What Effect Do Hormones Have on Atopic Dermatitis?

Atopic dermatitis (AD) can have periods of remission, where there are no symptoms, and periods of worsened symptoms, called “flares.” In women, hormone fluctuations may act as a trigger for AD, causing a flare of symptoms or a worsening of their condition. Hormone fluctuations are commonly experienced just before and during menstruation, during pregnancy, following pregnancy (postpartum), and at the transition to menopause (perimenopause).1

Female hormones and the skin

The hormones progesterone and estrogen are responsible for menstruation, and these hormones produce multiple responses in tissues and organs throughout the body. In a normal menstrual cycle, estrogen increases after menstruation and peaks just before ovulation (the release of the egg from the ovary). After ovulation, progesterone increases and estrogen decreases.2

The skin has numerous estrogen receptors, as well as progesterone receptors. Cyclical fluctuations of hormones influence the skin’s production of lipids and oils, skin thickness, fat deposition, skin hydration, and barrier function.

Estrogen has numerous beneficial effects on the skin, including:

  • Increasing the collagen production in the skin
  • Decreasing the sebum (oil)
  • Increasing the water-binding capacity
  • Increased fluid retention
  • Improved wound healing
  • Increased elasticity2

Estrogen also plays a role in the pigmentation of the skin, the skin’s sensitivity to UV light, and the microorganisms that live on the skin. The role of progesterone on the skin is less understood, although it is believed to influence the immune system.2

As estrogen drops, which occurs during the premenstrual period, after pregnancy, and at menopause, there are significant effects on the skin, including more water loss, an increase in microorganisms like bacteria, and decreased wound healing. These processes can aggravate skin affected by AD, which already has a compromised skin barrier due to a lack of the protein filaggrin. The damaged skin barrier leads to a reduced ability to maintain the skin’s natural amount of water. Excess water loss can lead to dry skin. In addition, the compromised barrier allows allergens and germs to penetrate the skin.2,3

Premenstrual syndrome (PMS) and atopic dermatitis

Premenstrual syndrome, or PMS, is the name given to the time just before menstruation begins when many women experience a variety of symptoms related to hormone fluctuations. Many women with AD find that their skin lesions worsen during PMS, although not all women experience this. It is estimated that 47% of women with AD experience worsening of AD during the premenstrual week.4,5

Pregnancy and atopic dermatitis

The highest levels of estrogen occur during pregnancy. Some women experience worse bouts of AD during pregnancy, while other women find that their symptoms improve during pregnancy. One study found that women with AD had worse symptoms during the first 20 weeks of gestation, while approximately 24% of women had an improvement in their AD during their pregnancy.2,4

Menopause and atopic dermatitis

Both estrogen and progesterone decline in menopause, when a woman stops menstruating. Menopause is officially reached one year after a woman’s last period. The years before reaching that point are called perimenopause and are marked by fluctuations in both estrogen and progesterone. As these hormones decline, the effects can be seen on the skin and can impact AD, particularly the water loss and increased dryness of the skin. Hormone replacement therapy can minimize these effects, although hormone replacement therapy has risks and benefits and is usually not recommended for its effects on the skin alone.2,6

Emily Downward | June 2017
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