Etiopathogenetic therapy of dry lips during perimenopause

Irina Kapshuchenko , dermatologist of the highest category, cosmetologist, center of aesthetic cosmetology “Compliment” (Ukraine)

Every woman experiences three stages of hormonal changes in the body, which are conventionally divided into:

1. perimenopausal;
2. menopausal;
3. postmenopausal.

All tissues of the female body change during the aging process. Osteoporosis develops in the bones, muscles begin to suffer from atony, the mucous membrane undergoes atrophy, and the skin is bothered by the manifestation of many aesthetic and dermatological problems, such as wrinkles, loss of elasticity, dryness, etc. All these are direct or indirect consequences of hypoestrogenemia, which are points the efforts of many specialists, from gynecologists to us, dermatocosmetologists. But within the framework of this article, we propose to consider in detail only one of the manifestations of hypoestrogenemia, namely its effect on the mucous membrane of the lips of women in the menopausal and postmenopausal periods.

Anatomy of the lips and patient complaints

• The lips are formed by two sections: the mucous membrane (inside) and the skin (outside).
• The red border of the lips is a transition zone between the skin and the mucous membrane.
• There is no submucosa in the red border of the lips; at the border of the muscular layer and the mucous membrane there are a large number of small salivary glands.
• The red border of the lips is covered with stratified squamous keratinizing epithelium, and on the side of the vestibule - with stratified squamous non-keratinizing epithelium.

Changes in the mucous membrane of the red border of the lips and mouth are the first clinical signs of menopause.

Degenerative changes in the epithelium and connective tissue layer (increased hyperkeratosis), as well as a decrease in the functions of the salivary glands (hyposalivation) are observed with a decrease in estrogen levels in the premenopausal, menopausal and postmenopausal periods.

Patients turn to aesthetic medicine specialists with complaints of dryness of the red border of the lips, fine wrinkles, and cracks. Doctors usually suggest injecting hyaluronic acid (fillers) as a treatment. This method is well suited for smoothing out fine wrinkles and increasing lost lip volume, but problems such as dryness, peeling and even the appearance of cracks intensify with the introduction of fillers, as a result of which patients begin to realize that their high expectations have not been realized.

Why is this happening?

Because in parallel with the introduction of fillers, the mucous membrane, which has become sensitive to hormonal imbalance, is not treated. Based on this, we have developed a special algorithm for the treatment of the lip mucosa in women during menopause, which is aimed at tissue remodeling by stimulating the proliferative and synthetic activity of resistant cells.

Suggested treatment algorithm

Stage 1:

Hormone replacement therapy.

First of all, these are estriol preparations, which affect the condition of all mucous membranes.

Stage 2:

Point injections of unstabilized hyaluronic acid into the red border of the lips (in the submucosal layer) and perioral area.

Hyaluronic acid has a moisturizing and anti-inflammatory effect. Already at this stage, patients note a decrease in dryness, healing of cracks and smoothing of fine wrinkles. We prescribe 3–5 procedures with an interval of 1 month. Injections are performed using the micropapular technique.

Stage 3:

PRP therapy: papular administration of autologous plasma into the mucous membrane of the oral cavity, lips and skin of the perioral zone.

PRP is an autologous product that contains about 30 growth factors, cyto- and chemokines. It is important to note the influence of growth factors such as WECF, HGF, TCF-b1, bFGI, PDGF-A, B, C and interleukin-8 on the stimulation of angiogenesis. The described growth factors influence the migration and proliferation of endothelial cells and the formation of new vessels, and growth factors such as angeostatin, endostatin, TGF-b, TSR-1 and others (angiogenesis inhibitors) control the excessive proliferation of vascular collaterals. Due to the unique properties of autologous plasma, we achieve improved microcirculation, trophism and increased cellular activity in the area of atrophy of the lip mucosa. We prescribe 3 procedures, once every 2 weeks, using micropapular or linear techniques. We follow the standard PRP production technology recommended by the manufacturer.

Stage 4:

Application of external products with phytoestrogens .

Recently, a large number of products containing phytoestrogens, active substances of plant origin, have appeared on the cosmetic market. They do not have hormonal activity and have a different chemical structure, but have an effect similar to that of estrogens. The effect occurs at the level of receptors, which are located at the level of the basement membrane. It takes 6–8 weeks for the effect to occur. External application to the mucous membrane of the lips is recommended 2 times a day.

NB! After a course of procedures, correction with filler is possible.

As a result of the therapy, patients note the complete disappearance of complaints of dryness, flaking, burning, and in addition, the appearance of the lips fully meets their expectations.

First published: Les Nouvelles Esthetiques Ukraine, No. 6 (88), 2014, pp. 66-68