Does estrogen prevent skin aging? Results from the First National Health and Nutrition Examination Survey (NHANES I)
L. B. Dunn, M. Damesyn, A. A. Moore, D. B. Reuben and G. A. Greendale
University of California at San Francisco, School of Medicine, USA.
OBJECTIVE: To evaluate the relation between noncontraceptive estrogen use
and skin wrinkling, dryness, and atrophy. DESIGN: Cross-sectional analysis
of a national probability sample-based cohort study. SETTING: Multiple
community sites throughout the United States. PARTICIPANTS: Postmenopausal
women (n = 3875) aged 40 years and older at baseline. MEASUREMENTS: Skin
conditions (wrinkling, dryness, and atrophy) were ascertained using a
uniform clinical examination by trained dermatology resident physicians.
Self-reported use of estrogen before the baseline examination, sunlight
exposure, and smoking history were obtained by standardized interview. Body
mass index, a measure of weight in kilograms divided by the square of the
height in meters, was evaluated in uniform examination clothing. RESULTS:
Mean (+/-SD) age of the participants was 61.6 (+/-9.0) years and mean
(+/-SD) number of years since menopause was 15.6 (+/-9.4). Most were white
(83.7%), the remainder being African American (15.9%) or another race
(0.4%). Atrophy was present in 499 (16.2%), dry skin in 1132 (36.2%), and
wrinkled skin in 880 women (28.2%). The prevalence of all 3 skin conditions
was lower in African American women compared with white women. Information
on hormone use was available for 3403 participants (88%). Among all women,
after adjustment for age, body mass index, and sunlight exposure, estrogen
use was associated with a statistically significant decrease in the
likelihood of senile dry skin (odds ratio, 0.76; 95% confidence interval,
0.60-0.97). The odds of wrinkling were substantially lower in estrogen
users, adjusted for age, body mass index, and sun exposure (odds ratio,
0.68; 95% confidence interval, 0.52-0.89) and additionally for smoking
(odds ratio, 0.67; 95% confidence interval, 0.44-1.01). In multivariable
models, estrogen use was not associated with skin atrophy. CONCLUSION:
These results strongly suggest that estrogen use prevents dry skin and skin
wrinkling, thus extending the potential benefits of postmenopausal estrogen
therapy to include protection against selected age- and
menopause-associated dermatologic conditions.
