Biological differences in skin create challenges in treating men


Ivan Camacho, MD: “The reality is that there are important differences in the skin of men and women that stem from biology.”

Men and women are biologically different, and so is their skin.

“In the past, we might have thought that skin is skin and that treating a male patient is no different from treating a female patient,” said Ivan Camacho, MD, voluntary assistant professor of dermatology at the University of Miami Miller School of Medicine. “The reality is that there are important differences in the skin of men and women that stem from biology. There are special considerations to keep in mind when we are treating men.”

Dr. Camacho outlined some of those differences in a special session, “Hot Topics in Men’s Medical and Cosmetic Dermatology” (U018) on Aug. 8. The general cultural image of men as being tougher and more resilient than women is misleading. Typical male dermis is about 20 percent thicker than female dermis, but thicker is not necessarily tougher.

A thicker dermis means that men have fewer and less pronounced superficial wrinkles compared to women, Dr. Camacho noted. But men also have more robust skeletal musculature. That larger muscle mass translates into deeper expression lines compared to women. Dermatologists must consider those differences in wrinkles and expression lines when planning procedures.

There also are pronounced functional differences between male and female skin. Although men have thicker skin, their thicker dermal layer is actually more sensitive to environmental conditions than thinner female skin.


Ivan Camacho, MD

Men have drier skin than women and have a greater need to moisturize, Dr. Camacho said. Male skin also is more sensitive to ultraviolet radiation than female skin.

“Remember that ultraviolet radiation is the single most important risk factor for both aging of the skin and the development of skin cancers,” he said. “Because men are more sensitive to ultraviolet radiation, they have higher incidences of both nonmelanoma [basal cell carcinoma, squamous cell carcinoma] and melanoma skin cancers. Not only do men have a higher incidence of these cancers, they also have a higher mortality rate. If you are a man with melanoma, your risk of mortality is about two times higher than a woman with similar disease. The reality goes against every idea we have of men’s skin being tougher and more resilient when it is actually more sensitive.”

Men produce about four times more sebum than women. That means men are more prone to develop large pores and related problems such as acne and secondarily scarring from acne. Differences in hormonal secretion, specifically the excess of androgen over estrogen seen in men, drive differences in hair growth. Men are far more susceptible to androgenic alopecia than women. But androgens also drive hair growth on other parts of the body, which make men more likely to grow unwanted hair and be great candidates for hair removal treatments.

Immune responses also differ between the genders. Not only do men have distinct dermal microflora, they are more prone to both bacterial and viral infections of the skin. Part of that increased susceptibility to infection is related to their grooming routines. The repetitive, often daily, trauma during shaving can lead to patterns of skin inflammation and infection rarely seen in women.

Recovery from wounds and other dermal trauma also is slower in men than in women. This slower healing in men is due largely to androgen production and its effect in healing, Dr. Camacho said. Not only does slower wound-healing play a role in grooming and skin care routines, it is an important factor in recovery from almost any medical or cosmetic treatment.

“We don’t emphasize these important differences between men and women enough in our daily practices,” he said. “Women regularly come to our offices seeking cosmetic intervention or anti-aging treatments, so of course we talk to them about sunscreen and sun protection. Because men are not as big seekers of cosmetic intervention, we fail to provide them with adequate counseling. Men see themselves as tougher, but the reality is that a man is more susceptible to aging and skin cancers because of sun exposure. We need to emphasize these realities as a part of our everyday practice and routine counseling when we see our male patients.”

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