Sunday, April 21, 2013

Prolactin and Stress

Prolactin and Acne 

Prolactin is a hormone best known for its role in breast milk production (pro lactation) and quite logically it increases over the course of pregnancy and is very high during pregnancy and while the mother is breast feeding.  It may then surprise some that even males have prolactin, but that's because prolactin has some other biological functions, some of which can promote acne. 

Prolactin increases 5AR [1] [2], the enzyme that converts testosterone into DHT.  DHT increases sebocyte proliferation, sebum production and hyperkeratinisation.  See Your Hormones are Going Crazy.  Prolactin is quite pro-inflammatory* as it promotes immune activation and the production of several pro-inflammatory cytokines** [3]. 

Evidence to support the role of prolactin in acne: 

  • 45% of adult women with acne have hyperprolactinemia, which may be responsible for their excessive androgen signalling as androgen levels often fall when hyperprolactinemia is treated [4]
  • There are several mechanisms by which zinc inhibits prolactin secretion, low zinc levels are associated with elevated prolactin [5] and zinc is therapeutic for acne
  • A drug that lowers prolactin improves acne greatly [6] 

“All patients had a fall of basal prolactin levels to normal and a great improvement in or even disappearance of their acne." [6] 

Also several things that increase prolactin also seem to trigger acne.  These include: pregnancy, breastfeeding, stress [7], sexual arousal and orgasm*** [8], hypo and hyperthyroidism [9] and several drugs including antipsychotics, antidepressants, opioids and perhaps estrogens**** [10] (the references are only for X >> prolactin.  While Dr. Google returns lots of searches for X >> acne, these relationships don’t seem to have been explored by the scientific community.) 

* Prolactin works synergistically with growth hormone, melatonin and leptin.  These hormones are elevated while sleeping, particularly slow wave sleep and all of them are pro-inflammatory by stimulating immune activity.  Cortisol and catecholamines are lower while you’re sleeping and are anti-inflammatory by suppressing immune activity.  This results in a highly pro-inflammatory environment during slow wave sleep [3]. 

** Consistent with its pro-inflammatory effects, prolactin is associated with some autoimmune diseases.  Elevated prolactin is seen in the active phase of some autoimmune diseases and is present before symptoms appear.  Elevated prolactin can induce a lupus-like phenotype and 20-30% of people with lupus have hyperprolactinemia [11] 

*** High prolactin inhibits sexual arousal and therefore may operate as a negative feedback mechanism, which is consistent with low sex drive being a symptom of hyperprolactinemia [8]. 

**** How do those drugs increase prolactin?  See below 

Drug
How Drug Increases Prolactin
Antipsychotics
↓ Dopamine >> ↑ Prolactin
Antidepressants
↑ Serotonin >> ↑ Prolactin
Opioids
↑ β-Endorphin >> ↑ Prolactin
Estrogens
↑ Estrogen >> ↑ Prolactin

***** Danny Roddy, who is inspired by Ray Peat, considers to prolactin to be a factor in male pattern baldness. 

Stress, Depression/Anxiety and Acne 

Acne is associated with depression, anxiety and other mental health issues.  Mental health impairment scores among acne patients are higher than other chronic, non-psychiatric medical conditions.  One explanation is the association exists because of acne (how visible it is, acne causing low self-esteem, negative body image, etc).  However, despite clinical success with acne, measurements of depression, mood and quality of life remain unchanged.  One study even found mood scores declined following clinical improvement [12] 

Some researchers speculate that there’s an ‘acne personality’ that precedes acne and increases the likelihood of stress reactivity, anxiety and depression [12].  Stress is a common trigger for depression and acne 

People often say chronic stress is harmful but rarely explain how.  I’ve previously mentioned that chronic stress increases pro-inflammatory cytokine release in the hippocampus and can cause glucocorticoid resistance, two mechanisms that promote depression (glucocorticoid resistance probably is a factor in other inflammatory diseases as well).  From researching these acne posts I’ve come across a few others: 

  • Dysbiosis.  If you recall from the previous post, many people with acne have altered gut bacteria in particular Bacteriodes, which are associated with stress [12].  Dysbiosis promotes a pro-inflammatory immune profile (high T helper cells, low T regulatory cells
  • Substance P.  One of the main functions of substance P is to be a neurotransmitter that signals pain.  Stress increases substance P and substance P promotes a hyperinflammatory immune response and increases sebum production [12]
  • Prolactin.  See above 

Acne and depression share other similarities besides stress.  People with acne or depression tend to have lower SOD enzymes, lower glutathione peroxidase activity, elevated MDA, and lower levels of zinc and selenium (minerals for antioxidant enzymes).  Also, vitamins A, C and D and zinc (especially zinc for both) can be therapeutic for both acne and depression* [13] 

“It may be the case that certain acne-prone individuals, or a subset of acne patients, are primed for lipid peroxidation long before depression and acne become clinically apparent” [13] 

* Although I suspect most chronic diseases would show signs of elevated oxidative stress and would also benefit from vitamins A, C and D and zinc

8 comments:

  1. Hi Steven,

    I find your post very interesting as someone who has only recently broke out in acne. I would love to chat to you a bit more about it and maybe even get some advice on how to get rid of it or what may help.

    Thanks,

    Andrew

    ReplyDelete
    Replies
    1. Hi Andrew, feel free to contact me at stevenhamley@gmail.com. Just remember that I'm not an expert, nor do I have any clinical experience

      Delete
  2. Steve
    Think my 23 year old daughter may suffer from some of this. Her skin is always bad.
    I have taken her to a integrative physician . She wants her to take vitex before checking other labs and I'm hesitant. We have put her on low sugar , no dairy diet.
    Also began probiotics by metagenics and supplement with zinc.
    I think her prolactin and iron levels should be checked as well as cortisol before mucking up the lh/fsh in brain. What are your thoughts??
    Sharon from florida

    ReplyDelete
    Replies
    1. Hi Sharon, there shouldn't be any harm in checking those if you have the means to do so, and then the result - whether positive or negative - can inform treatment.

      Delete
  3. Steve
    Think my 23 year old daughter may suffer from some of this. Her skin is always bad.
    I have taken her to a integrative physician . She wants her to take vitex before checking other labs and I'm hesitant. We have put her on low sugar , no dairy diet.
    Also began probiotics by metagenics and supplement with zinc.
    I think her prolactin and iron levels should be checked as well as cortisol before mucking up the lh/fsh in brain. What are your thoughts??
    Sharon from florida

    ReplyDelete