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Dr. G.E. Piérard, Department of Dermatopathology, CHU Sart-Tilman, B-4000 Liège (Belgium) The unprecedented size of the elderly population com Chronologic ageing Genetic ageing Photoageing Behavioral ageing Catabolic ageing, Type Endocrine ageing Gravitational aseins pels research to understand the physiological changes related to skin ageing. A classical, yet oversimplified classification of cutaneous alterations contrasts intrinsic ageing and photoageing. That dual classification does not precisely describe the wide diversity of factors influencing skin ageing. In such a perspective, seven distinct types of factors should be considered (table 1) [1]. In this framework, cutaneous climacteric ageing enters the spectrum of endocrine ageing. Over the past years, hormonal involvement in the ageing process of many tissues and organs has attracted increased interest. Molecular biology and biometrology have helped to sort through some unresolved questions. As a result, a fair amount is known about the basic science involved in estrogen functions. Hormone replacement therapy (HRT) is aimed at alleviating menopausal symptoms and is indicated for the prevention of long-term sequelae of estrogen deficiency. The preventive benefits include a substantial reduction in osteoporosis risk and, possibly, a reduction in the risk of coronary heart disease. Unfortunately, the picture that emerges from skin biology is odd and the influence of estrogen changes on cutaneous structures and functions remains largely unsubstantiated. The open study by Callens et al. [2] in this issue of the Journal is an additional attempt at analytic quantification of subclinical skin changes related to climacteric ageing and HRT. Before analyzing the data, one should remember the potential limitations of such a cross-sectional study design. The causal relationship between measures, estrogen deprivation and HRT cannot be determined with certainty because the characteristics of the women’s skin when they faced the decision regarding HRT are unknown. Subjects who are more likely to use HRT most probably belong to sociodemographic groups different from most untreated postmenopausal women [3]. Hence, the other factors influencing skin ageing may also differ between the two groups and introduce a bias to the study. That human skin changes dramatically with increasing age is patently obvious. However, climacteric ageing lacks unique and distinctive features. The manifestations such as xerosis and atrophy reflect structural changes in both the epidermis and dermis. Integumental reactivity also apparently changes at the time of the menopause, and there is reason to believe that the skin might then become more vulnerable to environmental insults [4-6]. At this point, one enters into a speculative realm, the effect of climacteric ageing being more subtle than has been expected.