Taking Care of Hormonal Skin

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I don’t need to tell you that endometriosis is more than period cramps. Months after my diagnosis of suspected endo, I’m still learning all the ways endometriosis has affected my life. So many of the health problems I’ve had over my lifetime, from allergies to “IBS,” stem from my endo — and that includes skin issues.

The first time I saw a dermatologist, I was 19 and had just gotten the Liletta IUD placed for my painful periods. I didn’t know it at the time, but IUDs can cause hormonal acne. Soon after my IUD was placed, I found myself as a young adult, who had never struggled with acne as a teen, breaking out across my chin and jawline for the first time. According to my derm, hormonal changes in our 20s often lead to adult acne, but the additional hormones in the IUD appear to increase that risk.

I experienced the same thing again this year, when I started Aygestin on top of my IUD to suppress my menstrual cycle. The increased progesterone (combined with wearing a mask due to COVID) have led me to break out more than I have in years. Because I’ve long known that hormonal changes can cause acne, I wasn’t surprised. But what I was surprised to learn is that endometriosis has also been linked to my other primary skin woe: eczema.

Eczema is an inflammatory condition, much like endo. The most common cause is atopic dermatitis, a chronic flaring skin rash that’s itchy, red, and bumpy, but eczema can also be caused by contact dermatitis, an allergic reaction of the skin to things like fragrance or detergent. My eczema is something I’ve had since elementary school, but something I’ve always been embarrassed to talk about — which you know is uncharacteristic of me, since I’m always oversharing on this blog! As a child, I struggled with eczema in “normal” places, like my inner elbows and inner thighs. But as I got older, I broke out in eczema on my nipples.

For obvious reasons, this wasn’t something I wanted to talk about, even with my parents — but it terrified me. I have inverted nipples, so combined with the itchy, flaky rash, I was convinced for years I might have breast cancer. Since then, my doctors have long since reassured me that my skin condition is benign. Still, that hasn’t changed the fact that eczema affects my confidence. When I became sexually active, I became especially worried that guys would think my cracked, chafed nipples were “weird” and wouldn’t want to hook up with me. Thankfully, I’ve always been with partners who were kind and accepting toward my skin condition — but it’s definitely harder to feel sexy when you have an unsightly, uncomfortable rash on your boobs.

When I found out eczema, acne, and endometriosis were linked, I was strangely relieved. Before my diagnosis, I thought that only breastfeeding moms could get the type of eczema I experienced, and that hormonal acne simply meant that I was “PMS-ing.” When I started to learn more about endo, though, I discovered an entire community of people suffering from the skin conditions that I do, alongside the pelvic pain, digestive issues, food intolerances, and all the other problems that go along with endo.

Discovering this community meant that I wasn’t alone in these annoying, embarrassing conditions. Just as important, however, is the fact that so many people with endo have found solutions to these skin problems that work for them. Finding the endometriosis community allowed me to uncover the products, tips, and tricks I always needed, but never knew existed for my acne and my eczema. Now, I’m passing along that wisdom to you guys in this guide to caring for hormonal skin. If you suffer from a hormonal skin condition, endo-related or not, I’m right there with you. I’ve got your back — and I’m here to help you find what will work for you!

Acne

For many people, acne is inherently a hormonal condition. Some people with periods find that they break out a week or so before their period, due to the shifting hormone levels associated with the menstrual cycle. Others face hormonal conditions — like endo — that lead them to break out. For example, patients with PCOS have higher-than-usual testosterone levels, which can cause painful cystic acne. Endometriosis has also been linked to a history of severe teenage acne. Furthermore, many treatments for endo, like hormonal birth control and menstrual suppressants, can cause acne, too. So, what’s a person with endo to do?

For all things acne-related, I defer to the advice in my favorite skincare book, The Skincare Bible by Dr. Anjali Mahto. This isn’t your typical, trendy celebrity skincare manual. Dr. Mahto is a consultant dermatologist who’s struggled with cystic acne herself — and, in fact, cautions against following the latest skincare fads. Instead, she looks to studies and scientific evidence to find solutions that have a solid body of research behind them, and only recommends treatments to her patients that have been proven to work over years of study. You can get The Skincare Bible on Amazon for $13 (Kindle) or $18 (paperback) — and while I will recount some of Dr. Mahto’s words of wisdom here, I highly recommend taking the time to read the entire book.

Acne and Skincare Ingredients

Let’s talk oily skin for a sec. It’s become popular to “double-cleanse,” first with an oil cleanser followed by a water-based cleanser. Anecdotes say the oil-based cleanser binds to excess oil (a.k.a. sebum) on the face, while the water-based cleanser binds to other impurities. Double-cleansing is supposed to make your face extra squeaky-clean, but Dr. Mahto advises anyone with acne to avoid oil-based products and instead opt for those marked “non-comedogenic.” While you should note that non-comedogenic is not a guarantee that products won’t make you break out, you’re better off choosing these than those that aren’t labeled as such! If you want to try double-cleansing, Dr. Mahto suggests following your regular cleanser with a micellar water for acne-prone skin.

Many people with acne think that because their skin is oily, they can withstand a lot of harsh exfoliation. That’s simply not true. Even those with oily skin should exfoliate no more than twice per week, which includes products like masks and scrubs, as well as AHA/BHA acid peels and pads. In fact, many people with acne also have sensitive skin and break out in response to certain ingredients. If you suspect this could be you, run the products in your current skincare regime through the site CosDNA, which analyzes skincare ingredients for potential culprits of acne, irritation, and more.

Finally, I want to touch on the concept of “natural” skincare products. Natural and organic products are something I talk a lot about on this blog. I’m all about minimizing my exposure to synthetic chemicals where I can, because there’s some evidence that chemicals (such as dioxins) contribute to endometriosis. But, Dr. Mahto’s book changed my opinion on this topic somewhat. As she pointed out, everything is made from chemicals, whether natural or man-made, and what’s most important is that these ingredients have been proven safe. Along the same lines, my IUD is man-made and contains synthetic progesterone, but that doesn’t mean it hasn’t been a godsend for my endo. That being said, many of the natural and organic products recommended for treating acne (such as witch hazel) aren’t recommended by dermatologists. Botanicals, herbs, and essential oils found in these products can still irritate skin. Furthermore, the word “natural” isn’t heavily regulated, so it’s virtually meaningless as anything more than a marketing term.

Acne Treatments

Acne treatments take two forms: over-the-counter (OTC) and prescription. You can get OTC products at any drugstore, while prescription treatments require an Rx from your primary care physician (PCP) or dermatologist. It’s important to note that many topical acne treatments can cause sun sensitivity, so you should always wear a non-comedogenic sunscreen when using them and reapply throughout the day. Of course, you should always be wearing sunscreen anyways, because skin cancer is no joke.

Now, let’s talk OTC acne treatments. These come in the form of cleansers, gels, or even patches that contain key ingredients for targeting breakouts. Dr. Mahto recommends looking for ingredients like benzoyl peroxide, glycolic acid, salicylic acid, and retinoids in your skincare products. However, be wary of combining too many acne treatments at once, since this can increase the risk of sun sensitivity, dryness, and irritation. Below, I’ll break down these key ingredients so you can understand what they mean and how to use them most effectively:

  • Benzoyl peroxide is an antibacterial ingredient. Acne is frequently caused by P. acnes bacteria in the skin. Overuse can lead to dryness, so don’t skimp on the non-comedogenic moisturizer when using this product. Dr. Mahto also cautions that it could bleach hair and clothing if it comes into contact with these items.
  • Glycolic acid is an alpha-hydroxy acid (AHA) product. It is the most researched AHA with the most proven benefits. AHAs like glycolic acid exfoliate the skin by sloughing off the top layer of skin cells. They should be used no more than once or twice weekly as part of your skincare routine. If you have sensitive skin, look for a lower concentration of glycolic acid in your chemical exfoliant.
  • Salicylic acid is a beta-hydroxy acid (BHA) product. Along with AHAs, it is a potent anti-inflammatory agent and chemical exfoliant that has been proven to treat problem skin. On its own, it’s most effective for treating blackheads, rather than whiteheads or cystic acne; however, it works well in combination with benzoyl peroxide to treat acne.
  • Retinoids are some of the best proven acne treatments out there. They are vitamin A-based products that work to unclog pores. Retinoids used to only be available as a prescription topical medication, but you can now find prescription-strength retinoids in your local drugstore, thanks to Differin (which I’ll talk about more in the section about my favorite acne products!).

The other category of acne treatments is prescription-based products. Higher concentrations of OTC topical treatments are available as a prescription from your dermatologist, as are oral medications. The combination birth control pill is one option for hormonal acne, which is often used to suppress endometriosis symptoms as well. Certain brands of the pill, like Yasmin, are favored for treating acne. Other medications for acne are treated as last-resort options for stubborn cases. These options include spironolactone (only safe for use by biological females) and roaccutane. You’ll need a prescription for these from a dermatologist or PCP.

Acne and Diet

You’ve probably heard some potent acne myths about what you should and shouldn’t eat to curb breakouts. I’m here to debunk those myths — and let me start by saying that you should forget everything you’ve heard about chocolate, and eat as much as you want!

….okay, maybe not as much as you want. Chocolate itself doesn’t cause acne, but high-glycemic foods (read: foods high in sugar and low in other nutrients) are thought to contribute to breakouts in some people. You should test your individual tolerance to sugary treats to see if they are a trigger food for your skin. The same goes for dairy, which has also been linked to acne. Some docs believe this is a myth, but commercially-raised cows are often treated with growth hormones. Since hormonal imbalance is also linked to acne, it doesn’t come as a surprise that factory-farmed dairy causes breakouts in some people.

Again, diet is highly individualized. Just as in endometriosis, what triggers an acne flare in one person might be perfectly find for another. An elimination diet (conducted under the guidance of a doctor) can help you identify trigger foods for acne and endo. Over the course of a couple of weeks, you’ll eliminate one food at a time and gradually reintroduce it, observing for signs of a breakout (or endo flare) as you reintroduce the foods you eliminated. This comprehensive guide to the elimination diet from the Institute for Functional Medicine will walk you through the process and the reasons why some foods can lead to reactions in sensitive individuals.

My Favorite Acne Products

Whew, that was a lot of information! If you’re anything like me, you need to know why you’re doing something before you do it. I’m a junkie for research — but I also understand if you scrolled past the info, straight to the solutions. After all, years of struggling with acne without finding answers can leave you pretty damn exhausted. Well, look no further! I can’t guarantee these products will clear your skin, but I know that 1) they have helped improve my acne and 2) I’ve screened them all for problem ingredients via CosDNA, and no product contains ingredients with higher than a score of “2.” (The closer a score is to 5, the more likely it is to cause acne.) Here’s how I made over my skincare routine to clear my skin — don’t worry, everything in my routine is under $40!

Cleanser: Differin Daily Deep Cleanser

Differin’s cleanser was carefully formulated to treat breakouts without angering sensitive skin, which is why I use it religiously. This product is fragrance- and dye-free to reduce your risk of breakouts or irritation. Its active acne-busting ingredient is benzoyl peroxide (5% concentration), which kills P. acnes bacteria for clearer skin.

Toner: Glow Recipe Watermelon Glow PHA + BHA Pore-Tight Toner

I received this toner for free through Influenster and immediately fell in love. Its active ingredients are polyhydroxy acid (PHA) and beta-hydroxy acid (BHA), two potent exfoliants. The toner also contains hyaluronic acid, an anti-aging ingredient. Glow Recipe’s product is safe for everyday use and derives many of its ingredients from natural sources.

Serum: Mad Hippie Vitamin A Serum

The magazine I used to work at turned me onto this gem of a product from Mad Hippie. A vitamin A serum is a must-have step in your routine if you are looking to fight early signs of aging without clogging your pores. Many experts say starting early is key to preventing aging and sun damage, so it’s never too soon to take care of your skin! This serum contains HPR, a unique retinol alternative. Mad Hippie is currently donating $1 of every sale to the BLM movement — and always donates $1 of every purchase to conservation efforts.

Mask: LUSH Mask of Magnaminty

As Dr. Mahto attests in her book, exfoliation plays a huge part in clearing up acne. Oily skin should be exfoliated once or twice a week, with either an acid or a mask. I like to alternate an acid with the Mask of Magnaminty, hand-crafted by LUSH. This minty-fresh mask cools and soothes red, inflamed skin, while pieces of crushed adzuki beans exfoliate your skin as you slather on this mask.

Acid: The Ordinary AHA 30% + BHA 2% Peeling Solution

The Ordinary has become a cult favorite for both its affordability and its high-quality product line. This AHA and BHA peeling solution is derm-grade, containing glycolic acid, lactic acid, and salicylic acid to slough off dead skin cells and reveal the glowing clear skin beneath. Be sure to use this no more than once a week, and to always use sun protection when treating skin with acid solutions.

Spot treatment: Differin Adapalene Gel

Differin revolutionized the skincare game when they produced the first OTC prescription-strength retinoid. Before this, the strongest blemish busters available were Clean & Clear and Clearasil. Now, you can get 0.1% adapalene gel — a drying and clearing agent applied to breakouts — at your local drugstore for under $20. A little goes a long way when spot-treating, so one tube of Differin will last you a long time. Just make sure to use sunscreen when applying a retinoid, and not to combine it with AHA or BHA products in the same routine!

Moisturizer: Simple Water Boost Hydrating Gel Cream

Simple Kind to Skin makes this lightweight hydrating gel cream. Those of us with oily skin often overlook moisturizer, thinking the oils in our skin will keep our skin soft and supple — but what we don’t think about is that many acne treatments are drying and strip the skin of essential moisture. Dry skin ages faster, so slather on some of this gel-based moisturizer after every cleanse to replenish skin without problem ingredients.

Sunscreen: Coola Classic Face Sunscreen

Coola’s face sunscreen is a classic for a reason: it contains SPF 50 (you need, at minimum, SPF 30), protects from both UVA and UVB rays, and doesn’t use harsh chemical ingredients. You always, always, ALWAYS need SPF, no matter the weather — to protect from skin cancer, yes, but also if you are using acne treatments like retinoids and AHA/BHA acids, which make the skin prone to sun sensitivity. Fragrance-free products like Coola’s original unscented face sunscreen are best for acne-prone skin, though I admit that I love and use the white tea scent!

Foundation: Pacifica Alight Multi-Mineral BB Cream

Good skin habits don’t end at skincare. Your skin is the largest, more porous organ in your body. As a highly absorbent surface, your skin will soak in anything you put on it — including makeup. That’s why it’s critical to choose a foundation that’s lightweight and non-comedogenic. Pacifica’s Alight Multi-Mineral BB Cream is vegan, provides light coverage, and contains special minerals that adjust to your skintone. (This definitely works best on fair skin, so if you have darker skin, I would recommend a different BB cream with a wider shade range, such as the Glossier Perfecting Skin Tint.)

Eczema

Like acne, eczema is a skin condition that produces reddened, inflamed patches of skin. While acne is caused by pores clogged by P. acnes bacteria, however, eczema is linked to an over-active immune system. People with eczema typically have a genetic predisposition for the condition. Some people have a specific mutation affecting the skin protein filaggrin, which makes up the top layer of our skin. Filaggrin forms a protective barrier to keep foreign particles and bacteria away. Changes in this barrier protein may lead to hypersensitivity to allergens and hormones, among other triggers that cause acne flares.

The National Eczema Association (NEA) has been invaluable to me in navigating my skin journey. Their NEA Seal of Acceptance (SOA) program marks products as safe for people with eczema. By “safe,” I mean free of potential triggers, like fragrances or dyes. Anything from the wet wipes you use on your hands, to the moisturizer you put on your face, to the laundry detergent you wash your clothes with could be responsible for an eczema flare. That’s why I stick to SOA products whenever possible, especially when those products come into contact with affected areas.

What Causes Eczema?

As in acne breakouts, eczema flares are often linked to specific triggers, one of which can be changes in our hormones. People may have eczema when they get stressed, which leads to the release of the stress hormone cortisol. Or, the body may respond to changes in hormones throughout the menstrual cycle, resulting in eczema only at certain times of the month. Since eczema affects the immune system as well as the endocrine system, it’s no wonder that people with endometriosis are more likely to suffer from it.

Many other triggers of eczema are environmental. This also makes sense, as people with endometriosis appear to be more sensitive to allergens than people without it. Common eczema triggers include nickel allergy, fragrance, soap, antibiotic ointment, and other personal care products, like wipes and lotions. Dry skin is also more prone to developing an eczema flare. As a result, you may experience more eczema in the winter months. Alternatively, some people experience eczema in response to heat and humidity during the summertime. Whatever the cause of your eczema, it’s important to understand your triggers to control an eczema flare and cease the discomfort.

Eczema Treatments

Avoiding triggers is the best way to control an eczema flare. That being said, treatments can also take the form of topical creams or ointments, as well as oral medications. Like acne treatments, you can get eczema treatments OTC or via prescription from a PCP or dermatologist. Topical agents are available both OTC and by Rx, while oral medications will require a prescription to get. In general, the treatments available OTC are weaker than those prescribed by a doctor, so you may want to make an appointment with your PCP or a dermatologist if you have a severe case of eczema.

Most topical agents used to treat eczema are either emollients or steroids. An emoillient is an intense, hydrating moisturizer, while steroids are medications that fight inflammation by blocking the production of certain substances. Corticosteroids, available as an OTC treatment for eczema in the form of 1% hydrocortisone cream, are the first line of defense. These drugs mimic the hormone cortisol and inhibit the immune system processes that trigger inflammation. Hydrocortisone is safe to apply up to four times a day to the affected area(s). Other, stronger corticosteroids are available as an Rx from your doctor, as are nonsteroidal topicals like topical calcineurin inhibitors (TCIs) and PDE4 inhibitors.

Your doctor may consider prescribing oral medications for severe cases of eczema that do not respond to topical agents. Doctors can prescribe immunosuppressants, which suppress the immune system (thought to be involved in the production of eczema), or biologics, which use human DNA to block chemicals called interleukins that promote inflammation. These are the same medications used to treat many autoimmune diseases, like inflammatory bowel disease or lupus. If you begin taking these medications, you may need to take extra precautions (especially during COVID-19), as they weaken your immune system and may make you more likely to get sick.

My Favorite Eczema Products

Before we get into talking about my favorite eczema products, I should clarify that while I have a very specific type of eczema, all of these products are suitable for anyone with eczema. Most of these products can be used anywhere on the body. That being said, everyone’s eczema is different. You should always make sure to check in with your doctor before changing your routine — especially if you’re taking other prescription medications that could interfere with the ingredients in these eczema products.

Emollient: 100% Pure Petroleum Jelly

It’s a classic for a reason! Vaseline, or 100% pure petroleum jelly (no need to buy brand-name if you’re on a budget), protects soothed and chapped skin while posing little risk of irritation. In other words, it’s an emollient that hydrates and protects from further damage to eczema-prone skin. As long as the brand you’re using contains no additional ingredients, this product is safe for external use just about anywhere on the body where eczema is present. The only downside is that petroleum jelly is a byproduct of oil, meaning it poses a significant burden to the environment.

Emollient: 100% Pure Lanolin

While this calls itself a nipple protectant for new moms, don’t be deterred by the packaging: 100% lanolin is a powerful emollient that’s safe for use anywhere on the body. The fact that it’s used by breastfeeding moms is a testament to its safety. After all, if it’s safe for baby’s mouth, then it’s sure as heck safe for your skin! Plus, it’s a more eco-friendly alternative to petroleum jelly, as it doesn’t rely on byproducts from Big Oil to get the job done. Like Vaseline, apply a thin layer of this product to affected areas after cleansing to soothe and protect damaged skin.

OTC treatment: 1% Hydrocortisone Cream

OTC hydrocortisone cream is the first line of defense for eczema. Many mild-to-moderate cases respond well to this treatment, which is amazing considering how affordable it is compared to its prescription-only equivalents. One tube of 1% hydrocortisone will set you back $5 or less at most drugstores or supermarkets and lasts for weeks. After cleansing, apply a thin layer of hydrocortisone cream to affected areas to nip itching and redness in the bud. Follow up with an emollient like petroleum jelly or lanolin for an extra round of protection.

Body wash: Cetaphil Pro Soothing Wash

As I mentioned previously, treating eczema on its own isn’t enough. You also need to remove triggers, which often include personal care products like body wash, lotion, and makeup. Usually it’s ingredients in these products, not the products themselves, that cause problems for eczema-prone skin. That’s why I love this Cetaphil body wash: it contains no fragrance or irritating ingredients, and even includes a fillagrin complex to protect your skin and help it retain moisture. This product bears the NEA’s SOA, meaning you can count on it as clinically proven not to induce eczema flares in affected patients. Best of all, it’s available at your local drugstore!

Moisturizer: CeraVe Moisturizing Cream

For many of us, dry skin triggers an eczema flare. We often think of dryness as a winter problem, but our skin needs to be protected and hydrated all year round. CeraVe’s Moisturizing Cream is a powerful moisturizer for the whole body, from hands to face to feet, that’s free of fragrance or irritating ingredients. It’s hypoallergenic and certified by the NEA’s SOA program, and contains soothing and hydrating agents like hyaluronic acid and ceramides to keep your skin supple and soft.

Detergent: All Free and Clear Detergent

One thing I never realized could be contributing to my eczema was the detergent I used in my washing machine. I didn’t think it mattered much what I used on my clothes, but in fact, irritating ingredients from detergent and dryer sheets can rub off on your skin and cause an eczema flare. For me, this means I pay extra special attention to what I use to wash my clothes. I exclusively use All’s Free and Clear Detergent, which bears the NEA’s SOA and contains no fragrance or irritating ingredients, on all of my clothing. Even though my eczema is confined to one area of my body, I know that eczema-prone skin can break out anywhere when exposed to a trigger, so I try my best to contain it by watching what I use on my clothing.

Dryer product: Babyganics Natural Wool Dryer Balls

Likewise, it also matters what you put in your dryer. I skip the fabric softener and dryer sheets altogether, opting instead for natural wool dryer balls. These dryer balls are made from 100% wool, with no bleach or dye. I trust the Babyganics brand because it’s safe for infants, meaning the manufacturers pay close attention to the allergenic potential of their ingredients. If it’s good enough for moms, who are fiercely protective of their children, then it’s good enough for me and my sensitive skin. In fact, even if you don’t have eczema, there are benefits to switching to wool dryer balls: they can be reused for 2-5 years, depending on how much laundry you do (they last up to 1,000 loads), meaning you save money and keep disposable dryer products out of our landfills.

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