxation techniques

Improve stress response with Ashwagandha (Withania somnifera) and relieve stress and anxiety or depression with St John’s wort (Hypericum perforatum), Lemon balm (Melissa officinalis) and skullcap (Scutellaria lateriflora).

Nutrients

Not only is eating a healthy natural diet important, a regular eating pattern helps blood sugar and stress levels remain normal. Some added nutrient can help. These include:

Vitamin A – Retinoids are biological active derivatives of vitamin A which are required for maintenance of epithelial tissue – skin. Vitamin A is a lipid antioxidant, supports the production of steroid hormones and increases resistance to infection. Deficiency maybe associated with acne.

Zinc – healing of wounds and supporting immunity make zinc an important nutrient in the treatment conditions of the skin. Zinc also reduces 5-alpha reductase. Deficiency of zinc may be the cause or associated with acne.

Vitamin B6 (pyridoxine) - supports the metabolism and action of steroid hormones and supports optimal nervous system function.

Vitamin C – is needed in acute and chronic inflammatory conditions, such as acne, as an anti-inflammatory, antioxidant and improves immunity and wound healing.

Probiotics – these live micro-organisms provide a health benefit to the host. As Acne lesions create an environment which encourages the excess growth of Propionibacterium acnes (P. acnes), some microorganisms have been shown to act not only in the prevention but to compete with the pathogenic microorganisms and beneficially affect the inflammatory process present in these conditions. Choose a broad spectrum probiotic.

Other

Treat the skin with care, as if it were a rose petal, easily bruised. There is no need for harsh, abrasive cleaners and over washing or scrubbing. Face masks are preferable over exfoliants, which can scratch and wound the skin. Choose gentle skin care products and remember less is best.

Keep nails away from the face – picking is the best way to introduce bacterial into the skin and can result in scaring.

Don’t hide the face behind the hair, keep hair clean and pulled back to give the skin the best chance of repair.

Treatment may take weeks to months to improve hormonal acne, persistence being the key.

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References

https://www.britannica.com/science/sebaceous-gland

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

Acne pathogenesis: history of concepts. https://www.ncbi.nlm.nih.gov/pubmed/25228295

https://www.sciencedirect.com/topics/medicine-and-dentistry/hyperkeratinization

https://www.webmd.com/skin-problems-and-treatments/acne/features/period#1

Romm, Aviva; 2010; Botanical Medicine of Women’s Health, Churchill Livingstone Elsevier, USA

Mills, Simon and Bone, Kerry; 2000, Principles and practice of Phytotherapy, Churchill Livingstone, Aust

The effect of probiotics on immune regulation, acne, and photoaging https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418745/

An approach on the potential use of probiotics in the treatment of skin conditions: acne and atopic dermatitis https://onlinelibrary.wiley.com/doi/abs/10.1111/ijd.13972

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