We are pleased to welcome back Michelle Skelly as Ticadoc’s guest blogger. Michelle is an Anti-Aging Skincare Specialist – Helping people achieve healthy, youthful-looking skin through safe & effective skincare.
American physician and thyroid expert Dr. Broda Barnes talks about in his book Hypothyroidism: The Unsuspected Illness, that when thyroid function is low, circulation is reduced, and in some advanced cases of hypothyroidism, skin may receive as little as one-fourth to one-fifth the normal blood supply. Maybe you’ve been dealing with chronic skin conditions that started at a young age such as melasma, dry itchy skin or scalp, and hair loss. Have you already been diagnosed with hypothyroidism or hyperthyroidism and struggling with skin-related conditions? Or maybe you’re experiencing skin-related issues like these which could be a sign of thyroid issues?
Here are some skin-related signs of an under-active thyroid:
• Intolerance to cold air and cold weather conditions
• Dry skin, hair, and nails
• Course, thinning hair (scalp, eye brows, armpits, and pubic hairs)
• Brittle or split nails
• Waxy skin
• Facial puffiness, especially on the eye lids
• Myxoedema (skin swelling)
• Thickened skin located on the lower legs with a pale or yellowish appearance
• Vitilgo or alopecia areata associated with Hashimoto’s thyroiditis
Thyroid hormone replacement is a treatment option for hypothyroidism. With thyroid hormone replacement, the symptoms and signs of hypothyroidism gradually return to normal. Some patients may continue to have a mild case of dry skin, even when blood tests indicate thyroid hormone levels are optimal. Thyroid hormone replacement should be undertaken gradually to avoid complications of treatment such as excessive flushing, sweating, and even further hair loss. Hypersensitivity reactions are rare, but can include getting rashes.
Photo source: HumanHealth.com
Here are some skin-related signs of an overactive thyroid:
• Intolerance to hot air and hot weather conditions (this can include increased perspiration with a warm, moist skin environment that can lead to sweat rashes in skin folds)
• Increased hair shedding
• Rapid nail growth with nails that may lift off the nail bed
• Vitiligo or alopecia areata associated with Hashimoto’s thyroiditis or Graves’ disease (protruding eyes are a sign of this autoimmune disease)
Treatment of hyperthyroidism is often with carbimazole or propylthiouracil. These can occasionally cause a mild, itchy rash. In some rare cases, hypersensitivity vasculitis arises, which can cause purple non-blanching bumps on the lower legs and feet. Palpable purpura should be checked immediately and medication should be stopped.
Melasma and Thyroid Disease
Melasma is more common in women than in men…1 out of 4 women compared to 1 out of 20 men are affected by melasma, depending on the population studied. It generally starts between the ages of 20 to 40 years old, but it can begin in childhood. Known triggers for melasma include sun exposure and sun damage (this is the most avoidable risk factor), pregnancy (in affected women, pigment often fades a few months after delivery), hormone replacement therapy, birth control pills containing estrogen and/or progesterone, and intrauterine devices and implants. These are all a factor in about a quarter of affected women with melasma. Certain medications (such as new cancer therapies), deodorant soaps, and cosmetics can also cause a photo toxic reaction that triggers melasma. Thyroid issues can trigger melasma as well. Here are several studies in relation to melasma and thyroid issues.
According to the Indian Journal of Dermatology 2006 study Thyroid and Skin:
Hyperpigmentation in thyroid disorders has been reported mainly in hyperthyroidism. Interestingly, we found pigmentary disorders – diffuse hyperpigmentation, melasma, and periocular pigmentation to be a very unusual common complaint in a total of 12 patients (37.5%). The explanation of hyperpigmentation in hyperthyroid patients is increased release of pituitary adrenocorticotropic hormone compensating for accelerated cortical degradation. In hypothyroidism though, the cause of melasma cannot be explained although it has been documented in literature.
According to the Journal of Dental and Medical Sciences, who published the article Skin Manifestations of Hypothyroidism – A Clinical Study:
Thyroid disorders are known to cause a wide range of skin manifestations. Hypothyroidism causes changes in the skin, hair and nails. The aim of our study was to evaluate the skin manifestations in patients with hypothyroidism. A total of 100 patients with hypothyroidism attending the General Medicine and Dermatology of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences over a period of one year were included in our study, and the skin lesions have been recorded after a detailed history and clinical examination. Out of 100 patients, 63 patients had skin manifestations. Xerosis (acquired ichthyosis) (abnormally dry skin) and diffuse hair loss were the common skin manifestations which were seen in 38.09% and 34.8% of patients respectively. Melasma (14.28%), chronic urticaria (14.28%) and generalised pruritus (11.1%) were the other common manifestations. Tinea corporis, vitiligo, alopecia areata, lichen planus and xanthelasma palpebrarum were the other skin disorders associated with hypothyroidism.We therefore conclude that a better understanding of the skin lesions helps in the early detection of the underlying hypothyroid state.
According to the 2015 study Evaluation of Autoimmune Thyroid Disease in Melasma:
Melasma is one of the most frequently acquired hyperpigmentation disorders clinically characterized by symmetrical brown patches on sun-exposed areas. To date, few studies have been conducted about the relationship between thyroid autoimmunity and melasma. To evaluate the thyroid dysfunction and autoimmunity in nonpregnant women with melasma. A total of 70 women with melasma and 70 age-matched healthy women with no history of melasma were enrolled in the study. We studied the thyroid hormone profile in both groups. Patients with melasma had 18.5% frequency of thyroid disorders, and 15.7% had positive anti-TPO, while subjects from the control group had a 4.3% frequency of thyroid abnormalities, and only 5.7% had positive anti-TPO. There was a significantly higher prevalence of thyroid dysfunction in women with melasma compared with control group. This study suggests that there is a relationship between thyroid autoimmunity and melasma.
As mentioned above, there are many possible underlying causes of melasma. The thyroid is not always the cause. However, if you have consistent melasma, be sure to speak to your doctor about full thyroid testing. Make sure that your levels are optimal, not just normal. It’s important to address the underlying cause of your skin hyperpigmentation issues. For example, to treat post inflammatory hyperpigmentation (PIH) due to acne, treat the acne and hyperpigmentation simultaneously with topical retinoids and hydroquinone.
A combination of topical products containing active ingredients such as niacinimide, vitamin A, and vitamin C have been found to help brighten the skin and can be used daily. For melasma, 2-4% hydroquinone is recommended as the best treatment. Patients resistant to non-prescription strength products (most of the time they are usually dark skinned individuals) should consider microdermabrasion or chemical peels in addition to effective skincare products. A combination of chemical peels, which contain higher concentrations of active ingredients than those used for lighter skin tones, allow the active ingredients to reach the deeper, affected pigment.
Non-ablative fractionated lasers and very low level Q-switched Nd:YAG lasers can be used in difficult to treat or resistant cases. However, PIH is a concern when using non-ablative fractionated lasers on dark skinned individuals, so make sure you do a thorough Q&A with the skin specialist performing the procedure as you would not want your hyperpigmentation issues to get even worse than before.
Daily use of a broad spectrum sunscreen or sunblock with at least an SPF of 30 is strongly recommended to prevent further darkening of the skin or melasma to come back.
If you’ve been struggling to find out what the main cause of your persistent melasma or other skin issues may be, it’s worth it to go see your doctor and take a full thyroid test. As with any health-related concerns, always consult with your physician regarding medical advice pertaining to your health. Then, if you have any questions regarding safe and effective skincare products to use for your hyperpigmentation issues, please feel free to email me at firstname.lastname@example.org.