Hormone Replacement Therapy (HRT) and Its Effects on Skin Appearance

For many women, hormone replacement therapy (HRT) can alleviate the physical symptoms associated with the change of life. But despite the initial hype generated by post-menopausal women who noticed a marked improvement in their skin’s appearance while on HRT, dermatologists argue that scientific studies of estrogen do not show definitive improvements for skin rejuvenation of photodamaged skin and the potential risks when used long-term outweigh any potential skin benefits.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Margaret E. Parsons, MD, FAAD, assistant clinical professor of dermatology at the University of California at Davis in Sacramento, reviewed studies that demonstrate mixed results when examining whether or not estrogen improves the appearance of the skin and why patients should opt for tried-and-true cosmetic therapies instead.

“Based on the research conducted thus far, it does not appear that topical or oral estrogens are a viable long-term solution for improving sun-damaged or aging skin,” said Dr. Parsons. “In my practice, I do not prescribe estrogens for skin rejuvenation because of the lack of consistent data to support their use and the known risks of prolonged estrogen therapy – including an increased risk of breast cancer.”

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. Dr. Parsons noted that 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.

In order to treat the most common symptoms associated with menopause – including hot flashes, mood swings and vaginal changes – physicians often prescribe hormone replacement therapy (HRT) to boost the body’s estrogen levels that drop dramatically during this change of life. However, when the results of the Women’s Health Initiative (WHI) study were announced in 2002, the way HRT was viewed to treat post-menopausal women changed significantly. For example, the WHI study found that women on long-term HRT could be at an increased risk for breast cancer and that the overall health risks of this therapy could outweigh the possible benefits. From that point on, HRT was prescribed more conservatively with lower dosing options and individualization based on each woman’s own health history.

Since there were reports of some women on HRT noticing an improvement in their skin, studies were conducted to determine if these results could be validated. Dr. Parsons explained that results of multiple studies examining the relationship between estrogens and skin improvement were inconclusive.

For example, one study examined whether low-dose hormone therapy improved aging skin in 485 women who were on average five years post-menopausal. Published in the September 2008 issue of the Journal of the American Academy of Dermatology, the study concluded that estrogen supplementation did not provide any significant improvement in sun-damaged skin.

“Although this study found no obvious skin benefits in this particular group of women, another study that looked at women who began HRT at the onset of menopause – and did not wait to start treatment like the other group – did experience noticeable improvements in their skin,” said Dr. Parsons. “These
studies pose unanswered questions as to the timing and duration of prescribing HRT to produce skin benefits. For this reason, the jury is still out as to whether estrogens can be effective for aging skin.”

In addition, another study showed that applying topical estrogen to sun-damaged facial skin and sun-protected skin on the hip of post-menopausal women resulted in stimulated collagen production and less wrinkling in the sun-
protected hip skin, but no noticeable improvement in the sun-damaged facial skin.

Dr. Parsons added that more research will likely continue in the future to examine the possible benefits of estrogen for improving aging skin. Until then, she stressed that there are many effective therapies that dermatologists regularly use to address the common signs of aging – including retinoids, alpha-hydroxy acids and other topical therapies, as well as chemical peels, lasers, botulinum toxin and skin fillers, to name a few.

“The best advice I can offer my patients to improve their overall skin health is to wear sunscreen with a sun protection factor (SPF) of at least 30, don’t smoke and use a topical retinoid,” said Dr. Parsons. “When it comes to minimizing the cumulative effects of sun damage, an ounce of prevention really does go a long way.”

New “Fractional Laser” Reduces Wrinkles, Acne Scarring, Removes Tattoos

Plastic surgeons at UT Southwestern Medical Center are using a new kind of laser that penetrates deeper into the skin to reduce wrinkles, treat pigmentation differences, and tighten surface structures.

The FDA approved the laser for only two U.S. Centers to test for general patient use, of which UT Southwestern was one. Testing has been completed by UT plastic surgeons who are now using the new carbon dioxide-based fractional laser. It combines minute focused columns of laser-induced injury with heat disposition, which reduces skin damage and aids quicker recovery tme.

"Fractional lasers are like aerating your lawn, where you have a bunch of holes in your lawn, but you have normal lawn in between. This allows for more rapid healing because intact, normal skin bridges the gap between the laser-induced injured skin," said Dr. Jeffrey Kenkel, vice chairman of plastic surgery whose research involves the effects of lasers on tissue.

Dr. Kenkel, director of the Clinical Center for Cosmetic Laser Treatment and chief of plastic surgery at the Veterans Administration Medical Center at Dallas, said the technology potentially could be one of the last decade’s biggest advancements in the laser world.

"What’s appealing about carbon dioxide lasers is that not only can you get surface and deeper skin changes, but you get heat that’s deposited into the skin resulting in improvement in wrinkles and skin tightening," said Dr. Kenkel. "We evaluate the laser on tissue that has either been removed from patients or that we plan on removing so we can determine what effect it’s going to have before we start treating patients clinically."

This latest laser was made by Lumenis Device Technologies. It has a larg arm and two heads an can be used on a wide range of conitions—wrinkle removal, acne scarring, alleviating dark pigmentation, and other conditions. UT Southwestern has more than 200 lasers available, and is a world leader in offering patients laser treatment options.

The new laser treatments are office-based procedures done on an out-patient basis, but may require some local or regional anesthetic, with recovery time related to the type of procedure. In most instances recovery is between three and five days. Depending on what’s required, procedure costs can range from $500 to $3,000 and are usually considered cosmetic.

"There are a lot of patients who would rather not have surgery and who are looking for things to improve their appearance without surgical down time," Dr. Kenkel said. "In addition, there’s a whole group of younger patients who are looking for improvement who are not necessarily in need of surgery but perhaps would benefit from some of the lesser invasive procedures that we have to offer."

Americans spent more than $12 billion last year on cosmetic procedures, involving 11.5 million surgical and nonsurgical procedures, according to the American Society for Aesthetic Plastic Surgery. Nonsurgical procedures, which include laser treatments, accounted for about 83 percent of those procedures.

Source: UT Southwestern Medical Center

Tans Fade but Wrinkles are Forever – Slip, Slop, Slap

Sun damages skin—period.
The obvious trick in summer is to balance exposure to sun with protection from the harmful rays that cause skin damage and can lead to cancer. These rays are known as UVA and UVB rays, with UV standing for Ultra Violet.

Australian health authorities, alarmed by the skyrocketing rise of minor skin cancers and deadly skin melanomas have instituted a health campaign with the tag line: SLIP (on a shirt), SLOP (on sunscreen), and SLAP (on a hat).

Lets briefly look at the elements of the campaign.
SLOP: Many people tend to confuse the terms "sunblock" and "sunscreen". Sunblock fully blocks the rays of the sun and consists of such "blocks" as titanium and zinc oxides. They are extremely effective in blocking sunlight, but they also are colored and leave the wearer appearing like a character on the canvas of "Women of Avignon" by Picasso. Furthermore, they need to be reapplied after only a few hours.

Two sunscreens that have hit the stores this year, Heliolex and Anthelios SX provide significant protection against UVA (80%) and UVB (90%) for up to five hours after application. Helioplex is sold by Neutrogena as UltraSheer. They go on easily, need to be reapplied less frequently than sunblocks, and are invisible.

SLIP: Nothing blocks the sun better than clothing, and when the sun is blazing, make sure you put a shirt on to protct your back and shoulders.

SLAP: You don’t have to look like a kangaroo hunter, but the more you can put your face in shadow, the less harmful rays your skin will accumulate.
And yes, you can get a fine tan with all of the above.
Drill this into your kids:

SLIP on a shirt
SLOP on sunscreen
SLAP on a hat

Get Rid of Sun Spots

Are sun spots on your skin becoming unwelcome reminders of aging? Today there are treatments available that can help you get rid of them.

Sun spots usually start appearing after the age of 40 and are common in people with light skin. They start spreading more once you cross 50. Long hours or days spent in the sun during your early years are one of the most likely causes of sun spots.

While sunspots are medically harmless, many seniors seek to hide sun spots for cosmetic reasons.

Sun spots can occur both in males and females, but women are more likely to opt for a treatment to get rid of them. Today, a wide variety of remedies, from bleach to laser therapy, are available to treat sun spots.

Fraxel laser treatments—costing up to $1,000 per treatment—are one of the most effective, though also expensive. After the treatment it’s necessary to avoid the sun by wearing protective clothing and using sunscreens in order to prevent these spots from reappearing.