Top

American Journal of Clinical Dermatology

Published in:

01-06-2003 | Current Opinion

Skin Aging and Menopause

Implications for Treatment

Authors: Nicholas J. Raine-Fenning, Prof. Mark P. Brincat, Yves Muscat-Baron

Published in: American Journal of Clinical Dermatology | Issue 6/2003

Abstract

The skin is one of the largest organs of the body, which is significantly affected by the aging process and menopause. The significant changes sustained by the skin during the menopause are due to the effect sustained on the skin’s individual components.

The estrogen receptor has been detected on the cellular components of the skin. Accordingly, dermal cellular metabolism is influenced by the hypoestrogenoemic state of menopause leading to changes in the collagen content, alterations in the concentration of glycoaminoglycans and most importantly the water content. Consequently changes in these basic components leads to an alteration in function compatible with skin aging.

Changes in the skin collagen leads to diminished elasticity and skin strength. Collagen content may be measured by various methods such as direct skin biopsy, skin blister assessment for collagen markers and skin thickness measurement. All these variables indicate a reduction in collagen content following menopause. This may be reversed with the administration of estrogen given both topically and systemically.

A reduction in hydrophilic glycoaminglycans leads to a direct reduction in water content, which influences the skin turgor. These effects on glycoaminoglycans, due to the hypoestrogenia, have been clearly shown in animal studies and appeared to be rapidly reversed with the application of estrogens. The sum total of these basic effects on the skin leads to wrinkles, the skin condition typifying skin aging.

Structures resident in the skin are likewise influenced by menopause. Changes to the cutaneous vascular reactivity are noted following menopause. Capillary blood flow velocity decreases significantly in postmenopausal women. Postmenopausal flushing is due to profound vasodilatation in the dermal papillae. Hair growth is also influenced by the hormonal milieu and consequently hair loss has been associated with the beginning of menopause.

Treatments administered for menopause, in particular hormone replacement therapy, appear to alter its effects on the basic components of the skin as well as the more complex structures residing in the skin, consequently retarding the skin aging process.

Raine-Fenning NJ, Sant RA, Brincat MP. HRT in the new millennium. Contemp Clin Gynecol & Obstets 2001; 1 (1): 7–23

Nelson LR, Bulun SE. Estrogen production and action. J Am Acad Dermatol 2001; 45: S116–S124PubMedCrossRef

Punnonen R, Lovgren T, Kouvonen I. Demonstration of estrogen receptors in the skin. J Endocrinol Invest 1980; 3 (3): 217–221

Alberts B, Bray D, Lewis J, et al. Molecular biology of the Cell. 3rd ed. New York: Garland Publishing Inc, 1994

Jemec GB, Bhogal BS, Wojnarowska F. Are acquired nevi oestrogen-dependent tumours? Acta Derm Venereol 1987; 67 (5): 451–453PubMed

Jemec GB, Wojnarowska F. The distribution of p29 protein in normal human skin. Br J Dermatol 1987; 117 (2): 217–224PubMedCrossRef

MacLean AB, Nicol LA, Hodgins MB. Immunohistochemical localization of estrogen receptors in the vulva and vagina. J Reprod Med 1990; 35 (11): 1015–1016PubMed

Schmidt JB, Lindmaier A, Spona J. Hormone receptors in pubic skin of premenopausal and postmenopausal females. Gynecol Obstet Invest 1990; 30 (2): 97–100PubMedCrossRef

Albright F, Bloomberg E, Smith PH. Postmenopausal osteoporosis. Trans Assoc Am Physicians 1940; 55: 298–305

10.

McConkey B, Fraser GR, Bligh AS, et al. Transparent skin and osteoporosis. Lancet 1963; I: 693–695CrossRef

11.

Brincat M, Moniz CJ, Studd JW, et al. Long-term effects of the menopause and sex hormones on skin thickness. Br J Obstet Gynaecol 1985; 92 (3): 256–259PubMedCrossRef

12.

Rauramo L, Punnonen R. Effect of oral estrogen treatment with estriol succinate on the skin of castrated women. Z Haut Geschlechtskr 1969; 44 (13): 463–470PubMed

13.

Punnonen R. On the effect of castration and peroral estrogen therapy on the skin. Acta Obstet Gynecol Scand 1971; 9 Suppl. 9: 32

14.

Pierard-Franchimont C, Cornil F, Dehavey J, et al. Climacteric skin ageing of the face: a prospective longitudinal comparative trail on the effect of oral hormone replacement therapy. Maturitas 1999; 32: 87–93PubMedCrossRef

15.

Tan CY, Statham B, Marks R, et al. Skin thickness measurement by pulsed ultrasound: its reproducibility, validation and variability. Br J Dermatol 1982; 106 (6): 657–667PubMed

16.

Haapasaari KM, Raudaskoski T, Kallioinen M, et al. Systemic therapy with estrogen or estrogen with progestin has no effect on skin collagen in postmenopausal women. Maturitas 1997; 27: 153–162PubMedCrossRef

17.

Chen L, Dyson M, Rymer J, et al. The use of high frequency diagnostic ultrasound to investigate the effect of hormone replacement therapy on skin thickness. Skin Res Technol 2001; 7: 95–97PubMedCrossRef

18.

Maheux R, Naud F, Rioux M, et al. A randomized, double-blind, placebocontrolled study on the effect of conjugated estrogens on skin thickness. Am J Obstet Gynecol 1994; 170 (2): 642–649PubMed

19.

Black MM, Bottoms E, Shuster S. Skin collagen content and thickness in systemic sclerosis. Br J Dermatol 1970; 83 (5): 552–555PubMedCrossRef

20.

Shuster S, Black MM, McVitie E. The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol 1975; 93 (6): 639–643PubMedCrossRef

21.

Brincat M, Moniz CF, Studd JW, et al. Sex hormones and skin collagen content in postmenopausal women. Br Med J (Clin Res Ed) 1983; 287 (6402): 1337–1338CrossRef

22.

Sauerbronn A VD, Fonseca AM, Bagnoli VR, et al. The effects of systemic hormonal replacement therapy on the skin of postmenopausal women. Int J Gynaecol Obstet 2000; 68: 35–41PubMedCrossRef

23.

Oikarinen A. Systemic estrogens have no conclusive beneficial effect on human skin connective tissur. Acta Obstet Gynaecol Scand 2000; 79: 250–254CrossRef

24.

Savvas M, Bishop J, Laurent G, et al. Type III collagen content in the skin of postmenopausal women receiving oestradiol and testosterone implants. Br J Obstet Gynaecol 1993; 100 (2): 154–156PubMedCrossRef

25.

Brincat M, Versi E, O’Dowd T, et al. Skin collagen changes in post-menopausal women receiving oestradiol gel. Maturitas 1987; 9 (1): 1–5PubMedCrossRef

26.

Shahrad P, Marks R. A pharmacological effect of oestrone on human epidermis. Br J Dermatol 1977; 97 (4): 383–386CrossRef

27.

Holland EF, Studd JW, Mansell JP, et al. Changes in collagen composition and cross-links in bone and skin of osteoporotic postmenopausal women treated with percutaneous estradiol implants. Obstet Gynecol 1994; 83 (2): 180–183PubMed

28.

Brincat M, Moniz CF, Kabalan S, et al. Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement. Br J Obstet Gynaecol 1987; 94 (2): 126–129PubMedCrossRef

29.

Varila E, Rantala I, Oikarinen A, et al. The effect of topical oestradiol on skin collagen of postmenopausal women. Br J Obstet Gynaecol 1995; 102 (12): 985–989PubMedCrossRef

30.

Black MM, Shuster S, Bottoms E. Osteoporosis, skin collagen, and androgen. BMJ 1970; 4 (738): 773–774PubMedCrossRef

31.

Shuster S, Black MM, Bottoms E. Skin collagen and thickness in women with hirsuties. BMJ 1970; 4 (738): 772PubMedCrossRef

32.

Hall DA, Reed FB, Nuki G, et al. The relative effects of age and corticosteroid therapy on the collagen profiles of dermis from subjects with rheumatoid arthritis. Age Ageing 1974; 3 (1): 15–22PubMedCrossRef

33.

Danforth DN, Veis A, Breen M, et al. The effect of pregnancy and labor on the human cervix: changes in collagen, glycoproteins, and glycosaminoglycans. Am J Obstet Gynecol 1974; 120 (5): 641–651PubMed

34.

Grosman N, Hvidberg E, Schou J. The effect of oestrogenic treatment on the acid mucopolysaccharide pattern in skin of mice. Acta Pharmacol Toxicol 1971; 30 (5): 458–464CrossRef

35.

Lim SC, Caballero AE, Arora S, et al. The effect of hormonal replacement therapy on the vascular reactivity and ebdothelial function of healthy individuals and individuals with type 2 diabetes. J Clin Endocrinol Metab 1999; 84: 4159–4164PubMedCrossRef

36.

Arora S, Veves A, Caballaro AE, et al. Estrogen improves endothelial function. J Vasc Surg 1998; 27 (6): 1141–1146PubMedCrossRef

37.

Harvell J, Hussona-Saeed I, Maibach HI. Changes in transepidermal water loss and cutaneous blood flow during the menstrual cycle. Contact Dermatitis 1992; 27 (5): 294–301PubMedCrossRef

38.

Haenggi W, Linder HR, Birkhaeuser MH, et al. Microscopic findings of the nail-fold capillaries: dependence on menopausal status and hormone replacement therapy. Maturitas 1995; 22 (1): 37–46PubMedCrossRef

39.

Brooks EM, Morgan AL, Pierzga JM, et al. Chronic hormone replacement therapy alters thermoregulatory and vasomotor function in postmenopausal women. J Appl Physiol 1997; 83 (2): 477–484PubMed

40.

Ginsburg J, Hardiman P, O’Reilly B. Peripheral blood flow in menopausal women who have hot flushes and in those who do not. BMJ 1989; 298 (6686): 1488–1490PubMedCrossRef

41.

Brincat M, de Trafford JC, Lafferty K, et al. Peripheral vasomotor control and menopausal flushing: a preliminary report. Br J Obstet Gynaecol 1984; 91 (11): 1107–1110PubMedCrossRef

42.

Brincat M, Kabalan S, Studd JW, et al. A study of the decrease of skin collagen content, skin thickness and bone mass in the postmenopausal woman. Obstet Gynaecol 1987; 70: 840–845

43.

Affinito P, Palomba S, Sorrentino C, et al. Effects of postmenopausal hypoestrogenism on skin collagen. Maturitas 1999; 33: 239–247PubMedCrossRef

44.

Shah MG, Maibach HI. Estrogen and skin: an overview. Am J Clin Dermatol 2001; 2: 143–150PubMedCrossRef

45.

Varila E, Sievanen H, Vuori I, et al. Limited value of ultrasound measured skin thickness in predicting bone mineral density in peri- and postmenopausal women. Maturitas 1995; 21 (1): 45–49PubMedCrossRef

46.

Shelley WB, Shelley ED, Talanin NY, et al. Estrogen dermatitis. J Am Acad Dermatol 1995; 32 (1): 25–31PubMedCrossRef

47.

Leylek OA, Unlu S, Ozturkcan S, et al. Estrogen dermatitis. Eur J Obstet Gynecol Reprod Biol 1997; 72 (1): 97–103PubMedCrossRef

48.

Kim KH, Yoon TJ, Oh CW, et al. A case of estrogen dermatitis. J Dermatol 1997; 24 (5): 332–336PubMed

49.

Paquet F, Pierard-Franchimont C, Fumal I, et al. Sensitive skin at menopause; dew point and electrometric properties of the stratum corneum. Maturitas 1998; 28 (3): 221–227PubMedCrossRef

50.

O’Neill S, Kirkegard Y. An Australian experience of transdermal oestradiol patches in a subtropical climate. Aust N Z J Obstet Gynaecol 1993; 33 (3): 327–329PubMedCrossRef

51.

McCarthy T, Dramrusic V, Ratnam S. Use of two types of estradiol-releasing skin patches for menopausal patients in a tropical climate. Am J Obstet Gynecol 1992; 166 (6 Pt 2): 2005–2010PubMed

52.

Corson SL. Clinical experience with Systen, a new transdermal form of hormone replacement therapy. Int J Fertil Menopausal Stud 1993; 38 Suppl. 1: 36–44PubMed

53.

Wallace ML, Smoller BR. Estrogen and progesterone receptors in androgenic alopecia versus alopecia areata. Am J Dermatopathol 1998; 20 (2): 160–163PubMedCrossRef

54.

Oh HS, Smart RC. An estrogen receptor pathway regulates the telogen-anagen hair follicle transition and influences epidermal cell proliferation. Proc Natl Acad Sci USA 1996; 93 (22): 12525–12530PubMedCrossRef

55.

Kossard S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris. J Am Acad Dermatol 1997; 36 (1): 59–66PubMedCrossRef

56.

Schmidt JB, Binder M, Macheiner W, et al. Treatment of skin ageing symptoms in perimenopausal females with estrogen compounds: a pilot study. Maturitas 1994; 20 (1): 25–30PubMedCrossRef

57.

Anttinen H, Orava S, Ryhanen L, et al. Assay of protocollagen lysyl hydroxylase activity in the skin of human subjects and changes in the activity with age. Clin Chim Acta 1973; 47 (2): 289–294PubMedCrossRef

58.

Henry F, Pierard-Franchimont C, Cauwenbergh G, et al. Age-related changes in facial skin contours and rheology. J Am Geriatr Soc 1997; 45 (2): 220–222PubMed

59.

Dunn LB, Damesyn M, Moore AA, et al. Does estrogen prevent skin aging? Results from the First National Health and Nutrition Examination Survey (NHANES I). Arch Dermatol 1997; 133 (3): 339–342PubMedCrossRef

60.

Pierard GE, Letawe C, Dowlati A, et al. Effect of hormone replacement therapy for menopause on the mechanical properties of skin. J Am Geriatr Soc 1995; 43 (6): 662–665PubMed

61.

Sator PG, Schmidt JB, Sator MO, et al. The influence of hormone replacement therapy on skin ageing: a pilot study Maturitas 2001; 39: 43–55

62.

Castelo-Branco C, Figueras F, Martinez de Osaba MJ, et al. Facial wrinkling in postmenopausal women: effects of smoking status and hormone replacement therapy. Maturitas 1998; 29 (1): 75–86PubMedCrossRef

63.

Ramamrurthy NS, McClain SA, Pirila E, et al. Wound healing in aged normal and ovariectomised rats: effects of chemically modified doxycycline (CMT-8) on MMP expression and collagen synthesis. Ann NY Acad Sci 1999; 878: 720–723

64.

Pirila E, Ramamrurthy N, Maisi P, et al. Wound healing in ovariectomised rats: effects of chemically modified tetracyclinr (VMT -8) and estrogen on matrix metalloproteinases-8, -13 and type I collagen expression. Curr Med Chem 2001; 8: 281–294PubMedCrossRef

65.

Ashcroft GS, Greenwelk-Wild T, Horan MA, et al. Topical estrogen accelerates cutaneous wound healing in aged humans associated with an altered inflammatory response. Am J Pathol 1999; 155: 1137–1146

66.

Ashcroft GS, Dodsworth J, van Boxtel E, et al. Estrogen accelerates cutaneous wound healing associated with an increase in TGF-betal levels. Nat Med 1997; 3 (11): 1209–1215PubMedCrossRef

67.

Schmidt JB, Binder M, Macheiner W, et al. New treatment of atrophic acne scars by iontophoresis with estriol and tretinoin. Int J Dermatol 1995; 34 (1): 53–57PubMedCrossRef

Title: Skin Aging and Menopause
Implications for Treatment
Authors: Nicholas J. Raine-Fenning
Prof. Mark P. Brincat
Yves Muscat-Baron
Publication date: 01-06-2003
Publisher: Springer International Publishing
Published in: American Journal of Clinical Dermatology / Issue 6/2003
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.2165/00128071-200304060-00001

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Skin Aging and Menopause

Implications for Treatment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2003

Thalidomide in Cutaneous Lupus Erythematosus

Mycosis Fungoides with Follicular Mucinosis Displaying Aggressive Tumor-Stage Transformation

Progress in the Understanding of the Pathology and Pathogenesis of Cutaneous Drug Eruptions

Management of Polymorphous Light Eruption

Cutaneous Drug Reaction Case Reports

A Guide to Selection and Appropriate Use of Macrolides in Skin Infections