ELSEVIER

Physiology of the Skin-Differences

Between Women and Men
Ethel Tur, MD

T
he skin, acting as an interface between the body ger; so if the skin reflects other characteristics of the
and the outside world, is a complex organ with body, the frog skin model :should apply to humans as
many intricate structures and mechanisms that well; however, skin thickness in humans is greater in
connect it to the entire body. It is a mirror reflecting the men than in women,3 whereas the subcutaneous fat
many internal characteristics of the body, and it is thickness is greater in women.4 Because human beings
readily available for visual evaluation. Differences be- are more complicated organisms than frogs, the
tween women and men, therefore, should be also re- strength of women apparently derives from complex
flected in the skin. Genetic and hormonal differences internal mechanisms rather than from a thicker skin.
affect skin structure and function, resulting in varia- The skin of men is thicker across the entire age range of
tions between women and men and causing these gen- 5 to 90 years.5 Hormonal mfluence on skin thickness
der variations to change with age. In addition, exog- was demonstrated when conjugated estrogens were
enous factors play a role, because they may differ given to postmenopausal women.6 Following 12
according to differences in life style between the sexes. months of therapy the dermis was significantly thicker,
It is now possible to substantiate impressions, such and histologic improvement in the previously atrophic
as the impression that women’s skin is lighter than epidermis was noted (Table 1).
men’s, and to distinguish between fact and fantasy. Skin collagen and collagen density were measured in
During the last few decades, quantitative measurement addition to dermal thickness.7 The skin of men demon-
techniques used in dermatological research have im- strated a gradual thinning with advancing age (12-93
proved substantially, providing means of objective years); whereas the thickness of women’s skin re-
evaluation of skin function and characteristics. Differ- mained constant up until the 5th decade, after which it
ences between women and men, however, were not yet decreased with age. The male forearm skin contained
systematically studied, and most of the available data more collagen at all ages in the range of 15-93 years. In
on differences between genders are a by-product of both sexes there was a linear decrease in skin collagen
studies having a different focus. with age. Collagen density calculated as the ratio of
This contribution outlines the various aspects of skin collagen to thickness was lower in women at all
physiological differences in the skin of women and ages. The rate of collagen loss was similar in both sexes.
men, with special emphasis on structural and anato- Women start with a lower collagen content; therefore
mical characteristics, biochemical composition, me- they seem to age earlier than men. Collagen density,
chanical properties, functional differences, differences representing the packing of fibrils in the dermis, is
in response to exogenous triggers, cutaneous microvas- lower in women than in men. This may be due to an-
culature, sensory functions, skin color, hormonal influ- drogen, since skin collagen density is increased in pa-
ence, and the pilosebaceous unit. tients with virilism.
Forearm skinfold thickness, as measured by a cali-
per, decreases starting at age 35 for women, and 45 for
Structural and anatomical characteristics
men. Starting at age 35 it is thinner in women than in
men.’ Another study found lower forearm, thigh and
The skin of female frogs is thicker than that of males in
calf skinfold thickness in women as compared to men in
all body regions,* (whereas the opposite is true for rat
younger subjects: 17-24 years.’
skin).’ The thickness of the dermis in frogs is deter-
Heel pad thickness is an indicator of soft tissue thick-
mined mainly by its content of collagen fibers, and this
ness in the body. In Ethiopian individuals, it was thicker
layer accounts for the frog skin’s durable construction.*
in men than in women.i’ Skinfold compressibility in
It is well known that the weaker sex is in fact the stron-
Japanese students was larger in women than in men at
the pectoral site, and small.er at nuchal, submental, bi-
--- ..- ceps, thigh, suprapatellar, and medial calf sites.4 The
From the Department of Dermatology, Tel Aviv Sourasky Medical Cen-
changes in the distribution of fat between the ages of 6
ter, and Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
Address correspondence to: Dr. Ethel Tur, Department of Dermatology, and 18 were studied in 2300 subjects.” Up to 12 years of
lchilou Medical Center. 6 Weizman St., Tel Avizl, Israel 64239. age, there was no difference between the two sexes: the

0 1997 by Efsevier Science Inc. 0738-081X/97/$32.00

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6 TUR

Table 1. Structural and Anatonric Cl1aracteristtc.s

Reference Findings Obtained by Subjecfs Conclusions

-- --_- _
Significant Differences
Skin thickness in humans Echographic evaluation 24 women; 24 men; halt
greater in men than in 27-31 years, half 60-9(!
women, except for lower veal-5
back in young subjects
Men’s skin thicker than Ultrasonic echographq 69 women; 54 men 5 to 90
women’s across the entire Forearm. years
age range of 5-90 years.
Thickening of dermis following Conjugated estrogens 28 estrogen; 26 placebo, Estrogens affect skin thickness.
12 months estrogen therapy. therapy. Women: .X-71 vears
Ultrasound measurement.
Men: gradual thinning of skin Skin collagen, skin thickness Collagen: HO women; 79 men, Rate of collagen loss same in
with advancing age. Women: and collagen density, 15-93 years. men and women, although
thickness constant up to 5th measured chemically and Thickness: 107 women; 90 total skin collagen content is
decade, then decreasing with histologically. men, 12-93 years. less in women than men at
age. Density: 26 women; 27 men, all ages.
15-93 vears.
Forearm skinfold thickness Caliper. 145 woken and men, S-84,
decreases starting at age 35 Forearm. bears.
for women, and 45 for men.
Starting at age 35 it is thinner
in women than in men.
Skinfold thickness lower in Caliper. 42 women, 37 men; 17-24
women. Forearm, thigh and calf. years.
Subcutaneous fat thickness Caliper and ultrasound. 45 women, 41 men; Japanese.
greater in women. 18-22 “ears.
Heel pad thickness thicker in Ankle X-ray 113 women, 125 men;
men than in women, in Ethiopian. lo-70 years.
correlation to body weight.
Skinfold compression in Caliper and ultrasound 45 women, 41 men; Japanese.
women is greater in the ‘I 8-22 vears.
trunk and fess in the limbs.
Up to 12 years of age no Caliper I292 women, 1008 men; ages
difference between the sexes. h. 8. 10, 18.
Subcutaneous fat increases
more than threefold, while
internal fat mass increases
less than twice. After 12
years, the relative mass of the
subcutaneous fat increased in
girls but not in boys
12 Lipoprotein lipase activity Lipoprotein lipase activity 8 women, II men; 37 + -I Regional and sex differences m
higher in women. Higher and mRNA levels years. lipoprotein lipase activity
values in gluteus than measured; hybridization, might underlie the difference
abdomen in women. Men: northern blot. in fat distribution and total
higher in abdomen. fat content. Variation is btith
at mRNA and
posttranslational levels.
No Significant Differences
‘I 1 Up to 12 years the mass of the Caliper. 1292 women, 1008 men; ages
subcutaneous fat increases b, 8, 10, 18.
more than threefold, while
that of the internal mass
increases less than twice in
both sexes.

massof the subcutaneous fat increased more than three-
fold, while that of the internal mass increased less than
twice. After the age of 12, the relative mass of the sub-
cutaneous fat continued to increase in girls but not in
boys (Table 1).
The distribution of fat over the body is different in
men from that in women.” In men, an increase in fat
tends to accumulate in the abdominal region and upper
parts of the body; whereas in women it is located in the
lower body, particularly in the gluteal and femoral re-
gions. In addition, the proportion of body fat is hi&er
in nonobese women than in nonobese men. The char-
Clinics in Dermatology l 1997;15:5-16 PHYSIOLOGY OF THE SKIN-DIFFERENCES BETWEEN WOMEN AND MEN 7

acteristic difference in body fat distribution between the
sexes exists both in nonobese subjects and in obese
ones. Lipoprotein lipase activity and mFWA levels were
higher in women both in the gluteal and in the abdomi-
nal regions. In women, higher enzyme activity was
found in the gluteus than in the abdomen, whereas in
men it was higher in the abdomen. These regional and
sex differences in lipoprotein lipase activity might un-
derlie the difference in fat distribution and total fat con-
tent. Variations is both at mRNA level and posttransla-
tional level (Table 1).
Biochemical composition
Significant age-related differences in the stratum cor-
neum sphingolipid composition was found in women,
but not in men.i” From prepubertal age to adulthood
there was a significant increase in ceramide 1 and 2,
accompanied by a decrease in cerarnide 3 and 6. After
maturity there was a decrease in ceramide 2 and an
increase in ceramide 3. These findings indicate an in-
fluence of female hormones on the composition of stra-
tum corneum sphinoglipids. These lipids play an im-
portant role in the water-permeability barrier function
of the human epidermis, and thus endocrinological fac-
tors may influence this barrier.
Differences in the metal content of human hair were
found between men and women, with higher concen-
trations of metals noted in women. Concentrations of
copper did not differ with age in men, whereas an in-
crease with increased age wad noted in women (Ta-
ble 2).r4
estriol or estradiol cream were applied on the face of
perimenopausal women.16
Frictional properties of the skin as well as stratum
corneum hydration did not differ between men and
women, in both young and old subjects.17,‘sIn addition,
transepidermal water loss showed no difference be-
tween the two sexes.17 In contrast, another study”
found lower values for basal transepidermal water loss
in women as compared to men aged 18-39 years.
The adhesion of the stratum corneum, measured in
vitro in skin biopsy samples, did not differ between
men and women in several body regions.* But age-
(and probably hormonal&related differences were dem-
onstrated in vivo by measuring the speed of dermal-
epidermal separation, utilizing the time required for
blisters to form by controlled suction.” From 15 years
up to 69 years of age, women exhibited longer blistering
times than men in both ante’cubital and abdominal sites.
The difference was more pronounced in the age range
of 15 to 39 years than in the range 40 to 69 years, and it
disappeared in older ages.
Skin elasticity did not differ between the sexes, as
measured by a suction device.** Similarly, torsional ex-
tensibility of the skin, as measured by a twistometer,
did not differ between the sexes.5
Cutaneous extensibility was identical in men and
women; but after hydration, it increased only in
women.23 Hydration changes the stratum corneum
properties, softening it; this allows the difference in der-
ma1 thickness to express itself as a difference in exten-
sibility. Since the dermis is thinner in women, elimina-
tion of the stratum corneum factor allows a rapid
extensibility of the skin in women (Table 3).

Mechanical properties
Clinical assessment, as well as objective measurement
of stratum corneum hydration, and grading of scaling
(by adhesive tape strippings followed by densitometry
readings) showed no differences between men and
women.r5 A positive effect of estrogens on stratum cor-
neum hydration and wrinkles was demonstrated when
Functional differences
Sebum secretion following pilocarpine iontophoresis
measured in healthy and chronic renal-failure subjects
revealed higher sebum sec:retion rates in men than in
women in both subject groups.18 The fatty acid compo-
sition of sebum is affected by androgen in both sexes.24

Table 2. Biochemical Composition

Reference Findings Obtained by Subjects Conclusions

Significant Differences
13 Stratum comeum Ethanolic extracts, 27 women, 26 men; 10-79 Female hormones influence
sphingolipid composition biochemical methods of years. the composition of stratum
differs with age in women, lipid identification. corneum sphingolipids.
but not in men.
14 Higher concentrations of Liquid chromatography; trace 60 women, 72 men; 6-40
metals in women’s hair. metal determination. years.
Concentrations of copper
did not differ with age in
men, whereas in women
they increased with age.
8 TUR

Table 3. Mechanical Properties

Reference Findings Obtained by Subjects Conclusiorzs
Significant Differences
21 From 15 years up to 6Y years Measuring the speed I>! 178 women, 15--l 0 I Wars;
of age, women exhibited dermal-epidermal 209 men. 16-96 venrs.
longer blistering times than separation, utilizing the
men. The difference WAC: time required for blisters to
more pronounced in the form by controlled suction,
age range of 15-39 years antecubital and abdominal
than in 4%69 years, and sites.
disappeared in older ages.
No Signiticant Differences
15 Stratum corneum hydration, Clinical assessment and 50 women, 22 men; 21-61
and grading of scaling bioengineering years.
showed no differences measurement.
between men and women.
16 A positive effect of estrogens Stratum corneum hydration 18 women (8 applied estriol, Topical treatment with
on facial skin: moisture and wrinkles- 10 estradiol); 46 - 66 years. estrogen seems promising.
increased, wrinkles profilometry of skin
decreased. replicas.
17 No difference between men Bioengineering measurement. 7 women, 25 years (mean); 7
and women in friction, men, 29 years.
moisture, transepidermal 7 women, 75 years; 8 men, 71
water loss. years.
18 No difference in moisture. Bioengineering; healthy and Healthy: 24 women, 21 men.
chronic renal failure Patients: 30 women, 50
subjects. men.
22 Skin elasticity did not differ In viva suction device Young: 8 women, 26 years; 8
between the sexes, as (bioengineering). men, 28 years.
measured by a suction CIld: Y women, 75 years; 8
device. men, 75 years.
5 Torsional extensibility did Twlstometer 6Y women, 54 men; 5-90
not differ between men vears.
and women.
20 The adhesion of the stratum Biopsy; in vitro measurement Y-34 women and men;
corneum did not differ of the force needed to number varied with site
between men and women. separate between cells. studied; 2040 years.

Sex-related differences in the metabolism in the skin of
topically applied compounds were found in he skin of
guinea pigs (Table 4).2”
Differences in response to exogenous triggers
The incidence of irritant dermatitis is higher in women
than in men, but experimental irritant dermatitis does
not differ between men and women.2h,27Occupational
factors that cause women to experience a greater expo-
sure to irritants may provide an explanation to this dis:
crepancy. In a study of skin irritability by sodium latiryl
sulfate, women showed lower baseline transepider&l
water loss as compared to men; but after irritation b6th
sexes gave similar values for transepidermal water
10~s.‘~The importance of interpretation of the results,
and the lack of a standardized way of analyzing them,
is illustrated in the latter study. The authors define an
irritation index as the ratio of the difference of the val-
ues of irritated and unirritated skin to the value of unir-

Table 4. Functional Differences

Reference Findings Obtained b!y Subjects Conclusions
Significant Differences
18 Men sweat more than I’ilocarpine iontophoresis; Healthy: 24 women, 21 men;
women. healthy and chronic renal patients: 30 women, 50
failure subjects. men; 18-75 years.
23 Cutaneous extensibility Rioengineering methods. 15 women, 14 men; 23-49 Hydration allows the effecl
increased only in women years and 60-93 years. of thinner dermis in
after hydration. women to be reflected in
extensibility.
- --. - -..
Clinics in Dermatology l 1997;15:5-16 PHYSIOLOGY OF THE SKIN-DIFFERENCES BE’lWEEN WOMEN AND MEN 9

ritated skin. Although the value of irritated skin did not
differ between men and women, this index was higher
in women, since the value of unirritated skin was lower
in men; therefore, the authors conclude that women’s
skin is more irritable. A review article considering the
absolute values following irritation interpreted the
same results as indicating no sex-related differences in
sodium lauryl sulfate irritation.26 Until a universal way
of interpretation of the results is established, contradic-
tory conclusions may be reached by different analyses
of the same set of data. In another study, baseline trans-
epidermal water loss did not differ between men and
women. *’ This study found no significant differences
between men and women in developing cumulative ir-
ritant dermatitis, when visual scoring, transepidermal
water loss, skin blood flow, and dielectric water content
were assessed. Changes during the menstrual cycle,
however, were demonstrated by measuring baseline
transepidermal water 10~s.~~ It was higher on the day of
minimal estrogen-progesterone secretion as compared
to the day of maximal secretion on both back and fore-
arm sites, suggesting that the barrier function is less
complete just prior to the onset of menses as compared
to the days just prior to ovulation. It was also higher on
the day of maximal progesterone secretion as compared
to the day of maximal estrogen secretion (Table 5).
Cutaneous microvasculature
Hormonal factors affect the :skin blood flow. Differences
between men and women were found during the re-
productive years, and differences were found within
the different phases of the menstrual cycle.30 Moreover,
vasospastic diseases, such *as Raynaud’s phenomenon
are more common in women, more prevalent in the
reproductive years, and improve during pregnancy,
suggesting an influence of female sex hormones.30
Skin circulation varied during the menstrual cycle.
Basal flow was lowest in the luteal phase, highest in the
preovulatory phase. In the luteal phase, finger skin per-
fusion showed the greatest cold-induced constriction
and the lowest recovery afterwards, as compared with
the other phases of the cycle.30 There might be a direct
influence of sex hormones on the blood vessel wall, or
an indirect systemic hormonal action causing a cyclic
pattern in women.

Table5. Exogenous Triggers

Reference Findings Obtained by Subjects Conclusions
Significant Differences
26 Incidence of irritant Occupational factors
dermatitis higher in
women than in men.
19 Lower baseline Sodium lauryl sulfate 15 women, 23 men; l&39 Comparing the irritation
transepidermal water loss irritation. years. index (the difference
in women as compared to Evaporimeter. between irritated and
men; but after irritation, unirritated values over
similar values in both unirritated): female skin
sexes. more irritable.
29 Higher on the day of Back and forearm sites. 9 women, 1946 years Barrier function is less
minimal estrogen/ Baseline transepidermal (mean 32). complete just prior to the
progesterone secretion as water loss. onset of menses as
compared to the day of Evaporimeter. compared to the days just
maximal secretion. Also prior to ovulation.
higher on the day of
maximal progesterone
secretion as compared to
the day of maximal
estrogen secretion.
No Significant Differences
27 No significant differences Irritation tested for 11 21 women, 21 men, with No tendency to stronger
between men and women irritants at several hand eczema; 21 women, reactions in either sex.
with or without hand concentrations. 21 men, without hand Speculation: women’s
eczema. eczema; 20-60 years. occupations lead to a
greater exposure to
irritants.
28 No significant differences Repeated once daily 7 women, 7 men; 16-65 No sex-related susceptibility
between men and women application of 3 years. to develop cumulative
in developing cumulative concentrations of irritant irritant dermatitis.
irritant dermatitis. (SLS), 5 days, followed by Speculation: women’s
a patch test. occupational and domestic
Upper back. Bioengineering duties lead to a greater
measurements. exposure to irritants.
 Estrogens influence the sympathetic nervous system,
inducing an up-regulation of vasoconstrictive (r2-
adrenoceptors. Thus, blood flow measurements utiliz-
ing laser Doppler flowmetry revealed a reduction of
basal cutaneous blood flow in women as compared to
men,3’-33 but these differences existed only in young
women and not in women over 5O.“4This reduction was
due to a basal increase in sympathetic tone rather than
to a local structural or functional difference in the cu-
taneous circulation.
The vasodilatation induced by local heating occurred
at a lower skin temperature in women.35 However, the
maximum skin blood flow following heating of the
skin was not different between men and women, and
neither was the postocclusive reactive-hyperemia re-
sponse in a study including a group of women aged
20 to 59 years.“’ In contrast, in a study that divided
women according to age, the reactive hyperemia re-
sponse was lower in young women as compared to
both women over 50 and young men.3’ The latter study
also measured the response to cooling, which was pro-
longed in young women as compared to the other two
groups.
The skin microvascular response to acetyicholine, an
endothelium-dependent vasodilator, and to nitroprus-
side and isoprenaline-two endothelium-independent
vasodilators with different modes of action-was:
evaluated by laser Doppler perfusion imager, which
maps the skin blood perfusion. The substances were
iontophorized into the skin. The response to nitroprus,-
side, and to a lesser extent to acetylcholine, was higher
in women before menopause than after,“h reflecting
functional and structural changes in skin vasculature
with aging (Table 6).
The cutaneous blood flow response to topical and
intradermal administration of histamine was compn-
rable in men and women at three anatomical sites: the
back, volar side of the forearm, and ankle.“? These ob-
servations indicate that there are no functional differ-
ences between men and women in the skin microvas-
cular response to histamine. On the other hand,
histamine administered by iontophoresis produced big-
ger wheals in women, as measured by laser Doppler
flowmetry.’ The bigger wheels were attributed to dif-
ferences in the stratum corneum layer, which is the
main obstacle to penetration.
Transcutaneous oxygen pressure is a method that
measures changes in oxygen pressure at the skin sur-
face that are mainly determined by changes in skin
blood flow. During skin surface measurement, signifi-
cantly higher values of transcutaneous oxygen pressure
were noted in women.3R,0yThe difference might be ex-
plained by the thinner epidermis of women. Age-
related sex differences were noted in measuring trans-
cutaneous oxygen pressure during postocclusive
reactive hyperemia. Greater values in adult women
than in men were found, but no differences between
boys and girls.“”
Sensory functions
Studies on human thermoregulation were conducted by
exposing subjects to various thermal environments. The
importance of taking into account all the possible vari-
ables is demonstrated in studies of the physiological
responses to heat stress4’ Data showed differences be-
tween women and men, however, when taking into
consideration the differences in the percentage of fat in
the body and the ratio between the body surface and
mass, the effect of gender disappeared.
In contrast to these results of heat stress, the respotltle
to cold stress of Japanese young subjects differed with
gender, although body surface area-to-mass ratios were
similar,” Subjects were exposed to cold 02°C) for I
hour at rest in summer and in winter. Women’s tolcr--
ante to cold was superior to men’s in winter, wherea
no significant differences between the sexes were found
in the summer. Differences in the distribution of tat
over the body, even though body surface area-to-mass
ratios were similar in the two sexes, might have con-
tributed to the differences in cold tolerance.
The decrease in finger temperature as a response tt.;
musical stimulus was greater in women.‘23 A possible
explanation may be differences between men and
women in vascular autonomic sensitivity to music, that
is, differences in sensitivity or density of peripheral ~a>,
cular adrenergic receptors.
Electrodermal asymmetry has been considered as ;an
index of hemispheric specialization. A study recorded
the magnitude and frequency of the skin conductance
responses when subjects listened to tones.“” Righl-
handed subjects were selected in order to control the
effects of handedness. Men displayed more asymmetry
between hands, with larger skin conductance response>
on the left hand. In women asymmetry was lesh
marked, and larger skin conductance responses ~~Y’TV
iound on the right hand. These results indicate a pos-
sible hemispheric difference in response to auditory
stimuli.
Thwzal and jmi’ain stmatiort, ymsure smsitiaity
Sensation in the skin can be studied in relation to pain.
Pain can be induced mechanically, electrically, b-)
chemical stimulus or by thermal stimulus. Pain sensa-
Clinics in Dermatology l 1997;15:5-26 PHYSIOLOGY OF THE SKIN-DIFFERENCES BETWEEN WOMEN AND MEN 11

Table 6. Cutaneous Microcirculation

Reference Findings Obtained by Subjects Conclusions

Significant Differences
31 Reduction in basal skin blood Bioengineering measurement. 56 women, 44 men; 20-59
flow in women. years.
33 Reduction in facial basal skin Laser Doppler. 5 women, 5 men; 25-52
blood flow in women. years.
32 Reduction in basal skin blood Bioengineering measurement, 26 women, 23 men; 22-38 Sympathetic tone is increased;
flow in women. cooling and warming to years. not a structural or functional
change sympathetic tone. difference in the cutaneous
circulation.
30 Skin circulation varied during Bioengineering 31 women, 1545 years Skin blood flow and its
menstrual cycle: basal flow measurements at 4 times response to cold varies
lowest in the luteal phase, during the menstrual cycle. during the hormonal changes
highest in the pre-ovulatory in the menstrual cycle.
phase. Greatest cold-induced
constriction and lowest
recovery in the luteal phase.
34 Reactive hyperemia response Bioengineering measurement. 12 women, 19-39 years; 13 Hormonal factors might explain
lower in young women as Postocclusive reactive women, 51-67 years; 13 the differences. Different
compared to both women hyperemia and direct and men, 2247 years. dressing habits may also
over 50 years or young men. indirect cooling. contribute.
The response to cooling
prolonged in young women
as compared to the other two
groups.
35 Vasodilatation induced by local Bioengineering measurement. 9 women, 6 men; age not
heating occurs at a lower specified.
skin temperature in women.
36 Response to nitroprusside Laser Doppler perfusion 21 women, 13 men; 18-80 Indicating functional and
higher in women before imager, iontophoresis. years. structural changes in skin
menopause than after. vasculature of women with
aging.
2 Histamine produced bigger Histamine administered by 33 women, 38 men; 15-52 Differences in the stratum
wheals in women. iontophoresis. years. corneum layer.

Transcutaneous Oxygen Pressure

Significant Differences
38 Significantly higher values of Bioengineering; anterior 18 women, 42 men; 22-88
transcutaneous oxygen chest, forearm. years.
pressure in women.
39 Significantly higher values of Bioengineering; 23 sites on 7 women, 12 men; 21-63 Might be explained by
transcutaneous oxygen face, extremities and trunk. years. women’s thinner epidermis.
pressure in women.
40 Transcutaneous oxygen Bioengineering measurement; Adults: 30 women, 37 men; Hormonal influence is
pressure during postocclusive forearm, postocclusive 22- 60 years. Children indicated.
reactive hyperemia greater in reactive hyperemia. before puberty: 34.
adult women than in men, 35-37°C.
but did not differ between
boys and girls.
No Significant Differences
37 No difference in cutaneous Topical and intradermal 10 women, 10 men; 24-34
blood flow response to administration; years.
histamine. bioengineering methods.
31 No difference in postocclusive Bioengineering methods. 56 women, 44 men; 20-59
reactive hyperemia and years.
maximum skin blood flow
followmg heating.

tion is best determined by the threshold at which pain
begins, and the stimulus required to produce it can be
quantified. Thermal and pain sensations are mediated
by cutaneous receptors, and they travel through my-
elinated (A-delta) and unmyelinated (C) nerve fibers.
Women were more sensitive to small temperature
changes and to pain caused by either heat or cold.45
Another study measured the threshold of the pricking
sensation provoked by heat projected to the skin from a
lamp.46 The pricking pain threshold increased with age
in both sexes. In addition, the threshold of women was
lower at all ages in the range of 18-90 years. Possible
12 TUR

explanations for the difference between the sexes are:
(1) anatomical differences in skin thickness; (2) differ-
ences in blood flow and blood vessels that absorb part
of the heat transmitted to the skin; (3) differences in the
nervous structure or function. Unlike the lower thresh-
old of pricking pain sensation in the forearms of
women, pressure threshold was lower in women than
in men on the palm and on the sole, but not on the
forearm.47
Autonomic function
Skin conductance measures one aspect of the auto-
nomic function. Neonate girls manifested a significantly
higher conductance than boys.*s These differences may
represent differences in maturation (Table 7).
Skin color
Tegner gives several examples of artists depicting their
female models as lighter skinned than males.“’ $I&
differences were indeed found utilizing spectroph+l-
metric measurements in various ethnic populations A
lighter skin in women was demonstrated in studies
from Iran,‘(’ India,” and Australia.52 In addition to hi.jx.
monal influences, differences in melanin, hemoglobin,
and carotene might be involved, as well as differences
in exposure to the sun. In general, both sexes darken 25
age increases.“’ But the changes are more intricate; from
the end of infancy to the onset of puberty there i:: ii
progressive skin darkening in both sexes.5’ During ado--
lescence they both lighten, but women lighten more.
Simple hormonal effects cannot explain this difference.

Table 7. Semory Futzctiorl

Reference Findings Obtained by Subjects Conclusions

-L-- ___-_._---..--.
Significant Ditferences
45 Women more sensitive to small Marstock mcthod-- 67 M’orncn, X3 men; lo- 71
temperature changes and to quantitative. year3
pain caused by either heat or
cold.
46 Lower threshold values in Pricking pain sensation to 9.3 women, 165 men; 18-28
women than in men. heat; threshold years. 132 women; 135
determination. v&r men: 50-90 years.
forearm.
47 Women more sensitive than Pressure threshold h8 wornen, 68 men: 17--30
men: palm and sole, but not measurement; palm, sole, years.
on the forearm. forearm.
48 Neonate girls: significantly Skin conductance (autonomic 20 women, 20 men, These differences nlay
higher conductance than function). Neonates: 60-l 10 hours represent differences in
boys. maturation. Very young. no
effect yet of training am!
different behavior accorded
the sexes.
42 Women’s tolerance to cold Exposed to cold (12°C) for 1 7 women, 8 men, Japanese; Differences in fat distributior:
superior to men’s in winter. hour at rest in summer and 18-26 years. over the body, even thoug!<
in winter; skin and body body surface area-to-mass
temperature. ratios were similar in the two
sexes, might have contributed
to the differences in cold
tolerance.
43 Greater decrease in women in Auditory stimulation: music; 60 women, 60 men; young Possible explanation: difference
finger temperature as a skin temperature, index students. in vascular autonomic
response to musical stimulus. finger. sensitivity to music.
44 Men: more asymmetry between Auditory stimulus; I5 women, 15 men; 19-27 Possible hemispherit
hands, larger skin magnitude and frequency years. Right-handed differences in response to
conductance responses on the of skin conductance auditory stimuli.
left hand. Women: less responses
asymmetry, larger skin
conductance responses on
right hand.
No Significant Differences
41 Physiological responses to heat Heat stress, ergometer; 12 women, 12 men; 20-28 Differences between womeri
stress differ with gender, but oxygen uptake, body and years. and men disappeared when
depend on fat content and skin temperature, sweat differences in the percenta@
body surface area. rate. of fat in the body and the
ratio between body surface
and mass taken into acccjunt.
Clinics in Dermafolo~py l 2997;15:5-16 PHYSIOLOGY OF THE SKIN-DIFFERENCES BETWEEN WOMEN AND MEN 13

since both testosterone and estrogen provoke darkening Hormonal influence

rather than lightening of the skin. These changes might
Any of the above mentioned differences between
be partly attributed to differences in exposure to sun-
women and men might be related to hormonal effects.
light, as UV irradiation increases the number of mela-
Some evidence for hormonal influence on the skin was
nocytes in both exposed and unexposed skin. already mentioned above, such as the increase of skin
Another study assessed skin color in adolescents.53 thickness following treatment of postmenopausal
The forehead (sun exposed) pigmentation of boys was women with conjugated estrogens;’ or the positive ef-
darker than that of girls. But the medial upper arm (less fect of estrogens on stratum corneum hydration and
sun exposure) pigmentation varied among the different wrinkles of the face of perimenopausal women;i6 or the
phases of adolescence. Girls were darker than boys dur- changes during the menstrual cycle demonstrated by
ing early adolescence; during middle adolescence the measuring baseline transep:idermal water loss and skin
pigmentation was similar in the two sexes; and during blood flo~.*~“’ Hormone replacement therapy for
late adolescence girls were significantly lighter than menopause had an effect on skin extensibility;56 in un-
boys. treated women a steep increase in skin extensibility was
The lighter skin color of women was attributed to evidenced during the menopause. Hormone replace-
differences in melanin, hemoglobin (variations in vas- ment treatment limited this age-related increase in skin
cularity), and carotene.54 Natural selection might give extensibility, thus having a preventive effect on skin
an explanation to the overall visual effect of lighter skin. slackness. Other parameters of skin viscoelasticity were
In addition, women are more homogenous in color than not affected. After menopause the skin becomes thin-
men; regional variations in reflectance spectrophotom- ner, associated with loss in skin collagen content. Col-
ery were smaller in women than in men.54 Calorimetric lagen content increased with hormone replacement
measurements revealed a darker and redder skin in el- therapy by 48% as compared to non-treated subjects.57
derly men (65-88 years) as compared to elderly women, Moreover, the ratio of type III to type I collagen in the
but such differences were not found in young subjects skin is reduced with age. Postmenopausal women re-
(18-26 years).55 Another study of 461 women and 346 ceiving hormone replacement therapy showed an in-
men aged 20 to 69 years found that both sexes darken crease proportion of type III collagen in the skin (Table
with age (Table 8).52 9).” In the future, further hormonal manipulation may

Table 8. Skin Color

Reference Findings Obtained bu Subjects Conclusions
Significant Differences
14 Women’s skin lighter. Spectrophotometry Review article. Not a simple hormonal effect;
differences in melanin,
hemoglobin and carotene.
50 Women’s skin lighter. Spectrophotometry 33 women, 68 men; 8-24 Differential tanning,
years. vascularity variations.
51 Women’s skin lighter. Spectrophotometry; upper 566 women, 578 men; l-50 During puberty: males
inner arm. years. darken, females lighten.
Different levels of MSH.
Hereditary and
environmental factors.
53 Forehead: boys darker than Skin color, measured by 105 women aged 10-16; 105 Physiologic changes during
girls. Medial upper arm: reflectance of forehead and men aged 12-18. adolescence may cause
girls darker than boys medial upper arm, in these sex differences.
during early adolescence, adolescents.
not different from boys
during middle adolescence,
and during late
adolescence girls lighter
than boys.
52 Women’s skin lighter. Both Spectrophotometry; inner 461 women, 346 men; 2@69 Different levels of MSH.
sexes darken with age. upper arms, lateral years. Difference in sun exposure
forearms, back of hands. (tanning and thickening of
skin).
55 In the elderly: skin of men Calorimetric measurements 8 women, 5 men, 65-88
darker and redder as of forehead (sun exposed) years; 9 women, 4 men,
compared to women, but and forearm (protected). 18-26 years.
not in the young.
Table 9. Homonal Influence
Reference Findings Obtained by Subjects Conclusions
-- -__--- ----...-.
Significant Differences
56 Hormone replacement Computerized surtion device Women: 13 nonmenopausal Hormonal replacement
treatment limited the measuring skin 119-W years); 25 therapy has a preventit L.
age-related increase in skin deformability and menopausal not treated effect on skin stacknesi
extensibility. Other viscoelasticity; inner (46-76 years); 46 on
parameters of skin forearm. hormonal replacement
viscoelasticity were not therapy since onset of
affected. menopause (38-73 years).
57 Collagen content increased Hydroxyproline and collagen Postmenopausal women, Estrogen or testosterone !nr
by 48% with hormone content; biopsies of right 35-62 years: 29 untreated, both) prevent the decrease
replacement therapy as thigh below the greater 26 &radio1 + testosterone. in skin collagen content
compared to non-treated trochanter. that occurs with aging
subjects.
58 Increased proportion of type Analysis of collagen types; I’ostmenopausaj women, The clinical improvemcnc ui
III collagen in the skin of biopsies of lateral thigh. 41-66 years: 14 untreated, the skin following
postmenopausal women 11 estradiol + testosterone. hormone replacement
receiving hormone therapy is due not or&to
replacement therapy increase in total collagei?
but also to changes in tllc:
ratio of type III to type i

change the skin of both men and women in ways we given in a study concerning this seasonal effect”” cvt:
cannot yet predict. calculated sex differences, which were not discussed in
the study. The data refer to the month of January. Wom-
en’s hair was denser and the percentage of telogen hair
Pilosebaceous unit
lower as compared to men. The diversity of male and
female hair patterns is determined by a difference in the
The sebaceous glands are hormone dependent. The in-
transformation of vellus to terminal hair, stimulated b);
creasein their activity during puberty can be stimulated
androgens, but also by racial and genetic factors.
by the administration of the appropriate hormone. An-
The effect of androgens on hair growth varies ac-
drogenic steroids, of either gonadal or adrenal origin
cording to body site, sometimes resulting in quite up-
have a direct stimulatory effect on sebaceous gland ac-
posite responses. Thus, at puberty men’s vellus hair on
tivity. Most of the hormones [thyroid-stimulating hor-
the face is transformed to terminal beard, and the rt‘-
mone (TSH); corticotropin (ACTH); follicle-stimulating
verse occurs on the scalp. The face, scalp, beard, axilb,
hormone (FSH); luteinizing hormone (LH)] act indi-
and pubic hair follicles are targets for androgens, Arl-
rectly by stimulating their respective endocrine tissues.
drogens affect different cells in the dermal papilla,
In other cases the hormones [for instance growth hor-
which is also affected by melanocyte-stimulating hor-
mone (GH)] act synergistically with another hormone to
mone (MSH), prolactin, thyroid hormones, pregnancy,
which the sebaceous gland is sensitive. Average values
and nutritional state.” In addition to higher serum lev-,
for sebum secretion were significantly higher in men
els of testosterone, female facial hirsutism correlated tc+
than in women for the age range 20 to over 69 years, but
obesity and to age.h2Despite exposure to the same cir,
not for the range 15 to 19 years.“’ This difference in
culatory hormones, the activity of hair follicles depends
sebaceousgland activity becomes more apparent in the
on the body site, varying from no effect on the eyelashes
50 to 70 age range, when the secretion in men remains
to stimulation in many other areas. High levels of tits-
unaltered; whereas in women there is a significant de-
tosterone inhibit the hair papilla cells and outer root
:rease in sebum output, probably a result of decrease
sheath keratinocytes and have a lesser effect on f&n.)-
zvarian activity. Beginning in young adulthood there is
blasts and interfollicular keratinocytes, while low level?
In age-related decline in the secretion of wax ester; thus
of testosterone have no effect. The opposite was foound
hormones also affect the composition of sebum.
with estrogen and cyproterone (Table lo).‘-?
Obviously, the distribution of hair over the body is
different in men from that in women. The hair follicles
possessindividual mechanisms that control the evolu- Conchsims
tion and triggering of successive phases; however, sys-
temic factors such as hormones and external factors also The majority of the findings require further study in
play a significant play. The season of the year has an terms of both more accurate measurements and better
?ffect on hair growth and hair shedding. From data understanding. More advanced instruments should be
Clinics in Dermatology l 1997;15:5-16 PHYSIOLOGY OF THE SKIN-DIFFERENCES BETWEEN WOMEN AND MEN 15

Table IO. Pilosebaceous Unit

Reference Findings Obtained by Subjects
Significant Differences
60 During January women’s hair was denser and the percentage of telogen Phototrichogram, b.air 7 women, 29-49 years;
hair lower as compared to men. count after washing. 7 men, 25-47 years.
59 Higher sebum secretion in men than in women for age ranges 20 to over Sebum production. 330 women, 458 men;
69, but not for the 1519 age range. In the 5C!-70 age range the secretion 15 to over 69 years.
in men remains unaltered, whereas in women there is a significant
decrease in sebum output, probably a result of decreased ovarian activity.
59 No correlation between sebum production and plasma testosterone. Sebum production and 8 women, 28 men.
plasma androe;en levels.

used and future studies should be more focused on 11. Malyarenko TN, Antonyuk SD, Malyarenko YE. Changes
gender differences. Indeed, gaining knowledge about in the human fat mass at the age of 6-18 years. Arkh Anat
the pathophysiology of human skin is quite valuable for Gist01 Embriol 1988;94:43-7.
the assessment and clinical management of skin dis- 12. Arner P, Lithe11 H, Wahrenberg H, Bronnegard M. Ex-
eases. Since the maintenance of skin health is an intri- pression of lipoprotein lipase in different human subcu-
taneous adipose tissue reg.ons. J Lipid Res 1991;32:423-9.
cate orchestration of many variables, additional studies
13. Denda M, Koyama J, Hori J, et al. Age and sex-dependent
of skin physiology and its relation to gender should
change in stratum corneum sphingolipids. Arch Dermatol
prove useful in identifying some of these variables and
Res 1993;285:415-7.
in the understanding of their importance. We hope this
14. Sturado A, Parvoli G, Doretti L, et al. The influence of
article will trigger further investigation of the subject.
color, age and sex on the content of zinc, copper, nickel,
manganese, and lead in human hair. Biol Trace Elem Res
1994;40:1-8.
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