By Maryann Mikhail, MD
The skin is the window into the body. This is especially true at the intersection of endocrinology and dermatology. Visible changes in the skin can signal abnormalities in various hormone levels. Identifying these conditions is important, not only for treatment of the skin, but also because they may lead to other health problems. Here are some of the most common skin manifestations of hormone imbalances:
A particular type of skin discoloration called Acanthosis Nigricans generally appears as dark, velvety patches on the neck, armpits and groin but can also show up on the knuckles, elbows and knees. The most frequent trigger of acanthosis nigricans is insulin resistance, meaning that higher levels of insulin are being pumped into the bloodstream to control blood sugar levels. When insulin production can no longer keep up with blood sugar, diabetes occurs. Any patient who presents with acanthosis nigricans should be screened for pre-diabetes. In many cases, early intervention and treatment can prevent the development of full-blown diabetes.
In women, cyclical, cystic breakouts localized to the beard area (lower face and neck), chest, or back may be hormonally driven. Male hormones, called androgens, stimulate the overproduction of sebum in these areas. Sebum clogs pores and attracts skin surface bacteria, which then triggers inflammation.
Therefore, women who have high androgen levels or who have normal levels but are sensitive to androgen fluctuations often present with cystic acne predominately located in these areas. Other clues that androgen levels are elevated include excess hair growth, hair loss, change in voice, or irregular periods. Hormonal acne may also be seen commonly in women with polycystic ovarian syndrome (PCOS).
Hair & Nail Changes
When hair thinning occurs diffusely and prematurely in a young person, it may be a sign of androgen or thyroid imbalance. Alopecia Areata, a condition that presents with round patches of hair loss, may be linked to autoimmune thyroid disease. Excess hair growth on the face, neck, or nipple region of a female may be seen in conditions of androgen excess or in PCOS.
Nail thinning, breakage and brittleness may be associated with hyper or hypothyroidism, especially when present with other symptoms such as dry skin, weight changes, cold intolerance, and fatigue.