International Journal of Dermatology, Vol. 35, No. 9, September 1996
PHARMACOLOGY AND THERAPEUTICS JOLANTA B. SCHMIDT, M.D., MARTINA BINDER, M.D., GABRIELE DEMSCHIK, M.D., CHRISTIAN BIEGLMAYER, PH.D., AND ANGELIKA REINER, M.D. Conclusions. Both estrogen compounds were found to be highly
Background. The coincidence of climacteric symptoms and the
effective in preventing or treating skin aging in peri-menopausal
beginning of skin aging suggests that estrogen deficiency may be a
women, clinically, by measurement data, and by an increase in
common and important factor in the perimeno-pausal woman. Often
hormones have been considered important in endogenous aging of
the skin, but their role has not been clearly defined. Therefore, we
investigated, whether topical treatment of the skin with estrogen
Topical tretinoin was the first substance with which
could reverse some of the changes in the aging skin.
significant improvements of skin appearance1 could be correlated with histologic and in vitro findings.2"4 Tretinoin
Materials and Methods. The effects of 0.01% estradiol and 0.3%
is a very effective agent against solar radiation-induced
estriol compounds were compared in 59 preclimac-teric women
exogenous skin aging.5 In contrast, so far no agents were
with skin aging symptoms. Monthly determinations of estradiol
found to be effective in endogenous aging. Although
(E2), follicle-stimulating hormone (FSH), and prolactin (PRL) were
hormones often were considered as important factors in
done and the monthly clinical monitoring was supplemented by
endogenous skin aging, the scient i f i c background of a
measurements of skin hydration by corneometry and profilometry.
hormonal role in the aging processes of the skin still
In 10 patients, skin biopsies were taken for immunohistochemical
determination of collagen types I and III.
In gynecology, the therapeutic effects of topical es-
trogens on atrophy of the vaginal and vulvar epithelia have
Results. After treatment for 6 months, elasticity and firmness of
been well described for many years.6,7 During the past
the skin had markedly improved and the wrinkle depth and pore
years, estrogen supplementation of the climacteric woman
sizes had decreased by 61 to 100% in both groups. Furthermore,
has opened new aspects on the wide variability of estrogen
skin moisture had increased and the measurement of wrinkles
effects in various tissues. Beneficial effects on serum
using skin profilometry, revealed significant, or even highly
cholesterol,8 on vascular actions in context with the
significant, decreases of wrinkle depth in the estradiol and the
myocardial infarction rate,9 and improvement and
estriol groups, respectively. Onimmunohistochemistry, significant
prevention of osteoporosis10 are only some of the
increases of Type III collagen labeling were combined with
increased numbers of collagen fibers at the end of the treatment
In skin tissue—an active target site of estrogens as
period. As to hormone levels, only those of PRL had increased
shown by estrogen receptor determinations
significantly and no systemic hormonal side effects were noted.
gens increase vascularization and show effects at various
levels of dermal tissue. Improvement of the structure of
From the Department of Dermatology, Division of Special and
elastic fibers after use of estriol cream13 has been described.
Environmental Dermatology, University of Vienna Medical
Furthermore, increases of acid mucopolysaccharides and of
School, Vienna, Austria; the Institute for Medical and
hyaluronic acid14'1;> augment the dermal water content.
Chemi-al Laboratory Diagnostics, Department of Hormone
Distinct trophic effects of estrogen compounds—and also of
Analysis, pretsiry of Vienna, Vienna, Austria; and the Institute
estriol—on vaginal atrophy by increasing the maturation
of Qmcal Pathology, University of Vienna, Vienna, Austria.
index associated with an increase of the number of superficial epithelial cells, support the epithelial actions of
ifctss for correspondence: Jolanta B. Schmidt, M.D.,
De-ranmcnt of Dermatology, Division of Special and
These actions of estrogens prompted us to investigate
Environ-j Kntal Dermatology, University of Vienna Medical
whether topical estrogen treatment of the skin could reverse
School, Wahringer Giirtel 18-20, A-1090 Vienna, Austria.
aging symptoms in estrogen-deficient women. In a preliminary study, the effects of a 0.3% topical estriol compound on the facial skin of climacteric women had been investigated17 and compared
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International Journal of Dermatology, Vol. 35, No. 9, September 1996
PHARMACOLOGY AND THERAPEUTICS