THE COSMETIC ASPECTS OF ESTROGENIC HORMONES By E,rL G. KLARVrANN, D.Sc. Vice-President in Charge of Research, Lehn and Fink, Inc., Bloomfield, N.J. A NU•BE• of different cos- metic preparations containing estro- genic hormones have been on the market for some thirteen years. During this period of time, a sub- stantial amount of clinical and other information has accumulated which bears either directly or indirectly upon the use of the estrogens in cos- metic formulations. In the follow- ing lines, an attempt has been made to review and to evaluate such evidence as is deemed to be relevant to the subject under consideration. THE ACTION OF COSMETIC Hov,- MONE CREAMS UPON THE SKIN Most cosmetic hormone creams, available on the market today con- tain from 7500 to 10,000 Interna- tional Units (I.U.) ofestrogenic sub- stance per ounce of' vehicle. This substance is usually of natural origin and consists essentially of estrone smaller proportions of alpha-estra- diol, equiline, and equilenin may be present in extracts from the urine of gravid mares which constitutes one of the most important sources of.this material. When applied in a cosmetic cream, this hormone potency may be safely regarded as being well below the threshold value for any systemic action. Assuming that a two-ounce jar of hormone cream with a total potency of 20,000 I.U. is used up over a period of one month, the in- dividual daily application would contain 666 I.U. It is known, how- ever, that absorption from an ex- ternally applied ointment does not take place to the extent of 100 per cent at best, it is not greater than 40 per cent, and usually consider- ably less. Therefore, a maximum absorption of 290 units should be taken into account, which certainly is far less than required for any sys- temic effect. According to the New and Nono2]i'cial Remedies (a publi- cation of The American Medical As- sociation), the therapeutic dose is 2000 to 10,000 I.U., by intramusct•- lar injection, one or more times weekly, depending on the patient's response. As much as 50,000 I.U. per week may be required in certain cases. Of course, intramuscular in- jection results in a practically corn- 406

:i,):,. COSMETIC ASPECTS OF i•.': • plete absorption, in contradistinc- iii.' i t•ion to percutaneous application. ii::i•i:i •:: An experiment with a cosmetic ?-i hormone cream (containing 7500 :,::. I.U. per ounce) was conducted by :•:.i'::• Curth (1) on women ranging in age :.i',, from 26 to 65 years. For a period of ß •!:!•:i:• four weeks the hormone cream was :?. applied to one thigh, and the cream , . ' ?:::without the hormone to the other .:i: thigh every day, preceded by '•': cleansing with soap and water. The ::i' subjects did not know which cream contained the hormone principle. At the end of the four-week period, •':' biopsies were performed on each of ':• the areas treated. The most constant finding was a succulence of the epidermal cells in the biopsies of the skin treated with the active cream. Another experiment with the ' same cream formula was carried out by Traub and co-workers (2) as a control, the cream vehicle which did not contain the hormonal substances was used on the opposite side of each subject. Twenty-five women, ranging between the ages of 35 and 55, were selected for this experiment. They were given the hormone cream to use on the right side of the face, neck, and the right hand. The con- trol cream was used on the left side of the face, neck, and back of the left hand. The subjects used the creams for a period of more than six months continuously. They were under the observation of a number of physicians, and a nurse was in constant charge of the experiment. None of the subjects confused the cream by using it on the wrong side. ESTROGENIC HORMONES 4O7 At the conclusion 6f the experi- ment, twenty-four of the patients showed a greater improvement on the hormone-treated right hand, as com- pared with that on the left. In one of the cases, no difference could be noted between the two sides. Twen- ty-three of the women appeared to have improved more decidedly on the hormone-treated right side of the face and neck than on the left. In one, the opposite side appeared to be better. In one case no appre- ciable difference could be noted be- tween the two sides. There were no untoward local effects whatever ob- served on the skin, or complained of during the course of the experiment, nor was there any evidence of sys- temic action, although no special study was undertaken to verify this point. A comparative histologic study was undertaken using the original sections of skin, one from each hand, removed from the subjects prior to the onset of the experiment, and those from the same subjects at its conclusion. The dermatological in- terpretation of these findings may be summarized as follows: 1. The original section con- formed to the histologic picture of the skin of the back of women's hands ranging between the ages of 35 and 55. 2. The final sections, both from the hormone-treated side and the control side showed that the use of the creams did not affect the epider- mis. 3. It was possible from the his- tologic sections to differentiate be-