Skin Ageing in Women: Pathophysiology and Treatment

Abstract

Skin ageing in women is due to a combination of factors including intrinsic biological ageing, extrinsic damage, particularly ultraviolet radiation and hormonal changes, importantly the menopause. The most obvious signs of ageing are atrophy, laxity, wrinkling, dryness, mottled pigmentation and sparse grey hair; most of these are attributable to chronic ultraviolet exposure rather than intrinsic ageing itself. The life expectancy of Western populations is increasing resulting in a rising demand for the treatment of the visible consequences of ageing. The skin has a number of important physiological functions which are all affected by the structural changes that occur with skin ageing. The menopause is not associated with any specific changes in the skin, but it is thought that the decrease in oestrogen levels is partly responsible for the dryness, thinning and decreased elasticity of skin seen. Use of hormone replacement therapy has been shown to improve many of these parameters. The main cutaneous feature of the menopause is flushing, although other conditions are also associated. Hormone replacement therapy has long been known to control many of the troublesome symptoms of the menopause, but there are a number of cutaneous side effects. This article will look specifically at the pathophysiology of the ageing skin in women, with particular reference to the effects of the menopause and of oestrogens. Certain conditions associated with the menopause and hormone replacement therapy will also be discussed, along with the treatment of photoageing.