How Does Addison's Disease Affect the Skin?

Addison's disease affects the skin in several ways including hyperpigmentation and vitiligo.

Addison’s disease is a rare and serious condition involving the adrenal glands. These glands sit above the kidneys and make hormones like cortisol and sex hormones. 

In most cases, Addison’s is an autoimmune disease. Autoimmune disease occurs when the immune system doesn’t recognize the body’s own tissues and cells and begins to attack itself. In the case of Addison’s disease, the body specifically attacks the adrenals, causing damage to the glands.

As a result, the glands don’t make enough cortisol and aldosterone, a steroid hormone that regulates salt and water balance.

The low level of cortisol triggers the release of another hormone called adrenocorticotropic hormone (ACTH). High ACTH leads to high levels of melanin, the chemical that gives skin its color and causes skin discoloration known as hyperpigmentation.

Addison’s disease usually progresses slowly and isn’t recognized until another illness or intense stress suddenly makes it worse. This can lead to a delayed diagnosis. 

There are several Addison’s disease symptoms, which include:

Hyperpigmentation

The appearance of dark patches on the skin is a common symptom of Addison’s disease. The discoloration develops over a variety of areas, including:

• Scars
• Elbows, knees, and joints
• Skin folds
• Mucous membranes in the mouth and nose
• Tongue and gums
• Genitals and rectum

Dark patches usually develop first in the mouth and gums, along with blue-black patches across the genitals and rectum, before they appear across the body.

Vitiligo

Vitiligo is an autoimmune disease that causes the skin to lose its color. Smooth white patches of skin appear as the immune system destroys the skin cells that make melanin. It may also affect hair color and the hair in the inner ear.

People with one autoimmune disease are more at risk of developing another. Because most cases of Addison’s disease are autoimmune, people with Addison’s disease may also develop vitiligo.

Other symptoms 

Addison’s disease usually includes other symptoms like:

• Extreme fatigue
• Weakness
• Weight loss
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Salt cravings
• Dehydration
• Low blood pressure
• Irritability 
• Dizziness

While most cases of Addison’s disease are autoimmune, anything that damages the adrenal glands can cause adrenal failure. Causes of adrenal gland damage include:

• Infections, including HIV, tuberculosis, and fungal infections
• Sepsis
• Surgical removal of the glands
• Cancer in the glands
• Bleeding in the glands
• Genetic mutations
• Amyloidosis, excess protein buildup in organs

Suddenly stopping steroid medications can also cause Addison’s disease.

With chronic low levels of cortisol, the adrenocorticotropic hormone is released and stays high, which causes high levels of melanin. Dark skin patches can then develop.

If dark patches appear across the skin — or if they appear on the inside of the mouth and gums, nose, or genitals — it’s time to see a doctor or dermatologist. Changes in the skin should be investigated. 

You should also see a dermatologist if white patches appear. These areas of the skin burn easily, and a doctor can monitor skin changes as well as rule out other conditions. 

To determine if you have Addison’s disease, your doctor may perform some of the following:

Physical examination

Your doctor may take your blood pressure, record your weight, and review your symptoms and history. They will also examine any dark patches on the skin. 

Blood tests

Your doctor will order tests to find the levels of adrenocorticotropic hormone, sodium, potassium, cortisol, and adrenal antibodies in your blood. 

ACTH stimulation test

This measures how the adrenal glands respond after taking a dose of adrenocorticotropic hormone. If the glands produce little cortisol after the medicine, they may not be working properly. A blood test will need to be done to measure cortisol levels. 

Imaging tests

Your doctor may use X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans to check for calcium deposits on, infection in, or damage to the glands.

Addison’s disease is serious and requires lifelong treatment. Your doctor may prescribe hormone medication like hydrocortisone to replace cortisol, and fludrocortisone acetate to replace aldosterone.

Hyperpigmentation 

The main treatment is medication to replace adrenal hormones. Over time, the hyperpigmentation may gradually fade, allowing the skin to return to its normal color.

Vitiligo 

Your doctor may prescribe steroid cream to treat the area. Sunscreen is also an important part of protecting vulnerable skin and maintaining skin health.