J. Soc. Uosmetic Chemists, 18, 549-562 (Aug. 19, 1967) Effect of Topical Hormones Aging Human Skin* on CHRISTOPHER M. PAPA, M.D.} Presented September 20-21, 1366, Seminar, New York City Synopsis--The male hormone, testosterone, has a rejuvenating or ameliorative effect when applied to aging human skin. Clinically evident changes, such as eftacement of wrinkles, hair growth, and augmented sweating, are present but modest, particularly when compared to the improvement in the microscopic architecture of the skin. Progesterone and pregnenolone produce similar but more diminutive alterations. The female hormone, ethinyl estradiol, was without effect, while the corticosteroids accentuated the degradative changes of sen- eseenee. The aged comprise an ever-increasing proportion of the popu- lation. The chronic internal disorders of old age are under intensive study because they threaten life and lessen the enjoyment of living. The age-dependent changes of the vital organs have been reasonably well appraised, but the skin is a special case. No one dies of aged skin appearance spoils life only indirectly as suggested by the statement that people feel as young as they look. The desolate appearance of truly senescent skin can impair mental and physical well-being. The importance of looking and feeling attractive may be easily submerged in the concern over the other traditional scourges. In light of recent medical advances against serious ailments, the time may be ripe to turn attention to the relatively minor skin problems. Indeed, if the medical utopia of the future could supply us with spanking new inner organs, what a dismal package it would still be, wrapped in old skin! * Supported in part by U.S. Public Health Service Grant. t Department of Dermatology, University of Pennsylvania School of Medicine, Phila- delphia, Pa. 19104. 549

55O JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS Research activities, carried out in these laboratories have centered about the biology of aging skin. Dissatisfied with merely cataloging the alterations of senescence, a decision was made to try to do something about them. A strictly empirical mode of attack was based on the clinical impression of waning endocrine function with advancing age and utilized pharmacologic doses of topically applied hormones. Repre- sentative steroids from the male, female, and adrenocortical hormones were included in the study. The following report is a brief, composite picture of published work, as well as some still in progress (1, 2). METHODS Approximately 200 residents of the Riverview Home for the Aged have participated in the research program over the past five years. Almost all subjects manifested obvious cutaneous deterioration the median age of the group is 65 years (range 57-88 years). Although equal numbers of men and women were included in each particular project, the sex of the aged subject is irrelevant with regard to the effect of the hormones on the skin. Biopsy samples obtained since the onset of the work amount to more than 1500 individual specimens. It is important to emphasize that only areas of skin with clear-cut aging alterations were used. The face, extensor forearm, and back of the hand, sun exposed sites which graphically illustrate the changes of senescence, were included. The axilla was studied since it also demon- strates recognizable aging, yet it is protected from solar radiation and so suffers less deterioration. The following hormones, compounded either into hydrophilic oint- ment base or alcoholic solutions, were used: testosterone propionate 1.0%, progesterone 1.0%, pregnenolone acetate* 0.5%, ethinyl estradiol 0.5 %, triamcinolone acetonide • 0.5 %, and fluocinolone acetonid e 0.2 % 11. Each unilateral test site received daily topical treatment with approxi- mately 0.5 g of preparation while the contralateral side had the corre- sponding vehicle similarly applied. GROSS PROPERTIES OF AGED SKIN The weather beaten, unsheltered face and hands are familiar land- marks on our aged population. Laced with fine and coarse furrows, such skin possesses a general laxness, sagging, and loss of resiliency. * Supplied by Revlon, Inc., as Eterna 27 Cream. t Supplied by E. R. Squibb & Sons as Kenalog Cream. J• Supplied by Syntex Laboratories, Inc., as Synalar Cream.