The patient: “Laurel,” a 48-year-old librarian.

Why she came to see me: Laurel arrived with a complaint that at first seemed better-suited for a dermatologist. Lifting the sleeves of her shirt, she pointed to the red, bumpy, dry skin on her forearms before showing me a similar patch on the T-zone of her face. Both places were consistently, if not relentlessly, itchy. The irritation had turned from mild to severe in the past three months and while she’d tried a number of treatments—from CBD oil to a consult with one of the city’s top dermatologist’s—she hadn’t been able to find any relief. She was intent on determining the root cause of this flare…and she was equally keen on treating it naturally.

How I evaluated her: We began with a thorough exploration of Laurel’s medical history and lifestyle. Three years sober, Laurel prioritized health. She followed a low-fat diet, practiced Pilates five times a week and meditated daily. She’d also quit smoking eight years earlier—a gift to herself on her 40th birthday. She was in a steady, happy relationship, loved her job at the library downtown and felt pleased with her overall progress and place in life, which, she said, made her recent health concerns all the more vexing.

The itchiness had started out of the blue and was at first only felt on her forearms and above her elbows before traveling upwards to her face. She’d switched to a mild, natural laundry detergent and made a point to use only using chemical-free soaps, sunscreens and lotions. But the itchiness and redness grew from mild to severe and oftentimes delayed her ability to fall asleep, frequently woke her up in the middle of the night and served as something of a social embarrassment.

Probing deeper, I found that a number of other symptoms had also started to emerge in Laurel’s life, including insomnia, mood swings and difficulty maintaining her weight, particularly around her midsection. Her once-predictable periods had become irregular as well, arriving every other month or so. When they did show up, they were heavier and carried with them more intense and aggravating PMS symptoms.

While I assumed that these skin problems and other symptoms were associated with her age, I ordered a PAP smear, a blood test, a kidney exam and a thyroid test to rule out any underlining medical issues. In addition, I ordered a hormone test that would allow me to assess where she stood in terms of hormone production.

What my evaluation revealed: While Laurel’s PAP and other exams were clear, her hormone test revealed precisely what I expected: She was in perimenopause and, as such, demonstrated lowered hormone levels, particularly estrogen.

As I explained to Laurel, this was not necessarily cause for concern—it is completely normal for hormones to decline in the years leading up to a woman’s final period. (Men see a fall in hormones with age as well, FYI.) As the ovaries mature, they release fewer hormones, which leads to decreased amounts of estrogen as well as progesterone and testosterone. In turn, a woman may experience any one of the symptoms Laurel was enduring, as well as hot flashes, vaginal dryness, memory loss, incontinence and more.

The hormonal decline that accompanies the onset of menopause can also impact the skin. As estrogen drops, so does the skin’s capacity for holding water and keeping it elastic. Estrogen also plays a key role in shielding skin against oxidative stress and in stimulating collagen—an essential protein that profoundly influences skin health. This waning of estrogen can manifest as wrinkling, dry skin, pigmentary changes, photo-aging—and the very itchiness Laurel was lamenting. This itchiness, technically known as pruritus, may be irritating but, as I assured her, it’s neither grave nor a life sentence.

How I addressed her problem: I wanted to treat not only Laurel’s itchy skin but also the discomfiting symptoms that were taking a toll on her otherwise-ideal life.

Before she considered estrogen replacement therapy—which, as the National Institutes of Health (NIH) reports, has been implicated as “a risk factor in breast and uterine cancer”—I urged Laurel to alter her diet to include more phytoestrogens. These plant-based compounds, first discovered in the early 1920s by Bernhard Zondek (who also, incidentally, developed the first pregnancy test), can mimic estrogen in the body and thus help moderate hormones. To this end, I encouraged her to add the following foods to her diet: soy, hummus, tempeh, rye bread, flax and sesame seeds, dried fruit (such as prunes and apricots), alfalfa sprouts, yams and apples.

I also suggested she add cruciferous vegetables such as Brussels sprouts, broccoli and cauliflower to her grocery list as they organically bolster estrogen metabolism through their inclusion of indole-3-carbinol. Furthermore, I recommended adding healthy fats—salmon, avocado and walnuts, to name just a few—to her diet. Rich in Omega-3 fatty acids, these foods naturally strengthen the skin’s oil barrier, which is a crucial component to keeping skin hydrated (and itch-less). They also enhance the body’s production of anti-inflammatory compounds, further protecting the skin from aging and the itchiness that can arrive with it. Additionally, I persuaded Laurel to eat more grapes, which contain a particular phytoestrogen that brims with resveratrol and has powerful antioxidant (read: skin-boosting) properties.

I recommended cutting sugar from her diet entirely. Sugar causes insulin to spike, which may prompt inflammation and the itchiness and signs of aging that can come with it.

I then urged Laurel to start using sea buckthorn oil. Obtained from the sea buckthorn plant, this oil nurtures the health and beauty of skin through its balanced combination of fatty acids and vitamins and has the potential to treat dry, flaky or rapidly aging skin. (According to the NIH, sea buckthorn oil also “improves blood circulation, facilitates oxygenation of the skin, removes excess toxins from the body and easily penetrates through the epidermis.”) It can be taken as a supplement or applied topically in a face oil (one to try: Kora Organics Noni Glow Face Oil, a terrific product that also includes skin-soothing rosehip oil).

To achieve fast relief during a bout of itchiness, I advised her to take an oatmeal bath by adding a cup of colloidal oats to a warm, not hot, bath (heat can further dry out the skin), soaking for at least 10 minutes and locking in moisture with a thick, quality cream.

Finally, I encouraged Laurel to supplement with 1,000 mg per day of Vitamin C, which has been shown to help prevent dry, itchy skin, and with 500 mg twice a day of dong quai. Known to some as the “female ginseng,” dong quai is a revitalizing tonic that operates as a phytoestrogen and can support skin and hormone health.

The patient’s progress: Within a month, the patches of irritation on Laurel’s forearms and T-zone had diminished to little more than a few bumps. As a result, she was sleeping better and feeling more apt to socialize. What’s more, she reported less fatigue and fewer mood swings and, thanks to her diet, she’d shed the last five pounds she’d aimed to lose when she got sober.

Above all, she claimed to feel far less anxious—not only about her skin and its itchiness, but also about getting older. She felt emboldened and powerful, which, I explained to her, are the two best- and least-known “side effects” of aging.

To learn more, visit Dr. Laurie Steelsmith’s website,, or click her to read her most recent book, Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.

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