Diet and Endocrine-induced Skin Conditions

adolescents of both sexes are affected, and 40-54% of women

Eating low GI foods and avoiding processed Diet and Endocrine-induced sugars may therefore reduce acne flares in patients with and without concurrent Skin Conditions PCOS, 10,19,20 and one study showed that women with elevated IGF-1 levels are more likely to experience acne compared to men. 19 I use an inDermatology nurse practitioner Emma Coleman depth consultation with acne patients to identify explains how one’s diet can influence skin and possible dietary issues alongside first-line topical preparations. hair and presents a supporting case study Studies have shown that soybean isoflavones (a type of phytoestrogen) exert an antiThe effects of diet on skin is a controversial subject due to a androgenic effect, altering disease pathways and skin health. 13,21 lack of strong evidence justifying this as an effective element Furthermore, there is data supporting a positive correlation in dermatology treatment. However, there is growing support for between eating foods rich in soybean isoflavone and acne multi-disciplinary approaches to the management of skin disease lesion reduction, due to inhibition of the steroidogenic due to evidence of higher success and faster discharge rates. 1,2 This hormone-inducing enzymes 3ß-hydroxysteroid dehydrogenase, approach is something I incorporate into my daily practice. 17ß-hydroxysteroid dehydrogenase and 5α-reductase. 13,21 In this article, I discuss the benefits of combining dietary and oral/ One study found that combining soybean supplementation topical preparations in management of four endocrine-induced skin (160mg daily) with 0.025% tretinoin cream and SPF 15 sunscreen conditions: acne vulgaris, hirsutism, menopausal skin ageing and over 12 weeks significantly reduced acne lesion number in female female pattern hair loss (FPHL). patients. 21 Such dermatology conditions may cause psychological disruption to Isoflavones contain antioxidant and antifungal properties. sufferers, resulting in feelings of shame, humiliation and depression. 3,4 Soybeans have four chemical types; aglycone, glucosides, One study reported that 5.6% of acne vulgaris patients have suicidal acetyl glucosides and aminoglycosides, containing the three ideation. 3 There is also evidence that diet may influence hormonal isoflavones daidzein, genistein and glycitein. Soybean isoflavone homeostasis in those who are experiencing these skin conditions, foods can be eaten in the fermented form; miso, tempeh, natto, imparting skin and hair changes. Diet as a management tool may be soy sauce for instance or non-fermented; soy milk, tofu, soybean used in conjunction with appropriate oral or topical preparations to sprouts. There is insufficient evidence to support that soy help accelerate symptom control. 5-16 products negatively affect hormone function in men and women 22 Acne vulgaris on oxidative stress, cholesterol and bone density in men and There is evidence to suggest that acne vulgaris is very common post-menopausal women. 23,24 Some of these foods can exert an in western populations, with statistics showing that 79-95% of additional probiotic effect. 25 and some studies have shown that soy exerts positive effects and men aged over 25 years. 5 Acne is caused when sebaceous Hirsutism glands become widened due to androgen targeting, stimulating Mild to moderate androgen abnormality and PCOS is associated prolific sebum production. 17 This often commences during with approximately 65% of hirsutism cases, where prolific hair adolescence when the production of the sex hormone precursor growth can commonly be seen on the upper lip, chin, chest and dehydroepiandrosterone sulphate by the adrenal glands is areola in female patients. 5 It is thought to occur largely due to hair heightened. There is some data supporting presence of higher follicle hyper-sensitivity to androgens, enlarging dermal papillae androgen-receptor sensitivity and density in acne-prone skin. 5-7 and altering duration of hair growth during adolescence, often Acne is less common amongst Asian populations, thought to be due increasing with age. 26 It is reported that 20% of cases are idiopathic, not only to genetic factors, but also the dairy-driven western diet characterised by prevalence of dihydrotestosterone (DHT) induced in comparison to low dairy consumption seen in Asian countries. 7 thickened hair growing on androgen-sensitive skin parts. 25 Similar Evidence suggests that daily consumption of two glasses of full fat or to acne in its signalling and pathways, hirsutism often occurs as skimmed milk leads to significantly greater glycaemic index (GI) and a result of insulin-induced IGF1 release, and subsequently lowers glycaemic load (P = .022 and P = .001, respectively), in patients with sex hormone-binding globulin, increasing levels of circulating acne compared to controls, whilst a low body mass index (BMI) and testosterone. 14 eating fish three times weekly appears to exert a protective effect. 8 A weight loss programme combined with oral metformin to One Turkish paper describes a positive correlation between high stabilise insulin, the combined contraceptive pill and, in some GI diet and acne development in 50 subjects. 9 Consuming milk and cases, spironolactone can improve PCOS and reduce symptoms of hyperglycaemic foods may induce insulin production, leading to hirsutism by reducing androgen levels. 27,28 sebocyte and keratinocyte proliferation plus sebaceous lipogenesis, As an adjuvant therapy, there are some dietary elements which significantly increasing acne lesions. 10 I include for my hirsutism patients. One small scale study found A significant proportion of females aged 17 to 40 years with resistant that women who drank spearmint tea twice daily for five days had acne vulgaris have polycystic ovary syndrome (PCOS). 11,12 Insulin decreased free testosterone levels and increased serum levels of production heightens androgen production by stromal cells of the luteinising and follicle-stimulating hormones as well as estradiol. 29 As ovaries; hyperinsulinemia increases hepatic insulin growth factor 1 there is some evidence to suggest that dietary soy-phytoestrogens (IGF-1) production, stimulating sebum gland activity and increasing reduce plasma testosterone levels by approximately 50%, 15 I would keratinocyte proliferation, leading directly to comedo formation. 10,18 also recommend inclusion of these food groups and reduced sugar

of genistein on menopausal features can be

Case study achieved at a specific dosage of 54 mg/day. 13

A post-menopausal female aged 56 years To my knowledge, there are no reputable presented in clinic with dry, dehydrated skin, facial oestrogen skincare products on the evidence of deep cheek rhytids and reported market, however the protective, moisturising accelerated ageing over an average of three and anti-inflammatory benefits of flavonoids, years. The patient had no accompanying skin curcuminoids, niacinamides and peptides conditions. She had not had a period for at least found in polyphenols are being increasingly one year but was experiencing hot flashes, sleep explored 36 and ceramides help to restore disturbance, mood swings and anxiety at initial skin barrier function, 38 making these elements consultation. She was a social smoker and drinker, my go-to recommendations to help restore consuming around three to five units weekly. She elasticity and hydration. Based on research, drinks caffeine daily. The patient had a main focus Figure 1: A 56-year-old patient before and 12 months after treatment I also supply dietary information, focusing on on restoring epidermal thickness and hydration aglycone genisteins (fermented forms), plus over one year. I put her on isoflavone and synbiotic supplements, provided realistic supplementation of 54mg daily, for patients at and bespoke dietary programmes including phytoestrogen-rich sources, reduced all stages of their menopausal phase. 13,37 caffeine, white wine and prosecco intake, (association with skin inflammation and Minoxidil 5% foam is generally the treatment grape-based alcohol is documented) 47,48 alongside provision of a regimented antioxidant of choice in menopausal female pattern hair and sunscreen-heavy skincare regime. Additionally, I treated her with microneedling loss, 39 although in my experience there is (mesotherapy alternated with SkinPen) and LED light therapy every six weeks over often poor treatment adherence. Studies 12 months, using these appointments as an opportunity to assess adherence and have reported variable success rates in tolerance. At the start of therapy, the average left eye wrinkle length was 7.8cm, treatment of FPHL with hormone replacement spanning a 5.2cm area, reducing to 1.8cm and 1.9cm respectively at the 12-month point. therapy; oral finasteride yields better

The skin appeared plumper and firmer following treatment. results. 40-42 Decreasing androgen secretion and thereby circulating testosterone has a positive effect on hair regrowth, 39 suggesting intake in my patient group. Yams, lentils, alfalfa and mung beans, flax, that isoflavone ingestion through diet or supplementation may reduce sunflower and sesame seeds are also good phytoestrogen sources. 30 hair loss. There is insufficient evidence to support relying solely on diet and supplementation. Menopausal skin and hair loss Skin changes leading to ageing are accelerated during the A note about pro and prebiotics peri and menopausal years due to a decline in oestrogen and Dermatologists Dr John Stokes and Dr Donald Pillsbury progesterone receptors residing in dermal fibroblasts and epidermal hypothesised 70 years ago that the emotional state of a person keratinocytes. 31,32 This can lead to skin thinning, loss of elasticity and (such as depression, worry and anxiety) will affect gut micro flora increased wrinkle formation. 32 Additionally, this reduction in oestrogen by causing small intestine bacteria overgrowth (SIBO) contributing receptors can cause lengthening of the anagen phase of hair growth, to skin imbalance. 43-45 Findings from one study suggest that which can lead to frontal fibrosing alopecia in the post-menopause lactobacillus paracasei therapy inhibits substance P-induced period. 33 The cutaneous changes we see in skin at peri and postinflammation. 44 Including fermented milk drinks such as kefir in menopausal stages are largely due to extensive decline in alpha (ERa) your diet or quality symbiotic supplement therapy could therefore and beta (ERb) oestrogen receptors, leading to reduction in stromal help to break the mind-gut-skin cycle in endocrinal skin conditions. collagen synthesis. Hormonal supplementation may reverse these For those patients experiencing teenage or adult acne, I would changes; however, hormone replacement therapy poses certain recommend kefir derived from coconut or soy milk for reasons risks and is not for everyone, so alternative options are important in discussed previously. 5,46 symptom management. 34 ERas are limited to the dermis, whereas ERbs are spread throughout the dermis, around hair follicle bulbs and Conclusion the epidermis. 13 One study showed that the isoflavone genistein acts Adopting a low GI diet with reduced dairy intake for acne vulgaris as a selective oestrogen receptor modulator (SERM), binding to and sufferers, and a diet rich in phytoestrogens in all patient groups reactivating ERb proliferation, suggesting it may have a beneficial discussed here could speed up symptom resolution, but should be effect in decelerating ageing by restoring epidermal thickness through used in conjunction with traditional approaches rather than in isolation. collagen synthesis. 35 In menopausal skin, diet and skincare combined may improve Another human study provided evidence that even in low doses, oral elasticity and reduce surface wrinkles. Probiotics may have a role in genistein is able to disrupt IGF1 pathways, exerting a protective effect balancing gut micro-flora and reducing skin inflammation. on dermal fibroblasts to prevent oxidative stress-induced collagen biosynthesis inhibition. 16 Another trial compared effects of application Emma Coleman is an aesthetic and dermatology nurse practitioner with award-winning clinics across London of topical oestrogen with isoflavone in post-menopausal women, and Kent. She frequently speaks and writes about taking a and showed that oestrogen leads to higher epidermal thickening holistic approach to skin ageing and dermatology. She has and increases in fibroblast and dermal papillae number compared to also launched her own natural, antioxidant skincare line. topical isoflavone therapy. 36 Dietary fermented aglyconerich soy foods are absorbed faster and in greater amounts compared to glucoside rich soy in postmenopausal Japanese women. 37 The beneficial effects

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