Friday, December 14, 2007

Estrogen improves skin

In case you are wondering if I am an estrogen junkie, the answer is yes, but estrogen in balance. We know that excessive estrogen increases stroke, and synthetic estrogen with synthetic progesterone increases breast cancer and heart disease. But it also improves bones, prevents fractures, helps mood and libido, and now... improves skin! We all knew that but it's good to have a randomized controlled trial prove it.... SG

Sator PG, Sator MO, Schmidt JB, et al. A prospective,
randomized, double-blind, placebo-controlled study on
the influence of a hormone replacement therapy on skin
aging in postmenopausal women. Climacteric 2007;
10:320-334. Level of evidence: I.

Menopausal hormone therapy (HT) has a positive
effect on skin in postmenopausal women,
according to a prospective, randomized, double-
blind, placebo-controlled study that examined the
effect of treatment with Femoston for 7 months.
The trial included 40 women between ages 44
and 55 (mean age, 51.3 y). The mean duration of
amenorrhea was 46.6 months in the HT group
and 39 months in the placebo group. The women
received the HT, a combination of 2 mg 17β-
estradiol/10 dydrogesterone, for seven 28-day

Women in the study visited the blinded
investigators at screening, randomization, weeks
7 and 13 of treatment, and weeks 1 to 3 after
treatment. Skin properties were measured by
noninvasive measures. Skin elasticity, skin
surface lipids, skin hydration, and skin thickness
were measured at time of randomization, week
13 of treatment, and at 1 to 3 weeks after
treatment. Instruments used to measure skin
properties included the Sebumeter, the
Corneometer, and high-frequency ultrasound. In
addition, a clinical dermatological exam of skin
status was performed. After 7 months of HT,
there were significant improvements in skin
elasticity, skin hydration, and skin thickness. The
dermatological exam was in concordance with
these results.

Comment. The condition of the skin is one of the
most visible signs of aging and has been
especially important to women’s sense of
attractiveness. Ingestion or topical application of
hormones is not a new strategy for inhibiting
aging. Estrogen and progesterone were common
cosmetic additives until laws prohibited the
inclusion of ingredients that altered the structure
and function of the skin.1 The presence of
hormone receptors in the skin and the dermal
benefits of HT are well documented, primarily in
European studies.2-6 No doubt the results of this
study will be of interest to the growing sector of
the population that spends millions of dollars on
Botox therapy, cosmetic surgery, and antiaging
skin moisturizers—results of the successful
marketing of “looking younger” in the twenty-
first century.

This study by Sator et al reports the findings of a
small European study of the influence of an oral
HT preparation, Femoston (not marketed in the
United States), on aging skin. All 40 participants
were reported to have medically indicated
reasons for taking HT. Three women in each
group withdrew or were lost to follow-up, with a
resulting sample size of 34 women. The paper
includes numerous tables with detailed results of
multiple statistical comparisons between baseline
measures and comparable assessments at 3
months and 7 months post initiation of therapy.

Although there are numerous statistically
significant findings, the clinical significance,
given the small sample size, is not apparent. With
so many comparisons reported, there is a greater
chance of there being spurious statistically
significant findings. One important finding,
however, was that the skin benefits were more
pronounced in women who initiated HT close to
the date of their final menses. The authors note
that the success of the therapy is likely to be
directly related to the timing of initiation and
duration of treatment. Possible harmful side
effects of HT were not noted. The short duration
of the intervention (7 mo) is also a limitation. A
variety of questions about prescribing HT for
cosmetic or quality of life reasons were raised.

Both the US Food and Drug Administration
(FDA) and NAMS have clearly indicated that
until reliable evidence proves otherwise, we must
assume that the risks and benefits of all systemic
estrogens are the same. Clearly, women who are
prescribed HT for medically indicated reasons
may experience positive skin effects. But
prescribing systemic HT for the express reason of
skin benefits is not warranted. Local estrogen
therapies provide clear benefits to vaginal and
vulvar tissue. And, for women with extremely
dry, inelastic, and poorly hydrated skin, HT
would be the treatment of choice for improving
their quality of life. However, larger, double-
blinded, well-controlled studies of topical
therapies are needed before HT as an antiaging
skin therapy can be considered.

Catherine L. Juve, PhD, MPH, WHNP, RN
Professor, School of Nursing
University of Minnesota
Minneapolis, MN
Member, NAMS Professional Education Committee
1. Draelos ZD. Topical and oral estrogens revisited for
antiaging purposes. Fertil Steril 2005;84:291-292.
2. Patriarca MT, Goldman KZ, Dos Santos JM, et al.
Effects of topical estradiol on the facial skin collagen of
postmenopausal women under oral hormone therapy: a
pilot study. Eur J Obstet Gynecol Reprod Biol 2007;
3. Hall G, Phillips TJ. Estrogen and skin: the effects of
estrogen, menopause, and hormone replacement therapy
on the skin. J Am Acad Dermatol 2005;53:555-568.
4. Holzer G, Riegler E, Hönigsmann H, Farokhnia S,
Schmidt JB. Effects and side-effects of 2% progesterone
cream on the skin of peri- and postmenopausal women:
results from a double-blind, vehicle-controlled, randomized
study. Br J Dermatol 2005;153:626-634.
5. Brincat MP, Baron YM, Galea R. Estrogens and the
skin. Climacteric 2005;8:110-123.
6. Naftolin F. Prevention during the menopause is critical
for good health: skin studies support protracted hormone
therapy. Fertil Steril 2005;84:293-294.

1 comment:

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