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Are Topical Estrogens Effective for Skin Aging?

Only where the sun doesn’t shine

Aging of the skin is caused by a combination of genetic factors (natural aging) and excessive sun exposure (photoaging). Natural aging appears as fine wrinkles, skin laxity, and sagging; photoaging produces coarse wrinkles. Both processes result, at least in part, from declines in types I and III collagen in the dermis. Topical medications that could restore the youthful appearance of skin are of great interest, and estrogen-containing creams have been suggested as potential candidates in this role. To test this theory, investigators examined the efficacy of topical estradiol on collagen production in 40 postmenopausal women (mean age, 75; range, 65–94).

After 1 week of therapy with topical estradiol, procollagen I and III synthesis and protein expression had increased as much as 3.25-fold in dermal fibroblasts in hip skin unexposed to the sun. Increases in procollagen I and III activity were also observed in 30 age-matched men, but their increases were smaller. Notwithstanding its effect on sun-protected skin, topical estradiol had no effect on collagen production in sun-exposed facial and forearm skin, even though the estradiol penetrated the skin, estrogen receptors were present in equal numbers in photoaged and sun-protected skin, and topical estradiol activated other genes in the skin.

Comment: Given the intense interest in creams that could reverse or prevent aging of the skin, patients will likely ask physicians about topical estrogens for this purpose. These findings showed that topical estradiol did not increase collagen production in the face and other sun-exposed skin. Additional manifestations of photoaging (such as uneven pigmentation and dry skin) might respond to an estrogen cream, but the long-term effects of topical estrogen are unknown, and other topical agents, such as retinoids and moisturizers, can address these problems. Systemic estrogens sometimes produce cutaneous telangiectasias and melasma, and topical formulations might do the same or have systemic effects. Are topical estrogens effective for skin aging? Based on the results of this study, the answer is no.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology November 7, 2008

Citation(s):

Rittié L et al. Induction of collagen by estradiol: Difference between sun-protected and photodamaged human skin in vivo. Arch Dermatol 2008 Sep; 144:1129.

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