Skin Disorders During Menopause
Menopause is the cessation of menstrual periods due to the loss of ovarian function. Among the various phases of a woman’s life, menopause has the greatest impact on health and has been one of the most neglected areas of research. Hormonal changes caused by menopause can lead to problems in the skin and its annexes, and despite the high frequency of dermatologic signs and symptoms, studies on this topic are limited. In this article, we review the skin disorders that result from the hormonal changes of menopause and other common dermatoses observed during this period and assess possible therapeutic approaches.
Practice Points
- Frontal fibrosing alopecia may respond to finasteride or dutasteride.
- Acute and chronic telogen effluvium may be associated with iron deficiency, mostly related to malabsorption or chronic gastrointestinal bleeding, during perimenopause.
- Oral and topical isoflavones may reduce skin aging in menopausal women.
- The use of estrogens as hormone replacement therapy in menopausal women promotes an increase in skin thickness and/or collagen content.
Treatment of Skin Disorders in Menopausal Women
Classic HRT
Several studies have used histologic analysis or ultrasonography to show that estrogens used in HRT thicken the skin or increase collagen content, whether given orally, topically, or transdermally.71-75 In a randomized, double-blind study comparing topical estrogen versus glycolic acid, 6 months of estrogen use on only one side of the face promoted a 23% increase in epidermal thickness (P=.00458), and the use of glycolic acid stimulated a 27% increase (P=.00467). The combined use of estrogen and glycolic acid prompted a 38% increase in epidermal thickness (P=.000181), with significant differences observed for all groups compared with the controls for the reversal of histologic markers of skin aging.76
,Finally, collagen synthesis also is increased as inferred by the increase in procollagen type I and II terminal peptides.75 Hormone replacement therapy also affects the skin’s ability to retain water and leads to a reduction in skin wrinkling; however, the effects of HRT on dyschromic alterations have not been well studied.77 The numerous adverse effects of HRT, such as an increased incidence of cancer and cardiovascular morbidity, limit its use.
Isoflavones
Estrogen use is capable of causing morphologic changes in the aged skin of menopausal women.19,77 Given that HRT is contraindicated for some women and can cause adverse effects or pose unacceptable risks for others, Accorsi-Neto et al15 studied the possibility of achieving the beneficial effects of estrogen with plant hormones. Oral isoflavones given to rats that had been irradiated with UV light inhibited the increased expression of UV-induced metalloproteinases, reducing collagen degradation.78
Among the phytoestrogens, genistein, an isoflavone, is notable for its selectivity, with a high affinity for estrogen receptor β and low affinity for estrogen receptor α, which is found in the uterus and breasts. Accorsi-Neto et al15 assessed whether soy isoflavones also would reduce skin aging in women, as observed in the aforementioned rat study. After 6 months of using 100 mg of concentrated soy extract daily, the investigators noted increased thickness of the dermis and epidermis, increased dermal vasculature, an increased number of collagen and elastic fibers, and an increased papillary index. In rats, genistein increases antioxidant enzymes, such as superoxide dismutase, catalase, and glutathione.78,79 Topical phytoestrogens also were evaluated, with promising results for increased skin thickness. In animals, the use of isoflavones also offers protection against carcinogenesis in sun-damaged skin.15
Some investigators believe that a better understanding of the mechanism of action and possible side effects of phytoestrogens is essential to allow their use as a promising antiaging alternative.80 There is no evidence that estrogens (eg, HRT) possess antioxidant or photoprotective properties.78 Moreover, it is possible that new selective estrogen receptor modulators will specifically affect the skin without the expected systemic effects of existing estrogens.80
Conclusion
Although often overlooked, skin disorders are quite common during menopause. Understanding the physiology of this important period in a woman’s life is essential for developing an early and effective preventive therapeutic approach. Use of sunscreens has been questioned due to a concern about osteoporosis, but studies have not shown a connection between sunscreen use and reduced VD levels. Intentional sun exposure should not be considered a source of VD; instead, recommend dietary or artificial supplementation. Although studies have shown HRT to positively affect wound healing, reduce signs of aging, increase hydration, and yield other benefits, its use is not recommended for treating skin disorders. Isoflavones could be promising alternatives to estrogen; however, further studies are needed before their use can be recommended.
