MANAGING ESTROGEN-DEFICIENT SKIN: A NARRATIVE REVIEW ON THE ROLE OF HRT AND EMERGING ESTROGEN-MODULATING THERAPIES

Estrogen plays a critical role in maintaining skin structure and function, influencing collagen synthesis, elasticity, hydration, barrier integrity, and wound healing. Menopause-related estrogen deficiency accelerates cutaneous aging, leading to increased dryness, laxity, thinning, and impaired repair. This review synthesizes current evidence on the effects of systemic hormone replacement therapy (HRT), topical estrogen treatments, and emerging estrogen-modulating compounds on estrogen-deficient skin. Systemic HRT has demonstrated improvements in dermal thickness, collagen content, elasticity, and hydration; however, study outcomes remain heterogeneous and clinical use is limited by systemic risks, including venous thromboembolism and breast cancer. Transdermal administration of HRT appears to offer a more favorable safety profile. Because systemic therapy cannot currently be recommended solely for dermatologic benefit, interest has shifted toward localized and selective approaches. Early data suggest that topical estrogen, SERMs and phytoestrogens, may enhance skin quality while minimizing systemic exposure, though long-term safety and efficacy remain insufficiently studied. Future research should focus on dedicated dermatologic trials, optimized dosing strategies, and tissue-selective therapies to support more personalized and safe treatment options. Also, scientists should consider external factors that may influence the results. Collectively, these findings underscore the potential of estrogen-targeted therapies to mitigate cutaneous aging in postmenopausal women while highlighting the need for more robust clinical evidence.