Weight fluctuation, acne, and mood disruptions are familiar symptoms of hormonal changes. Hormonal fluctuations are associated with other conditions, however, that are less commonly discussed. Knowing how hormonal changes affect the development and severity of eczema will help you recognize and manage this itchy skin condition.
Is there a connection between hormones and eczema?
Eczema is a complex condition. There is no singular cause; genetics, an unbalanced skin microbiome, and inflammation all factor into the development of the disorder. Allergens, diet, and exposure to irritants (such as pet dander or household cleaning supplies) frequently trigger eczema flares or worsen them. As it turns out, shifts or imbalances in hormones trigger eczema, as well.
Eczema flares that seem to appear from out of nowhere, or symptoms that worsen despite the absence of known triggers, could be caused by hormonal changes. Hormonal shifts occur at many key stages of life, and eczema flares could develop at any of these stages.
In the adolescent years, puberty kicks off a period of dramatic hormonal fluctuations. For many children, the onset of puberty brings relief from childhood eczema. For others, though, rapidly changing hormones trigger eczema flares. Studies show that girls are more likely than boys to develop eczema or to experience worsening eczema symptoms during adolescence.
There are many possible reasons for this disparity. Girls tend to have a higher (more alkaline) skin pH than boys, which can lead to an imbalance in the skin’s microbiome. This imbalance could trigger eczema.
Androgens such as testosterone are produced in greater levels by boys; these hormones stimulate the sebaceous glands during puberty, causing them to secrete more sebum (oil). This lowers the skin’s pH, making it more acidic, while also defending against dryness.
Girls also experience cycles of hormonal fluctuation as their bodies prepare for menstruation. Hormones such as estrogen and progesterone influence the skin barrier, and when they are out of balance, the skin can become dry and prone to irritation.
Nearly 50% of women with eczema report that their symptoms worsen the week before their periods. In scientific studies, women reported more intense itching and lowered quality of life during their periods and the preceding week.
This could be due to sharp increases in both estrogen and progesterone during the luteal phase (the part of the menstrual cycle between ovulation and menstruation). Both of these hormones stimulate the production of cytokines associated with inflammation. Progesterone also is associated with a decrease in the skin’s barrier function. This combination of decreased barrier function and heightened inflammatory response set the stage for an eczema flare.
Eczema and pregnancy
Eczema is the most common skin disorder reported during pregnancy. While about 25% of eczema sufferers experience improvement during pregnancy, more than 50% experience a worsening of symptoms. A significant number of eczema sufferers experience their very first eczema flare during pregnancy.
What role does pregnancy play in the development of new or worsening eczema symptoms? Progesterone levels increase throughout pregnancy–and like we said before, progesterone interferes with the skin’s barrier function. In addition to this the immune system changes during pregnancy, with T cells shifting towards what is known as a 2 T helper response.
This shift in the immune system prevents the mother’s body from rejecting the developing fetus. However, it is also strongly associated with the inflammatory response noted in eczema and allergies.
Several key treatments for eczema are contraindicated during pregnancy. This leaves mothers with little defense against worsening symptoms.
Eczema during perimenopause and menopause
About 8 to 10 years prior to menopause (a period called perimenopause), estrogen levels begin to decrease steadily. During menopause, the ovaries stop producing most of their estrogen. This drop in estrogen leads to a weakened skin barrier, which allows moisture to evaporate more rapidly from the skin.
In and of itself, dry skin is a significant eczema trigger. When the skin barrier is compromised, though, the body also loses one of its first defenses against external irritants and pathogens. Skin can become sensitized to environmental triggers.
Women often find that the eczema they outgrew in adolescence returns with a vengeance during perimenopause. Those whom eczema has spared until now might suddenly experience their first flare.
Your skin may become sensitive to things that never bothered you before, such as wool clothing or nickel in jewelry. Skincare products and cleaning supplies might aggravate your skin and worsen your symptoms.
Transitioning With Eczema
Gender-affirming hormone therapy changes the skin in several different ways. Patients receiving either masculinizing or feminizing hormones often experience new skin disorders during treatment. Studies have found that feminizing hormone therapy correlates strongly with the development of eczema. While this connection has not yet been studied extensively, the relationship is similar to that between eczema and hormone shifts during adolescence or pregnancy.
Stress is a well-documented eczema trigger. Here, too, hormones play a key role. In response to a perceived threat, the hypothalamus secretes corticotropin-releasing hormone (CRH). This hormone is key in the production of both cortisol and epinephrine (aka adrenaline), the so-called stress hormones.
The production of cortisol and epinephrine leads to a system-wide response that allows the body to make better use of energy. Your skin is part of this fight-or-flight reaction, responding to signals from neurotransmitters and sending out signals of its own. Special cells within the skin produce CRH, leading to even greater production of cortisol.
In short bursts, cortisol is an anti-inflammatory. During prolonged periods of stress, though, excess cortisol activates mast cells in the skin and triggers inflammation. Eczema flares are the result of this inflammation.
Hormonal shifts and eczema care
Hormonal changes can be difficult to navigate under the best conditions. Eczema flares only add to the stress and discomfort during these times. Proactive self-care is a vital part of managing eczema during hormonal shifts.
Good skincare is a crucial part of managing eczema symptoms at any stage of life. This means protecting your skin from sun damage, using gentle cleansers, and, most importantly, moisturizing regularly. Monitoring triggers, managing stress, and regular visits to the dermatologist are also key.
It’s also important to be armed with the right treatments when flares erupt. Developed by board-certified dermatologist Dr. Steve Harlan, SmartLotionⓇ offers a unique, prebiotic formula that promotes the restoration of the skin’s microbiome. Formulated with 0.75% hydrocortisone, it is a powerful treatment for itch and redness–and unlike most over-the-counter hydrocortisone creams, it won’t cause topical steroid withdrawal.
SmartLotionⓇ, our flagship eczema cream, does not cause skin atrophy. This is a particular concern during the perimenopausal/menopausal years when skin becomes thinner and more prone to injury.
For most people, SmartLotionⓇ is safe to use under a doctor’s supervision. With your dermatologist’s approval, it can even be added to existing treatment regimens. It’s an indispensable tool for those going through prolonged and unpredictable hormonal changes.