Revisiting the Beneficial Effects of Estrogen on the Skin: A Comprehensive Review of the Literature and a Look to the Future

The process of aging is associated with anticipated cutaneous changes such as epidermal thinning, dehydration, loss of barrier function, and decreased extracellular matrix components. These physiologic changes translate to clinical findings such as atrophy, pigmentary changes, and wrinkling. Over the past century, the role of decreased circulating estrogens in the process of cutaneous aging has been elucidated. Estrogen replacement, both systemic and topical, has been shown to have positive effects on aging skin by promoting fibroblast proliferation and increasing collagen density. However, despite these positive effects on skin health and appearance, estrogens also display a wide-range of actions on various other systems. Even topical estrogen application can result in unwanted systemic effects. Research into alternative substances such as soft estrogens—synthetic, non-hormonal molecules that produce local, cutaneous estrogenic effects and are then metabolized to inactive compounds prior to being absorbed into the systemic circulation— suggests that estrogenic-like benefits on aging skin could be harnessed safely, while avoiding the potential pitfalls associated with estrogen use.