27 September The Effects of Stress and Hormonal Decline on the Skin
In our clinic, we are seeing increasing numbers of people experiencing stress and anxiety. Whether the stress is work related, financial, or personal, it can have a huge impact on our health as a whole. Last year, a study by the Mental Health Foundation revealed that 74 per cent of us have felt so stressed we were overwhelmed or unable to cope – and women seem to be more susceptible, with 81 per cent saying they felt this way (compared with 67 per cent of men).
Unfortunately, stress is bad for our health. It has been found to affect the immune system and contribute to heart disease, insomnia, and poor gut health. However, there is another, possibly lesser-known effect – stress is also a contributory factor for ageing skin and can affect its health and appearance.
When we are stressed, the adrenal glands produce excessive amounts of the stress hormone cortisol, which surges the body and can bring about weight gain and sleep disturbances. A low- level, drip feed of daily cortisol is pervasive, and over time, chronic, low-grade stress builds in our bodies and can lead to adrenal fatigue, which can result in exhaustion, brain fog, low mood, and an inability to be able to cope.
The skin suffers too. Keratinocytes in the epidermis (the outer cell layers of skin) produce cortisol when we feel stressed. Cortisol is an inflammatory hormone and so, depending on your skin type, it can make your skin red, dry, wrinkled, tired-looking, reactive and sensitive, oily and acne-prone, or cause under-eye dark circles.
Large quantities of cortisol cause elevated sugar levels in the bloodstream which results in by-products called advanced glycation end products (AGEs), which cause the destruction of both collagen and elastin. This results in loss of elasticity, while inflammation encourages fine lines and wrinkles. It also results in thin, crêpey skin around the eyes because increased cortisol also breaks down the thin tissues surrounding the eye area, making the tiny blood vessels around them more visible.
The first sign is a darkening of the skin, like dark circles under the eyes. The next is dryness and redness. Stressed skin is also more prone to blemishes. Extra cortisol makes our skin glands produce more oil, and oily skin is more prone to acne. So, if you’re breaking out more than usual, it could be a sign of too much stress in your system. Stress also slows down healing, so breakouts and spots take longer to clear. And anxiety has a direct effect on more serious skin conditions, such as eczema and psoriasis.
Unfortunately, stress isn’t the only factor ageing our skin. Decline in hormones, especially around the menopause, has a great impact on our skin heath.
A major culprit for the skin thinning, wrinkling, and dryness associated with ageing is the decline in hormones such as oestrogen and progesterone in women, and testosterone in men.
Therefore, it’s no surprise that the decline in hormone levels as people age parallels the decline in skin quality frequently associated with ageing.
The skin is one of the main targets of oestrogen action, and facial skin expresses much higher concentrations of oestrogen receptors than other areas. This means that the effects of falling oestrogen levels as women reach the menopause are far more obvious on the skin of the face than on the skin covering other parts of the body.
Reduced oestrogen levels affect skin health in a number of ways: these include wrinkling, dryness, thinning, reduced collagen, slower wound healing, and loss of elasticity.
Interestingly, overweight patients often don’t show this deterioration in skin health to the same extent as normal weight people; this is because they maintain higher oestrogen levels as a result of increased aromatase activity in fat and skin tissue. Aromatase is an enzyme that converts testosterone into oestradiol and androstenedione into estrone, and it is present in large quantities in fatty tissue. Estrone and oestradiol are therefore found in larger amounts in obese individuals than in normal weight people of the same age.
Oestradiol is the most potent oestrogen, and its main source is the ovaries in reproductive women. Estrone, with weaker estrogenic effects, becomes the more prominent oestrogen produced in postmenopausal women as their ovaries stop oestradiol production.
Studies of oestrogen replacement therapy have shown some improvement in those skin properties affected by low oestrogen levels, e.g. increased collagen content, skin thickness, and skin elasticity. Hormone replacement has also been found to increase skin surface lipids, which enhances the barrier function and may prevent dryness. Oestrogen also plays a role in maintaining skin glycosaminoglycan content, which retains moisture.
Low testosterone in men is associated with thinning skin. This is thought to be because there is less testosterone available for local conversion to oestrogen through the action of aromatase present in the skin. Testosterone replacement has been found to increase skin thickness.
Progesterone has been used in cosmetic skin creams as well as in hormone replacement therapy and has been found to improve skin thickness and elasticity.
Low progesterone levels are thought to increase the impact of androgens on sebaceous glands and body and head hair. This is because progesterone reduces 5-alpha reductase activity, which converts testosterone to its active metabolite dihydrotestosterone (DHT). DHT is the culprit for androgenic side effects in women such as unwanted facial hair growth, which tends to appear with ageing or in androgen excess conditions such as PCOS. In both men and women, excess DHT in the skin contributes to acne, and in the skin of the scalp it is responsible for “male pattern baldness.” High levels of hormones can contribute to skin discoloration, e.g. the brown patches (“chloasma”) associated with pregnancy or with hormone replacement therapy.
Hormones and skin wellness go hand-in-hand, and Dr Manning and Dr Woodward at River are able to carry out full medical consultations to address your needs. Hormonal deficiencies can be identified using blood, saliva, or urine testing and we are able to treat with hormone replacement to improve overall health and wellness as well as to mitigate the effects of ageing.
While hormone replacement therapy is not usually recommended solely for cosmetic purposes, proper monitoring of hormone levels in an ageing population can help identify deficiencies that can be resolved with judicious hormone use, which may have the added benefit of improving skin wellness and thereby saving substantial costs in cosmetic treatments.