Dermatological alterations induced by gynecological hormonal imbalances: Acne, hirsutism and alopecia

Sex hormones play a fundamental role in regulating skin physiology, influencing collagen synthesis, wound healing, immune modulation, and barrier function. Estrogens and progesterone, through their respective receptors, modulate gene expression in cutaneous structures. Hormonal fluctuations throughout the female lifespan such as those occurring during puberty, pregnancy, and menopause affect dermatological conditions including psoriasis, xerosis, and age-related thinning. Disorders characterized by androgen excess, particularly polycystic ovary syndrome, are strongly associated with acne, excessive terminal hair growth, and hormonally mediated hair loss. In these cases, elevated androgen levels and insulin resistance act synergistically to worsen clinical manifestations. Other endocrine disorders, such as non-classic congenital adrenal hyperplasia and estrogen deficiency during menopause, also contribute to cutaneous alterations.Hormonal acne, often concentrated in the lower facial region, is linked to elevated androgens and requires targeted therapies such as combined hormonal contraceptives, antiandrogenic medications like spironolactone, or isotretinoin in resistant cases. Excessive terminal hair growth is evaluated using standardized scoring systems and treated with hormonal therapies and cosmetic procedures. Hormonal hair loss includes female pattern hair thinning and telogen effluvium, the latter often triggered by estrogen withdrawal or thyroid dysfunction. Diagnosis includes trichoscopy and comprehensive hormonal profiling.Key hormonal tests such as total and free testosterone, dehydroepiandrosterone sulfate, seventeen-hydroxyprogesterone, thyroid-stimulating hormone, prolactin, and the luteinizing hormone to follicle-stimulating hormone ratio aid in identifying endocrine dysfunction. A multidisciplinary approach that integrates dermatological, gynecological, and endocrine care is essential. Given the significant psychological burden of these conditions, holistic strategies that incorporate mental health support are necessary to improve both physical and emotional outcomes.