Uses of Estrogen in Treating the Skin
The population of women in the United States, and much our our collective client base, is aging. In 2018 the US Census Bureau reported that:
Lower fertility and increased longevity have led to the rapid growth of the older population across the world and in the United States. In 2015, among the 7.3 billion people estimated worldwide, 617.1 million (9 percent) were aged 65 and older. By 2030, the older population will be about 1 billion (12 percent of the projected total world population) and by 2050, 1.6 billion (17 percent) of the total population of 9.4 billion will be 65 and older. This rapid growth of the older population contrasts with an almost flat youth population (under age 20) and moderate increase in the working age (aged 20 to 64) population projected over the same period.
The same report detailed that this is a trend, not just in the U.S., but around the globe. And with 51 percent of the population being women (even more with the aged population) there are a lot of women whose natural estrogen is depleting. This has an effect on their skin. Beyond just aging women, estrogen may help many different skin issues. And while the research pool on this topic is less robust than in many others that TSLMS members deal with, the body is growing in recent years.
Estrogen and the Skin
As early as 2001, the National Institutes of Health were reporting on the intersection between estrogen and skin. They noted that doctors and scientists were noticing some pretty remarkable things:
As the population of postmenopausal women increases, interest in the effects of estrogen grows. The influence of estrogen on several body systems has been well-documented; however, one area that has not been explored is the effects of estrogen on skin. Estrogen appears to aid in the prevention of skin aging in several ways. This reproductive hormone prevents a decrease in skin collagen in postmenopausal women; topical and systemic estrogen therapy can increase the skin collagen content and therefore maintain skin thickness. In addition, estrogen maintains skin moisture by increasing acid mucopolysaccharides and hyaluronic acid in the skin and possibly maintaining stratum corneum barrier function. Sebum levels are higher in postmenopausal women receiving hormone replacement therapy. Skin wrinkling also may benefit from estrogen as a result of the effects of the hormone on the elastic fibers and collagen. Outside of its influence on skin aging, it has been suggested that estrogen increases cutaneous wound healing by regulating the levels of a cytokine. In fact, topical estrogen has been found to accelerate and improve wound healing in elderly men and women. The role of estrogen in scarring is unclear but recent studies indicate that the lack of estrogen or the addition of tamoxifen may improve the quality of scarring.
Initially, and for about a decade thereafter, dermatologists did not respond overwhelmingly positively to estrogen’s uses in skincare, as noted in the 2009 article by the American Academy of Dermatology Association, Estrogen Getting Cool Reception From Dermatologists for Mixed Results in Improving Appearance of Skin. Notably, the positive impact of naturally occurring estrogen on the skin was cited:
Estrogens are a group of hormones that play a key role in regulating many aspects of a woman’s overall health, including reproduction. Certain parts of the body contain cells that are more receptive to the effects of estrogen than others, including the face… estrogens benefit the skin in many ways, including an increase in collagen content, water retention and elasticity. During pregnancy when estrogen levels are at their highest, women experience thicker hair and glowing skin. On the other hand, post-menopausal women may notice that their skin does not have the same elasticity as it once did and that it is drier than normal.
Current Knowledge: Estrogen and the Skin
A recent publication by the University of Rochester Medical Center indicates what a lot of us already know: estrogen products can help the skin.
In menopause, as estradiol levels decline, skin thickness decreases by over 1% each year for the first five years, while collagen decreases yearly by 2%. Wrinkles are caused by a reduction in elasticity secondary to loss of connective tissue which decreases 1.5% each year. Why is the face preferentially involved? Estrogen receptors are higher in the face than in the breast or thigh.
Are these skin changes reversible with estrogen supplementation? In one study, Premarin® cream, applied to the face for 24 months, produced significant increases in skin thickness and decreases in wrinkles. In a different study, 0.01% estradiol and 0.3% estriol for six months produced no changes in systemic hormone status, but both increased skin elasticity, skin moisture, firmness, and reduced wrinkles.
Interestingly, there is a growing amount of treatments and products coming on the market that can help so many of the women we see all the time.
Latest and Greatest in Estrogen Treatments
There are plenty of brand names of estrogen treatments; but what we now fully medically understand about them is that estrogen can be absorbed directly through the skin. This means that almost any cream, lotion, serum, or even injectable can have estrogen added to it and become a better product.
Estrogen is one of the topics of discussion at SCALE2019 Music City and something that you can expect us all to be paying a lot of attention to in the short and the long term.