Menopause Live (13 June, 2011) from IMS

Leitch and colleagues [1] have recently reported the results of a survey performed in a group of women attending a specialist menopause clinic in Edinburgh. The aims of the study were to establish the current prevalence of skin disorders in a group of peri- and postmenopausal women and to investigate any perceived effects of hormone therapy (HT) on the skin. Women were invited to complete a short anonymous questionnaire. Respondents were asked about their age, the length of time since their last spontaneous menstrual period and whether they were taking HT or other medications. To establish the current prevalence of skin problems, respondents were asked to identify common skin problems that they had had in the past and to give their opinion as to whether these were influenced by the menopause, and whether they had been more or less troublesome, gone away altogether or only started at the time of the menopause. For those taking HT, they were asked if they had noticed any change in their skin problems since starting the therapy and were asked to rate their skin condition using a nine-point matching scale from ‘gone away completely’ to ‘much worse all the time’.

A total of 87 women responded (mean age 52 years, range 32–74 years; mean time from menopause 7.3 years, range 0–39 years). Sixty-two women (71%) were current or past users of HT. Fifty-six women (64%) reported one or more skin problems in the past: in 22 cases, the diagnosis was performed by a skin specialist, in 38 by their GP and in 46 it was self-diagnosed. Nearly half of the responders reported changes in the skin since the menopause, dry skin being the predominant complaint. The remaining half thought that their skin was not affected by menopause. Among those reporting on skin changes, 38% rated their skin problems as being more troublesome since menopause, 20% noted that new skin problems developed since menopause, but 18% felt their skin problems were resolved completely. Among the women taking HT, only 30% perceived a change in their skin related to treatment. Just over half of the respondents who rated their skin condition on a nine-statement scale thought their condition worsened, while the remaining women described their skin problems as better.

Comment
The rate of the skin aging process increases rapidly after the age of 50 years. Deterioration of the skin with age results from a combination of genetic and environmental factors, particularly sun exposure and smoking. For postmenopausal women, decreasing estrogen levels may play a role in skin aging. Lack of estrogen affects several skin functions such as elasticity, water-holding capacity, pigmentation and vascularity [2]. Therefore, common skin changes associated with menopause include: dryness, loss of firmness and elasticity, fine wrinkling and poor wound healing. An important parameter of skin aging is skin thickness, reflecting the status of the collagen tissue. The declining content of collagen and elastic fibers is related to menopause age, but not to chronological age. Approximately 30% of skin collagen (both type I and type II) is lost in the first 5 years after menopause, and estrogen may reverse this trend. Several studies have shown the beneficial effects of HT on collagen content and skin thickness and other parameters of skin aging [3]. However, contradictory results were obtained in the some double-blind, placebo-controlled studies. While positive effects were documented at various skin sites at the end of 7 months’ standard-dose, oral therapy in 40 postmenopausal women [4], a low-dose, oral hormone formulation given for 48 weeks in 485 participants did not show any statistically significant benefit in patients with mild to moderate facial skin aging changes [5]. The effects of estrogen on the skin need, therefore, further elucidation and are still controversial. Obviously, HT cannot be recommended solely for the treatment of skin aging in menopausal women.

Debora Yankelevich
Climacteric Unit, Hospital de Clinicas, Universidad de Buenos Aires, Argentina

References
1. Leitch C, Doherty V, Gebbie A. Women’s perceptions of the effects of menopause and hormone replacement therapy on skin. Menopause Int 2011;17:11–13.
http://www.ncbi.nlm.nih.gov/pubmed/21427418
2. Verdier-Sevrain S. Effect of estrogens on skin aging and the potential role of selective estrogen receptor modulators. Climacteric 2007;10:289-97.
http://www.ncbi.nlm.nih.gov/pubmed/17653955
3. Hall G, Phillips TJ. Estrogen and skin: the effects of oestrogen, menopause, and hormone replacement therapy on the skin. J Am Acad Dermatol 2005;53:555–68.
http://www.ncbi.nlm.nih.gov/pubmed/16198774
4. 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;10:320-34.
http://www.ncbi.nlm.nih.gov/pubmed/17653959
5. Phillips TJ, Symons J, Menon S; HT Study Group. Does hormone therapy improve age-related skin changes in postmenopausal women? A randomized, double-blind, double-dummy, placebo-controlled multicenter study assessing the effects of norethindrone acetate and ethinyl estradiol in the improvement of mild to moderate age-related skin changes in postmenopausal women. J Am Acad Dermatol. 2008;59:397-404.
http://www.ncbi.nlm.nih.gov/pubmed/18625536