Seeking a replacement for HRT

March 1, 2007

National report - Topical estrogen is one possible therapy for improving the skin of menopausal and postmenopausal women who choose to avoid hormone replacement therapy. But topicals, too, have their drawbacks, say dermatologists, who continue to look for answers to patient inquiries about HRT.

"Estrogen is very lipid-soluble, so it easily becomes systemic, even in the topical form," says Larissa Zaulyanov-Scanlan, M.D., a dermatologist who practices in Delray Beach and Margate, Fla., and a voluntary faculty member at the University of Miami Miller School of Medicine, department of dermatology and cutaneous surgery.

"Currently, the only patients that I consider using estrogen (or HRT in patch or pill form) on are those with chronic nonhealing wounds who are postmenopausal," Dr. Zaulyanov-Scanlan says.

"I think all of us are being asked by our patients whether we think they should personally continue or discontinue hormone therapy," says Patricia K. Farris, M.D., a dermatologist who practices in New Orleans and clinical assistant professor, department of dermatology, Tulane University.

"I know a lot of women who feel like they not only feel better but look better because they are on estrogen-based therapies," Dr. Farris says.

A rough ride

The premature halt in 2002 to the Women's Health Initiative study of more than 16,600 women taking hormones and the news that HRT could raise women's heart disease and stroke risk caused women to leave the therapy in droves.

Because of the complexities, HRT became a multidisciplinary issue, Dr. Farris says.

"It turns out, there is no one answer for everybody," she says.

Dr. Farris says there is no denying that good studies show that women on HRT have less wrinkling and their skin is thicker, long-term.

"They have less problem with dryness of the skin and mucous membranes," she says.

"HRT absolutely benefits the skin," agrees Leslie Baumann, M.D., professor, University of Miami Miller School of Medicine, department of dermatology and cutaneous surgery, Miami, Fla.

Dr. Baumann thought hormone therapy was so beneficial to postmenopausal women's skin that she included a chapter on the subject in her textbook, "Cosmetic Dermatology: Principles and Practice."