Perimenopause acne on chin

  • Salicylic or glycolic acid: These ingredients help exfoliate the skin. Both Aveeno Clear Complexion Foaming Wash ($7) and La Roche-Posay Effaclar Medicated Gel Cleanser ($15) are derm-approved picks for acne-prone skin.

  • Probiotics: Jegasothy recommends a probiotic cleanser, such as Glowbiotics MD Probiotic Acne Treatment Cleanser ($30). “It’s very effective in controlling the microbiome, or bacterial and yeast environment, in the skin,” she says. “This keeps the skin in normal pH balance for optimal penetration of stronger prescription topical treatments.” Research suggests that some microbial strains in topical probiotics can improve the skin’s protective mechanisms, impede inflammation, and inhibit the P. acnes bacteria that causes breakouts.

Topical retinoids

In acne patients of any age, most dermatologists will consider topical retinoids as the first step for treatment of mild to moderate acne, especially when it’s hormonal. “Retinoids help your skin slough off dead skin cells at a more normal rate so the dead skin cells don’t bind together and clog your pores,” explains Peredo. “They are the preferred avenue for long-term treatment because of the limited severe side effects and are known for preventing new acne in the long term.”

While you can get retinol-containing products like Differin Gel ($11) over the counter, your dermatologist can prescribe you much higher concentrations, which is likely the level of strength you’ll need to get rid of hormonal acne.

Important note: Retinoids, especially prescription ones, can be super harsh when you first start them. We’re talking dry, red, flaky, painful skin. So make sure to follow your dermatologist’s instructions carefully (they’ll likely suggest using it just a few times a week to start). And if you have particularly sensitive skin or a skin condition like rosacea, retinoids may be too harsh for you to handle, possibly resulting in even more breakouts. You should also avoid retinoids if you’re pregnant. Your best bet is talking to a dermatologist before jumping in.

Birth control

If you’ve ever been on birth control, and then gotten off of it, you probably noticed your skin go into total panic mode. But before you go cursing your sensitive skin, know that this type of reaction is totally normal, as oral contraceptives can do a great job of clearing acne in women.

In fact, some, like Ortho Tri-Cyclen and YAZ, are approved by the U.S. Food and Drug Administration for the treatment of hormonal acne. “These oral contraceptives are composed of ethinyl estradiol plus either the progestin norgestimate, norethindrone acetate, or drospirenone, which work together to alter levels and activity of hormones that can trigger acne,” explains Peredo. If you’re not on the Pill, you might want to ask your doctor if he or she recommends it to help stabilize your hormones and treat hormonal acne.

Antiandrogen drugs

“These oral therapies help reduce the amount of excess androgens (primarily male hormones) that can cause hormonal acne,” says Peredo. Antiandrogen drugs, such as the spironolactone pill, work by blocking androgen receptors to decrease the actions and effects of testosterone in the body. “When given at low doses, spironolactone works very well to improve cystic acne and decrease overall oil production in the skin,” says Levi.

Isotretinoin

A much stronger defense mechanism against breakouts is Isotretinoin (also known as Accutane, even though that specific brand was discontinued in 2009). Isotretinoin is a form of oral vitamin A (meaning it’s similar to a retinoid but taken orally) that reduces the amount of oil released by oil glands in your skin, helping it renew itself more quickly. “It’s used in the treatment of severe acne, and is usually given after other acne medicines or antibiotics have been tried without success,” Peredo explains. “Due to its strength and potential side effects, however, this treatment isn’t typically considered as a first solution, but it can be quite effective when other remedies aren’t working.”

Your doctor will likely ask whether or not you’re pregnant or trying to conceive in the near future before writing you a prescription for isotretinoin, as it’s been shown to cause birth defects. Peredo tells SELF, however, that taking isotretinoin in general will not affect your child-bearing potential for the future.

The bottom line: Hormonal acne is annoying but you don’t have to live with it. Work with your dermatologist to find a solution, which may entail a combination of over-the-counter and prescription treatments.

Related:

  • 7 Reasons You Have Adult Acne, and 7 Ways to Get Rid Of It
  • 4 Reasons You Have Big, Painful Pimples—And What To Do About It
  • 12 Common Face Bumps and How to Deal With Them

Menopause and Acne: Causes and Control

  • Oral medications. In addition to topical treatments, doctors may also prescribe oral medications such as antibiotics, low-dose oral isotretinoin (an acne treatment commonly known by the brand name Accutane), or spironolactone, an anti-androgen diuretic.
  • Self-Care Strategies for Menopausal Acne

    Maintaining a good self-care regimen is necessary for skin health throughout your life, but it is especially important for women experiencing the dual challenges of delicate skin and breakouts during menopause. Dermatologists recommend:

    • Daily cleansing. Wash your face twice a day with a gentle, nondrying cleanser followed by a light moisturizer.
    • Gentle approach. Harsh products and vigorous scrubbing are a definite no-no for mature skin that can be easily irritated or damaged.
    • No picking. Squeezing or picking at pimples must be avoided completely since skin, which becomes more fragile at menopause, may scar more easily.
    • No tanning.

    In addition to proper skin care, Prior encourages women to reevaluate their cosmetics collection. “Oil-based cosmetics can exacerbate the problems for skin that is already clogged with excess oil.” Look for water-based or mineral cosmetics to replace oily products and “take extra care to remove all traces of makeup when you wash your face,” she says.

    Acne in Menopausal Skin

    Menopause often comes with a plethora of skin changes which we have discussed in a previous article here. Sometimes, these changes include acne. It doesn’t seem fair to have to battle pimples, wrinkles and menopause symptoms at the same time, but please know that you are not alone.

    Clinical studies have shown that as much as 26.3% of women in their 40s and 15.3% of women aged 50 or older reported experiencing acne1. It is even common for women who have never had acne in their teens to be battling with breakouts for the first time as an adult. Dermatologists are even finding that acne in older women has been increasing for the last 10-20 years2. Adult acne is also much more common amongst women than men.

    If you are experiencing troubles with your skin, or you would simply like to see a youthful, healthy glow, be sure to give Dr. Rivers’ 15 day free sample kit a try. Developed specifically for his patients to reduce sun damage, dark spots and fine lines in mature skin, the free sample kit should be enough to make sure Riversol works for you.

    What Causes Acne in Older Women?

    Acne during and after menopause is most likely due to a combination of different factors, with hormonal imbalances being the main culprit. During both puberty and menopause, changes in hormonal levels lead to a relatively higher number of androgens (male sex hormones) than estrogens. As women start menopause, there is a steady decline in the production of estrogen by the ovaries while androgen levels remain the same3.

    Androgens stimulate the skin’s oil glands and hair follicles, and overstimulation can lead to acne. For some women, it may also be responsible for a deepening of the voice and the appearance of facial hair. Although most mature women with acne have normal androgen levels, it is recommended to check for any hormonal irregularities if you’re noticing acne later in life, especially in the case of cystic acne4.

    Besides hormones, there are a number of other factors that may trigger or worsen breakouts. There is solid evidence to support the theory that stress may trigger acne flare-ups. Studies have shown that stress stimulates the body to produce more pimple-causing androgens5. This explains why you may see more breakouts than usual during periods of stress. Although it may seem impossible at times, it is important to learn how to manage stress in life. At Riversol, our favorite activity to help us relax is yoga – that post-yoga glow is definitely not a myth!

    Do any of your parents or siblings have acne? If they do, it might indicate that you are more likely to get it. Research published by the American Academy of Dermatology has found that some people may have a genetic predisposition for acne6. Acne can also be a side effect of certain medications. If you notice that a medication is causing you to breakout or make the pre-existing acne worse, chat with your prescribing doctor.

    Sometimes, acne can indicate an underlying medical condition7. In this case, breakouts may clear once the medical condition is diagnosed and treated. It may also be possible for your hair and skin care products to be the culprit. Make sure to check that you are using products least likely to cause acne. These are often indicate that they “Won’t clog pores”, or are “Non-comedogenic”.

    Dr. Jason Rivers created Riversol, his line of non-comedic skincare with antioxidant ingredients. While he didn’t create the line specifically for acne, many customers have indicated success controlling breakouts while reducing the look of hyperpigmentation, fine lines, and visible signs of aging. You can try a 15-day sample completely free to be sure these products are right for your skin.

    Does Acne in Menopausal Women and Adolescents Look Different?

    Generally, the answer is yes. While teens usually get blackheads, whiteheads, papules or pustules, acne in adult women tend to be small, hard, tender cysts that commonly occur around the lower part of the face (chin, jawline and upper neck)8. These cysts last longer and can be unpredictable. In older women, it is common for acne and rosacea to go together.

    A subtype of rosacea (papulopustular rosacea) is characterized by a constant or persistent redness and bumps or pimples forming. According to Dr. Rivers, adult acne and rosacea require separate treatments, but they may overlap in more advanced cases. For example, oral antibiotics may improve severe acne and rosacea, but the dose needed for rosacea is much less than that for acne. If you want to learn more about rosacea, it’s causes and how to manage it we have a great resource here.

    Are There any Treatments out There That Can Help?

    Absolutely! Admittedly, it is tough to deal with aging skin and acne at the same time. But there is no reason to be disheartened. Although there is no single cure for acne, there are effective solutions out there for your complexion woes. Depending on the severity, you may find that a combination of different treatments is best.

    Most acne medications are developed for younger skin, and since acne in menopause is different than in adolescence, many of these won’t work as well in older women9. Some can have a harsh drying effect that may not be tolerated as well by older skin. Adult acne can also be more resistant to treatment and it may take several weeks or months for the treatments to show results, so patience is key10. Here are 8 solutions that have shown to be a great help for some individuals with adult acne:

    1. Topical Retinoids

      Retinoids are derivatives of Vitamin A that can tackle both acne and aging concerns. They comes in either topical gels or creams that are available by prescription. They treat acne by opening up pores, which helps prevent pimples and improves the absorption of other acne medications11. Retinoids also stimulate the production of collagen, reducing fine lines and wrinkles.

      Initially, retinoids can be harsh and very drying to the skin. In the first few weeks your skin might peel and flake, but panicking and giving up may be a big mistake. There are steps that you can take to minimize these undesirable side effects, such as starting out slowly so your skin can get acclimated to it, only applying it to dry skin (ideally waiting 20 minutes after cleansing), and applying a gentle moisturizer. Retinoids may not be suitable for your skin if you also have rosacea or very sensitive skin.

    2. Combination of Antimicrobials (Benzoyl Peroxide or Topical Antibiotics) with Retinoids

      Dermatologists often prescribe topical antibiotics to treat acne because they have both antimicrobial and anti-inflammatory properties. Benzoyl peroxide is an antibacterial medication that you can find over-the-counter in lower concentrations. Some research has shown that a combination of either topical antibiotics or benzoyl peroxide with retinoids are much more effective than just using a single treatment12.

    3. Oral Antibiotics

      Oral antibiotics can be effective for treating menopausal acne, especially for controlling severe flare-ups. However, many dermatologists have reservations about prescribing them for long-term use as the bacteria can become resistant, and render the medication useless.

    4. Hormonal Therapies

      The most effective treatment for adult acne is usually some form of hormonal therapy. For menopausal women, this means Hormone Replacement Therapy (HRT) or spironolactone, which controls the imbalance between androgens and estrogens in the body. However, not everyone is a good candidate for HRT. It is especially risky for women with a history of breast cancer, coronary heart disease, stroke, or active liver disease. It is best to discuss your personal risk factors with your doctor.

    5. Light Therapy

      Blue light therapy has been shown to lessen acne by reducing the acne-causing bacteria, P.acnes, and reducing the skin’s production of oil. Generally, a series of treatments are needed and the results do not last forever. You will need maintenance treatments several times a year13.

    6. Topical Vitamin C

      Incorporating skin care products containing vitamin C can help reduce the redness associated with acne14. As an added bonus, they also help build collagen, boost your sunscreen’s efficiency and brighten your skin.

    7. Chemical Peels

      A chemical peel is a non-invasive treatment that uses naturally occurring acids such as alpha hydroxy acid (AHA) or beta hydroxy acid (BHA) to exfoliate the uppermost layer of skin. It can help reduce redness, blackheads, whiteheads and clogged pores, but not so much cystic acne15. Azelaic acid is also a type of acid that is usually prescribed as a topical gel or cream to treat acne and rosacea.

      Besides professional peels at your dermatologist’s clinic, it may be helpful to incorporate lower strength at-home peels. You can readily find peel products over the counter with the most common forms being salicylic acid (BHA) or glycolic acid (AHA). These safe and effective Glycolic Peels can help you uncover a new layer of fresh and vibrant skin. They can also clear the pores which, when clogged lead to breakouts. The Riversol Exfoliating Glycolic Peel was formulated by Dr. Jason Rivers specifically to be gentle on sensitive skin prone to oiliness or breakouts.

    8. Diet

      Let’s start with the bad news. It may be time to avoid your favorite cheese or ice cream. Dr. Rivers advises those who struggle with breakouts to avoid dairy products and foods with a high glycemic index. The glycemic index is a ranking of carbohydrate-rich foods based on how fast they raise blood sugar levels. The good news is that you can eat chocolate and greasy food without feeling guilty! Although you may want to eat less greasy food for health’s sake, there is no scientific evidence that links both chocolate and greasy food with acne16.

    Conclusion

    Coming to terms with adult acne is difficult, not to mention the wrinkles and lines that are simultaneously starting to deepen. There are plenty of reasons you can get breakouts well into your 40s, 50s and even 60s. Hormonal changes, stress, genetics, just to name a few, are possible culprits. It is usually hard to narrow down acne to a single cause, and likewise, it is also difficult to get rid of it with just a single treatment. If you’ve tried over-the-counter acne creams with no luck, it may be best to see your family doctor or dermatologist. There is no reason to have to endure acne, and as we have discussed, there are so many effective treatment options available. If you have any questions at all, please don’t hesitate to contact us.

    1. American Academy of Dermatology. “Women More Likely Than Men To Be Affected By Acne As Adults.” ScienceDaily. ScienceDaily, 20 October 2007.
    2. American Academy of Dermatology. “Hormonal factors key to understanding acne in women.” American Academy of Dermatology. 13 Mar. 2012.
    3. Meisler, Jodi Godfrey. “Toward Optimal Health: The Experts Discuss Facial Skin and Related Concerns in Women.” Medscape. n.d.
    4. Meisler, Jodi Godfrey. “Toward Optimal Health: The Experts Discuss Facial Skin and Related Concerns in Women.” Medscape. n.d.
    5. American Academy of Dermatology. “Adult Acne.” American Academy of Dermatology. 2017.
    6. American Academy of Dermatology. “Adult Acne.” American Academy of Dermatology. 2017.
    7. American Academy of Dermatology. “Adult Acne.” American Academy of Dermatology. 2017.
    8. Brandith, Irwin. “Menopause and Acne.” Skintour. Skintour, n.d.
    9. Brandith, Irwin. “Menopause and Acne.” Skintour. Skintour, n.d.
    10. EveL. “Menopause and acne: Everything you need to know.” Lifeclimax. 30 Mar. 2014.
    11. Addor, FA, and S Schalka. “Acne in Adult Women: Epidemiological, Diagnostic and Therapeutic Aspects.” An Bras Dermatol 6.85 (2010): 789=95.
    12. EveL. “Menopause and acne: Everything you need to know.” Lifeclimax. 30 Mar. 2014.
    13. Brandith, Irwin. “Menopause and Acne.” Skintour. Skintour, n.d.
    14. Meisler, Jodi Godfrey. “Toward Optimal Health: The Experts Discuss Facial Skin and Related Concerns in Women.” Medscape. n.d.
    15. Brandith, Irwin. “Menopause and Acne.” Skintour. Skintour, n.d.
    16. Burris, J, W Rietkerk, and K Woolfe. “Acne: The Role of Medical Nutrition Therapy.” J Acad Nutr Diet. 3.113 (2013): 416–39.

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    Dr. Graf is a Board Certified, Clinical and Research Dermatologist and Assistant Clinical Professor of Dermatology at Mount Sinai Medical Center in New York, NY. She is widely respected for her expertise and objectivity.

    Many of our lovely customers come to us for help with skin care challenges related to perimenopause and menopause: Estrogen levels that fall while androgens stay constant can lead to a variety of unwelcome changes, ranging from acne that’s reminiscent of the teen years to wrinkles that seem to have settled in overnight. We thought a guide to some of the most common menopause-related skin changes, and the best approaches to their treatment, was long overdue. We approached top dermatologist Jeannette Graf, MD, for expert advice on the topic.

    Ayla: Generally speaking, when do you find that women begin to experience skin changes related to menopause?
    DR. GRAF: Well, it begins with perimenopause, which often starts sometime in your mid-forties and lasts for 3-4 years. Perimenopause is very different from menopause: Periods might become irregular at this point, but you still have estrogen. During perimenopause, you’re getting hot flashes, so you might find that your skin gets red. You might also have breakouts, and skin that was previously balanced might start to get dry or oily patches. Sometimes women experience rosacea at this point, too.

    Once women reach menopause, things change again. If you go on estrogen therapy (which is typically not considered until you’ve lost your period for 6 months), you won’t experience a lot of skin-related shifts. If you don’t go on estrogen therapy, your skin will get quite dry. Skin also becomes thinner in menopause, since there’s a relationship between collagen production, skin thickness, and lack of estrogen. The natural slowdown of cell turnover and decrease in humectants in the skin exacerbates the dryness, too.

    Ayla: Are these shifts gradual, or do they occur all at once?
    DR. GRAF: It’s an ongoing change. Some people will notice it overnight, others more gradually. But it happens. The problem is that hormone replacement therapy — which would alleviate many of these issues — works very nicely, but a lot of times, transdermal estrogen is administered as a treatment for menopause, and not everyone is a candidate. In the future, perhaps we’ll have the ability to use estrogen on skin without fear of worsening cancer risks.

    Ayla: What do you most often recommend to address skin changes during perimenopause and menopause?
    DR. GRAF: For acne, I often put women on spironolactone, especially during perimenopause. It’s a fabulous androgen blocker — in this case, acne often occurs because estrogen levels are starting to decrease while androgens stay constant. I also recommend taking high amounts of flaxseed oil, which is a great anti-inflammatory (and acne is an inflammatory condition).
    As far as other acne treatment products are concerned, you want to be as gentle as you can. Take care to use non-drying products, because most acne products can be drying. Salicylic acid cleansers are good. However, the kinds of breakouts you often get at this point are not necessarily best treated with topical products. Sometimes they’re under cysts, and that’s when spironolactone helps.
    Ayla recommendations: Check out Marie Veronique’s Treatment Cleanser, Treatment Mist, Treatment Serum, and Treatment Oil, all designed to address acne prone skin without drying it out. We carry Marie Veronique’s acne book, too!

    Once menopause arrives, there are three things I usually recommend:

    Retinoids. Whether you use retinol, retinaldehyde, or tretinoin, once any form of vitamin A gets into the skin, it interacts with an enzyme that creates transretinoic acid, which then binds with about 52-57 different types of DNA, repairing skin and stimulating collagen production. It’s safe, and as long as the treatment you choose doesn’t dry you out, it’s fine to use it for an extended period of time.
    Ayla recommendations: Marie Veronique’s Gentle Retinol Night Serum is one of our best sellers. It boasts a whopping 7% microencapsulated retinol along with anti-inflammatories for great results without irritation.

    Peptides. These will also stimulate collagen production and boost skin’s elasticity, which is important as skin becomes thinner and starts to sag. I think peptides are great as you age and suggest them for anyone over 50.
    Ayla recommendation: We love Luzern’s Firming Collagen Booster serum, which is rich in peptides as well as hyaluronic acid and glycerin (which Dr. Graf mentions next).

    A really good, rich moisturizer. Something with hyaluronic acid or glycerin will be particularly helpful at easing the dryness that many women experience with menopause.
    Ayla recommendation: One of our best sellers is the super hydrating but non-comedogenic BioRecept LycOconfort de Peau, which is rich in hyaluronic acid and a variety of other great anti-aging ingredients.

    It’s also not a bad idea to do a gentle at-home peel twice a week to remove dead skin cells, brighten, and allow products to more easily penetrate the skin.
    Ayla recommendation: We think The Organic Pharmacy’s Enzyme Peel Mask is delightful.

    Ayla: What other specific concerns are often raised during menopause?
    DR. GRAF: In addition to acne, dryness, and the thinness, sagging, and wrinkling that’s related to the loss of collagen, I often see the following:

    -Flushing can occur due to rosacea or skin reactivity. Some of it is related to vasodilation. There are a lot of good anti-redness products on the market that work well, and I typically treat rosacea symptomatically.

    -Increased sensitivity happens as we age and the natural lipids in our skin diminish. Studies show that, after the age of 50, the pH level of our skin gets higher. There’s a certain level (5.4) where the pH of our skin allows for optimal operation of our microflora and defensive cells. As the pH level climbs, those cells are less able to help defend the skin and we’re more prone to rashes, sensitivity, and dermatitis. It becomes important to repair the skin’s moisture barrier with good, effective emollients.

    -Scraggly facial hair can start to appear due to the imbalance of estrogen and testosterone. Electrolysis is the best treatment for this.

    -Hyperpigmentation can sometimes be more of an issue because skin is thinner, and you’ve had more chronic sun exposure at this point. You might have had lots of tans or burns in the past, so you have a lot of melanin in your skin and get darker more easily. Retinoids can help with this, too.

    Ayla: Is it true that menopausal skin changes are more visible on the face than on the body?
    DR. GRAF: Possibly, and facial skin is very hormone-rich. But we also dry out on our bodies way before menopause. For the body, I love extra-virgin coconut oil as a moisturizer. There’s tons of literature about it. It’s solid at room temperature and melts on the skin, and it’s very nutritious when ingested, too. Although it’s a saturated fat, its lauric acid content seems to cause it to have an opposite effect in heart disease.

    Ayla: Speaking of nutrition, what do you recommend in terms of dietary changes?
    DR. GRAF: The healthiest diet is a colorful, Mediterranean diet with lots of water with lemon, few processed foods, and very little sugar. I’m also not a big fan of dairy. A lot of cows are treated with hormones; there’s also a lot of allergy associated with milk, and it’s mucous-y. I’d substitute coconut milk.
    I generally advise supplementation through food, but I think vitamin D3 is the most important supplement and we often underdose it. I think a minimum of 5000 IUD is important for keeping skin firm, supporting its repair mechanisms, and activating its anti-microbial systems.

    Ayla: What about vitamin E, which is often suggested for menopausal women?
    DR. GRAF: It’s good, but I’d say vitamin D is the more important supplement. And I don’t suggest taking vitamin E out of a capsule and putting it on the skin, since that can cause contact dermatitis. However, you can do that with evening primrose oil, which is great for the skin.

    Ayla: What else do you wish more 50+ women knew about skincare?
    DR. GRAF: I’d reiterate the ones I mentioned earlier — at night, you need to use a retinoid to keep skin firm (I often hear complaints that their pores are too large, which is due to lack of firmness) you should use a peptide product to boost collagen. And you need to keep skin moisturized.
    Aside from that, you need to wear sunscreen every single day, including during the wintertime.
    And other products that stimulate the skin are wonderful. Products with lactic acid are great, and I love antioxidant serums for daytime, under moisturizer and sunblock. That’s a great companion regimen to a nighttime routine of retinol or peptides under a good moisturizer.

    Ayla product recommendations:
    Marie Veronique Treatment Cleanser, a wonderfully refreshing, creamy cleanser for acne-prone skin
    Marie Veronique Gentle Retinol Night Serum, a serum with 7% microencapsulated retinol
    Luzern Labs Firming Collagen Booster Serum, a peptide-rich wonder serum
    Luzern Labs La Defense SPF 30, our favorite sunscreen
    Marie Veronique + Kristina Holey Intensive Repair Serum, which contains lactic acid
    MyHavtorn Organic Face Oil, which is rich in antioxidants and great for rosacea-prone skin
    MyHavtorn Organic Face Cream, a customer favorite that’s also antioxidant-rich
    Luzern Labs Force de Vie Crème Luxe and Crème Intensive, multi-benefit anti-aging creams that our customers adore
    37 Extreme Actives Extra Rich, which features peptides, antioxidants, and humectants, all in one jar

    Ayla: Will starting an anti-aging regimen early prevent some of these problems?
    DR. GRAF: It can prevent a lot of them and slow a lot of them down. So will having a diet that is healthy, and taking care to keep skin moisturized. But at end of the day, estrogen is estrogen!

    About Dr. Graf: Jeannette Graf, MD is an Assistant Clinical Professor of Dermatology at Mount Sinai Medical Center in New York, NY and a Board Certified, Clinical and Research Dermatologist with a private practice in Great Neck, New York. While at the NIH, Dr. Graf was one of the first doctors to work with peptides, earning a NIH patent in 1987. She continues to research innovative technologies and has been published in several scientific journals. Widely respected for her expertise and objectivity, she is regularly called upon to forecast on dermatology and cosmetic trends, and she’s a frequent guest on TV programs like The Dr. Oz Show, The View, Good Morning America and The Early Show on CBS. Dr. Graf is also the author of the best-seller Stop Aging, Start Living. Learn more about Dr. Graf’s impressive background here.

    Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.

    How Does Menopause Affect your Skin

    Menopause is an incredibly complicated process that all women endure as they reach middle age. For some, symptoms appear to be a mere end to the monthly cycle. For others, it is a difficult process that can last for a few years and cause a variety of changes.

    Menopause not only affects the internal body, it affects the skin as well. But before we look at menopause and the affect it has on skin, let’s discuss the changes to a woman’s hormones during menopause.

    What Happens to Hormones During Menopause?

    Hormonal changes and declines, as well as the slowdown in ovarian activity (which includes the decrease in B-Estradiol levels), cause many of the changes we see associated with menopause. Hormones can cause hot flashes, which are intense feelings of warmth in the skin, particularly of the face, accompanied by profuse sweating. In addition, the adrenal glands and ovaries of post-menopausal women secrete increased androgens. These hormones, in the absence of estrogens, cause some menopausal symptoms such as voice deepening, enlargement of the clitoris and appearance of facial hair.

    Menopause and the Skin

    So what does this have to do with the skin? A lot. The hormonal changes that occur during and after menopause tend to change the skin’s physiology in new and different ways.

    We know that the decline of B-Estradiol during menopause is one of the culprits in the accelerated aging of the skin. We also know that menopause is mostly caused by age-related changes in the ovaries, and the number of follicles remaining in the ovaries of menopausal women is significantly reduced. In addition, the follicles that remain become less sensitive to stimulation by pituitary hormones, even though their levels are elevated, resulting in fewer mature follicles and a reduction in the production of corpora lutea. This results in lowered estrogen and progesterone production, which in turn leads to changes in the skin.

    As a woman gets closer to menopause, the following changes begin to occur in the skin:

    Oily Skin: During the reproductive years, B-Estradiol stimulates a more fluid sebaceous gland secretion (“anti-acne” effect). During menopause, as estrogen levels decrease, testosterone (produced by the adrenal glands) is no longer masked in the woman’s body. Testosterone reveals itself by stimulating sebaceous glands to secrete thicker sebum, giving the appearance of oily skin (and the tendency toward adult acne in some women).

    Tip: Try Breakout Control to control excess sebum without drying effects.

    Facial Hair: Also due to the unmasking of testosterone, some women may develop facial hair, particularly in the chin area.

    Sagging Skin and Wrinkles: “>Estrogens stimulate fat deposits over the female body; as estrogen levels drop during menopause, fat deposits tend to become redistributed and often concentrated over the abdomen and/or on the thighs and buttocks. The result is a loss of supportive fat below the skin of the face, neck, hands and arms; this allows sagging wrinkles to appear, and the skin over these areas is less easily compressed, as it loses its mobility. Also, fat deposits are reduced in the breasts, resulting in loss of turgor, which causes the breasts to begin to sag and flatten.

    Tip: Try Extra Firming Booster to treat sagging skin on the face and neck.

    Elastosis: Protein synthesis, particularly that of collagen and elastin, are partially controlled by estrogens. Thus, during menopause, the lowered estrogen levels result in less production and repair of collagen and elastin in the dermis of the skin. This lack of repair is particularly pronounced if the skin is exposed to ultraviolet (UV) rays. UV rays are very destructive to collagen, and if we lose our repair mechanism, then we lose our skin’s resiliency. This results in elastosis.

    Thinning Epidermis: The growth and maintenance of blood capillaries in the dermis are partially under the control of the estrogens. Thus, blood flow through the dermal capillaries is reduced during menopause, and less nutrients and oxygen are available to the Stratum Germinativum or Basal Cell layers of the epidermis. This contributes to the thinning of the epidermis and a slower cell turnover rate, which is accompanied by a reduction in the barrier function of the epidermis, leading to increased trans-epidermal water loss and dry skin.

    An interesting note, the cells that make up the surface of the skin are similar in structure to those of the urinary tract and vagina. Often times when a woman begins to notice changes in her skin (wrinkling, sagging, dryness, flaking, loss of resiliency, etc.), there are similar changes occurring in the lining of the urethra, bladder and vagina. Thus, the skin may be revealing other tell-tale signs of menopause.

    More Prone to Sun Damage: The maintenance of Melanocytes (cells that manufacture the pigment Melanin) is under the control of estrogens. As menopause progresses, the number of melanocytes in the skin is reduced (they degenerate). With less melanocytes, we produce less of the protective melanin and skin appears lighter. Menopausal skin is, therefore, more prone to sun damage, making it even more important to protect the skin with a sunblock.

    Tip: Try Dynamic Skin Recovery SPF50 to protect from sun damage.

    Hyperpigmentation / Age Spots: Estrogens also temper melanin production. That is, estrogen exerts a regulatory effect on the production of melanin; it keeps it under control. In areas of the skin that have been exposed to UV rays over the years, as menopause arrives, melanin synthesis increases (due to lack of regulation by estrogen). This can result in brown “age spots” appearing on the face, hands, neck, arms and chest of many women.

    Tip: Try C-12 Pure Bright Serum to treat hyperpigmentation.

    Hot Flashes: Hot flashes are typically defined by a strong sense of warmth in the skin, (mainly the face), followed by excessive sweating. It had long been thought that hot flashes were caused directly by the abrupt lowering of B-Estradiol levels, but we now know that a woman’s sympathetic nervous system is more active after menopause because of low estrogen, causing the dilation of skin arterioles and sweating, as well as the rise in body temperature and an increase in heart rate. Hour-to-hour changes in the secretion of the Luteinizing Hormone (LH) from the pituitary gland of post-menopausal women have also been associated with hot flashes.

    Tip: Try Antioxidant HydraMist to refresh and firm the skin.

    Other Symptoms of Menopause

    Menopause affects much more than the skin. Some possible internal symptoms can include dizziness, numbness, heart palpitations, insomnia, backaches and dry mouth, among others.

    About 85% of women have menopausal symptoms both before and after they reach it; the occurrence and intensity of symptoms vary from woman to woman. For most, these symptoms stop within a year, but for some, symptoms can last as much as three years or more.

    For more information, read Skin Care Tips for Aging Skin.

    So many of us women are in or approaching that menopausal, or maybe we should call it period-free (sounds much better, don’t you think) time of life, that I wanted to give you some information on menopause and acne, oily skin, and generally mature skin.

    Change of life acne is pretty common. It often starts a year or two prior to actual cessation of our periods. Acne evolves during our lifetime, and the acne we have around menopause in our 40s-50s is usually concentrated around the jawline, chin, and sometimes the upper neck – a normal pattern for this age. It is less common in the T-zone.

    Also, acne around menopause tends to be deeper, i.e., not surface plugs (comedones), small pustules, or red bumps. Neither is it the big cysts (nodulocystic) that teens have. Instead it is usually deep, small, often tender cysts and sometimes called microcystic acne. And, no surprise, it is related to hormones.

    (For more information on skin care and menopause or perimenopause, see Dr. Irwin’s article Menopause and Skincare. For more information on acne in general and at all ages, see Dr. Irwin’s detailed article Acne in Depth.)

    Here is a good general rule when deciding on acne treatment options: the more superficial the acne, the more likely topicals will be effective. The deeper the acne (as in the small tender cysts common in menopause), the more likely you are to need something to take orally, either alone or in combination with topicals.

    If you have mostly the deeper cysts, topical treatment won’t help much because the creams, lotions, etc can’t really get down to the level of the problem.

    Treatment Options for Menopause and Acne

    The main treatment options for acne in menopause are:

    • Topicals that are over-the-counter
    • Prescription topicals
    • Oral prescription medications

    Let’s take non-prescription or over-the-counter topicals first.

    Most of the non-prescription drugstore medications for acne are formulated for oily, teenage skin and tend to be too irritating or drying for the mature skin of our menopause years. If you have very oily skin still, they might be fine.

    If you’d like to try the drugstore route first for acne in menopause, then look for the acne products that say they are for sensitive skin. Also, many of these products contain benzoyl peroxide which can work well but also stains pillow cases and clothing, so be careful. If your skin tends to be dry, you might want to test any product that has benzoyl peroxide, or save it for spot treatments.

    Now for prescription topicals.

    I still think the gold standard is Renova or the generic tretinoin. Renova is better, in my opinion, even though it’s more expensive, because it’s formulated in a moisturizing base that doesn’t irritate mature skin. But if you’re very oily, you might do fine with generic tretinoin, which is cheaper. Renova unplugs clogged pores, causes natural exfoliation, and has an anti-wrinkle and anti-skin cancer effect. It’s hard to beat.

    Also well tolerated by mature skin are creams/gels based on azeleic acid like Azelex or Finacea. Clindamycin (a topical antibiotic) tends to also be friendly to mature skin. You’ll see lots of acne medications with benzoyl peroxide in them. For menopausal skin with acne, I would save anything with benzoyl peroxide in it for spot treating.

    And last, oral medicatons available by prescription.

    Because these are available only by prescription, you’ll need to discuss these with your doctor.

    Really there are 3 options – oral contraceptives, oral antibiotics, and spironolactone. In general, oral contraceptives aren’t recommended for women over 35. But your doctor can discuss this with you because there are now some very low dose options for some perimenopausal women.

    I don’t usually recommend long-term oral antibiotics use for the reason that it changes the balance of our healthy intestinal bacteria and can also breed antibiotic resistance.

    Spironolactone can be a good choice. It has been around for 30+ years and has a good safety profile. It reduces our “male” hormones (androgens) just slightly but keeps them in the normal range still. This is often enough to control menopausal acne. It has the nice side effects of lowering blood pressure a little and preventing pre-period bloating. You won’t be happy on this if your blood pressure runs very low. Talk to your doctor to see what might be best for you.

    See Dr. Irwin’s expert answers to other reader’s questions on Acne and Menopause:
    How do I sort out a complex product problem and acne?
    What can I do about post menopausal acne?
    Mature Skin and Acne (#2)

    Winning question

    I am currently going through the peri-menopause and my skin is suffering. I have breakouts on my chin when my period is due, and I suffer from hard almost under-the-skin spots around my jawline. I have always looked after my skin; I drink water, exercise regularly and eat a largely organic diet. I exfoliate once a week. My skin is fairly sensitive and it can be prone to dryness across my cheekbones, but I also have a fairly oily T-zone.
    Sian Weston

    So many people send letters about adult acne, teenage acne, post-coming-off-the-pill acne and stress-related skin breakouts. I asked Dr Dennis Gross, a Manhattan dermatologist, creator of MD Skincare, and Dr Howard Murad, LA dermatologist and pharmacist, to look at your question specifically. These days it is not considered right to dry out skin problems, new products hydrate as well as treat the skin and almost every dermatologist line has acne products or are developing one. Apart from the odd product I come across that I am impressed with, such as Visibly Clear Gentle Exfoliating Wash (£3.99, Boots), these are two men whose opinion I rate. Dr Gross says: ‘Peri-menopausal hormonal changes/fluctuations may change the oil-chemistry of the skin, which can lead to adult acne. Acne is brought on by one’s own oils being too heavy. Genetics plays a large part as well. Tap water can also be a factor depending on a city’s calcium and magnesium levels.’

    According to Howard Murad, oestrogen levels start to decline in the years prior to menopause and this decline can contribute to breakouts as androgen levels become more dominant.

    ‘This is a good time to utilise skincare products that contain plant-based, or phyto-oestrogen products that may contain soy extract, clover flower extract or wild yam extract for example,’ he says.

    Dennis Gross recommends looking for products that contain Bisabolol, an active ingredient derived from chamomile extract that helps soothe redness and reduce inflammation. ‘Salicylic acid is also a good ingredient and so is sulphur, which controls the oil that feeds the bacteria. I also recommend using products that contain a chelator that blocks the action of calcium and magnesium. Over-the-counter (OTC) products are usually very simple formulae using benzoyl peroxide or salicylic acid. Trial and error with OTC products is usually quite simple because there are only two active ingredients so there is very little difference between the majority of the products out there.’

    ‘Breakouts in peri-menopause are common in the lower part of the face,’ says Howard Murad. ‘Using a spot treatment that has sulphur and salicylic acid immediately and a few times per day, will reduce the inflammation and often stop the breakout from getting worse.’ (Try MD Skincare All-Over Blemish Solution, £21.45 for 75ml, Selfridges or Dermalogica’s Special Clearing Booster £31.80 for 30ml, stockists: 0800 591818 ).

    ‘The problem with many OTCs,’ says Gross, ‘is that they are very drying. Treatment for adult acne has to be consistent and prevention is really the best step because it is important to realise that a blemish can begin to form up to three weeks before it appears on the surface of the skin.’ Interestingly, Howard Murad also suggests you reduce the intake of shellfish or iodine rich foods, ‘as iodine has been shown to have a direct link to acne breakouts’.

    Dr Gross suggests that it is time to see a dermatologist about adult acne ‘when OTC products are failing to improve your condition or if you have scarring from acne in the past, painful bumps above or below the skin, pimples that last for weeks or leave red marks behind, or acne that is getting worse and not better.’ You might also look at an at-home tool called the Zeno (www.myzenoeurope.com, £129, see Beauty Testing) which is a hand-held device clinically proven to trigger a heat shock response in the micro-organisms that cause skin lesions. A new and even more high-tech version of this gadget is due to launch in spring 2008. Laser treatments are another option although an eminent dermatological surgeon friend tells me that currently none of the lasers comes close to medical treatment for acne.

    Murad Resurgence Brand and Murad Blemish Spot Treatment and consultations , treatments and mail order available from www.thepeachtreeclinic.co.uk; MD Skincare® acne collection is available at Harvey Nichols and Space NK.

    I am over 50 and use Mary Kay’s Time Wise Age-Fighting moisturiser but would like a change – my pigment does need evening out.
    Janet Marsh

    I think it’s a good idea to have a change and at over 50 you need more than just a daily moisturiser to give your skin a lift. You need a good, richer, moisturiser to nourish your skin – Neutrogena Ultimate Moisture Cream (£ 6.99, 50ml) is a very good one. But if you want to even out your pigment you need something more hard-hitting. You could try Shiseido’s White Lucency Refining softener (£68 for 150ml, stockists: 020 7313 4774) under your moisturiser or try Biotherm’s White Detox Lotion (£19.50) and White Detox Essence serum (£42, stockists: 0800 037 1020) which are designed to even out skin tone. (Incidentally, I’ve just been in Korea and these products were voted favourites by magazine readers there.)

    Kathy’s hot products of the month

    This is the time of the year to try a new fragrance. Diptyque’s coffret of Quatre Eaux de Toilette gives several great options (£50, 020 7727 8673) and Fendi’s new deep sexy scent, Palazzo, (90ml, £50, Selfridges) has a fabulous bottle too.

    Kathy Phillips is beauty director of Condé Nast Asia. Author of four books, she has her own critically acclaimed aromatherapy range, This Works.

    If you have a beauty question, email [email protected] The best one receives a product from This Works, Kathy Phillips’s range (www.thisworks.com)

    This article contains affiliate links, which means we may earn a small commission if a reader clicks through and makes a purchase. All our journalism is independent and is in no way influenced by any advertiser or commercial initiative. By clicking on an affiliate link, you accept that third-party cookies will be set. More information.

    If you’ve got acne in your 40s we could have the answer to your problem

    Diet (15%) and pollution (12%) were also named by experts as causes of adult acne. Dr Terry Loong, cosmetic doctor, hormonal expert and author of The Hormonal Acne Solution, says triggers include:

    A high-sugar diet: Sugar is inflammatory and increases oil production by converting testosterone (a male hormone which governs the oil our skin produces) to a more potent dihydrotestosterone.

    Not so sweet: Sugar can inflame your skin (Image: Science Photo Library)

    Stress: Increased cortisol – the stress hormone – increases blood sugar, inflammation and blood pressure. It also affects gut health, affecting digestion and nutrient absorption. Stress can also increase wear and tear of skin cells and impact skin repair.

    An unhappy gut: The official term is gut dysbiosis – the gut may be over-populated by bad bacteria so nutrient absorption is affected, leading to leaky gut syndrome, allergies or breakouts. This can occur because of antibiotics, illness or a bad diet.

    Food sensitivity: Food intolerance caused by a genetic tendency or gut dysbiosis can trigger acne, skin rashes, aches and pains, foggy brain, excessive phlegm and disturbed sleep. Common acne culprits include dairy, gluten, caffeine, alcohol and peanuts.

    Pollution:Exhaust fumes and toxic chemicals can lead to inflammation, pore blockage and a higher acne risk.

    Bad air: Pollution can increase acne risk (Image: SUNDAY MERCURY)

    Hormonal imbalance: Fluctuations during the menstrual cycle, pregnancy and around the menopause have all been linked to acne. Women who suffer with polycystic ovary syndrome are also more prone. They have higher levels of testosterone, which increases sebum, leading to coarser hair growth so follicles are likely to get blocked.

    Medication: Drugs including ­corticosteroids, anticonvulsants, lithium, barbiturates, androgenic ­steroids, DHEA and medication with bromides or iodides can cause acne.

    Vitamin D deficiency: This is an intracellular hormone that affects the balance of other hormones. When it is low, it can affect immunity, including how skin repairs itself and fights off bacteria. It also suppresses sebaceous gland activity and oil production.

    What to do

    “Acne usually gets better over a year or two, so the first line is to suppress the inflammation until the acne disappears,” explains Dr Adam Friedmann, leading dermatologist at The Harley Street Dermatology Clinic. “The more severe the disease, the stronger ­the medication required.”

    Discuss medication and whether the contraceptive pill might help with your doctor if you have hormonal acne. It’s worth asking to be referred to a ­dermatologist, but this can be tricky on the NHS. To go private, see the British Association of Dermatologists (www.bad.org.uk).

    Acne types and treatment

    “Acne is a complex process involving the blocking of the pore with ­impurities, excessive oil, inflammation, P. acne (Propionibacterium acne) bacteria and a sluggish skin turnover,” explains Dr Loong. Adult acne occurs on cheeks (81%), chin (67%) and the jaw (58.3%).

    The main spot types

    Comedones

    These are follicles clogged with oil and dead skin cells and they can develop into whiteheads and blackheads.

    Treatment: Retinoid gels or creams. “For whiteheads, look for benzoyl peroxide and salicylic acid in a product. But prescription antibiotic gels and creams work best if topical creams don’t work,” explains Dr Friedmann. Look for the words non-comedogenic (non-clogging) on labels when choosing make-up and creams.

    Breakout: Acne doesn’t end with the teenage years (Image: Getty)

    Papules and pustules

    Papules are comedones that have become inflamed, forming a sore small red or pink bump. Pustules resemble a whitehead with a red ring around the bump with white or yellow pus.

    Treatment: Use products with anti-inflammatory ingredients such as tea tree oil or benzoyl peroxide to reduce inflammation. And consider taking a contraceptive pill like Yasmin. A low-dose long course of antibiotics, such as tetracycline, may be prescribed.

    Nodules and cysts

    Nodules are large, inflamed bumps that feel firm. They develop deep in the skin and can be painful. Cysts are large, pus-filled, painful lesions.

    Treatment: Ask to be referred to a dermatologist. “If the nodules and cysts are big, treat them aggressively with a retinoid to reduce the likelihood of scarring,” advises Dr Friedmann. “A combination of antibiotics and topical treatments is the first option for severe acne. But if you have a big occasion coming up, a cortisone injection can quickly reduce swelling and redness.”

    Most dermatologists would prescribe a drug called isotretinoin for severe nodules and cysts.

    Take action: Exercise can unblock your pores (Image: Getty)

    Top tips to zap zits

    Dr Jonathan Bowling, consultant dermatologist at The Nuffield Health Manor Hospital, Oxford says:

    Exercise: It can help unblock your pores by making you sweat. Wash after exercise before the sweat dries.

    Eat right: Too much sugar, dairy and refined carbohydrates can make acne worse. Almonds, blueberries, avocados and kidney beans are among a range of foods which may help to reduce and to prevent inflammation.

    Get some rays: Just 15 minutes of sun a day could help treat the symptoms of acne. However, any longer and the drying effects could block pores further.

    Drink lots of water: It’s essential for liver function which controls hormone production.

    What is hormonal acne and how do you treat it?

    Whilst it’s often thought of as merely a teenage problem, acne can strike at any age.

    In your teens, acne usually rears its head on the T-zone, whereas adult acne generally manifests more across the cheeks and jawline.

    Whichever type of acne you may suffer from though, it can have a debilitating effect on your self-esteem. After all, you can’t hide your face.

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    In fact, a recent study by the British Association of Dermatologists found that 54 per cent of British adults who have ever experienced acne feel that it has had a negative impact on their self-confidence.

    John Anastasiou, President and CEO of Frezyderm, said: “As a condition which has an impact on how we look, acne can have a big emotional toll.

    “If we are unhappy with our appearance then this can often spill into other areas of our lives, for example the 19 per cent of those who’ve ever had acne who felt that their acne had negatively affected their romantic relationships.”

    Their research found that 48 per cent of people report having acne at some point in their lives, and 19 per cent have had it over the age of 25.

    Many people claim that they get spots after eating too much chocolate or greasy food, but acne is actually caused by our hormones.

    “Fundamentally, all acne is hormonal,” consultant dermatologist at Skin55 and author of The Skincare Bible, Dr. Anjali Mahto told Refinery29.

    “Skin concerns can often be attributed to hormonal changes that take place during the course of one’s life, and there are certain periods, namely puberty, pregnancy and the menopause, where this holds particularly true. Hormones can wreak havoc on the skin in a rather unpredictable manner during these times.”

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    How this works is hormones known as androgens (such as testosterone) increase the production of sebum which can lead to pore-blocking and thus spots.

    The sebaceous glands of people who get acne are particularly sensitive to normal blood levels of certain hormones, which cause the glands to produce an excess of oil. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles.

    Everyone has acne bacteria, but it’s only in certain unfortunate people that the build-up of oil creates an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of red or pus-filled spots.

    Dr Mahto says that around two-thirds of women who suffer from acne will notice it worsening in the run-up to their periods because their androgen levels are higher at this time.

    There’s no one way acne can appear either – it might be red cysts, pus-filled spots (pustules) blackheads or whiteheads (together known as comedones).

    When it comes to treating acne, there are various different approaches you can try, and what works for one person may not work for another.

    If you have severe acne, over-the-counter treatments are unlikely to be sufficient so you need to go and see a GP who may refer you to a dermatologist.

    Of the prescribed treatments, there are three main options: antibiotics, hormone therapy and roaccutane.

    Antibiotics

    Whether a topical cream/ointment or a tablet you take on a daily basis, taking antibiotics should kill the bacteria associated with inflamed acne.

    Antibiotics are also often combined with other treatments options such as retinoids or benzoyl peroxide.

    Common oral antibiotics for acne include tetracycline, oxytetracycline, doxycycline and lymecycline. Common topical antibiotics for acne include clindamycin and erythromycin.

    Hormone therapy

    Hormone therapy is a treatment option offered to women and girls who have started their periods – the most common way to take it is through the combined contraceptive pill. Certain forms of the pill, such as Yasmin and Dianette, are thought to be better for combatting acne, however your doctor may advise not taking them for more than nine months due to increased risk of blood clots.

    By taking the pill, you can reduce the amount of hormones in the body that are associated with causing acne ie. reducing testosterone and possibly increasing oestrogen, which encourages the skin’s oil glands to produce less sebum.

    However as with anyone taking the contraceptive pill, side effects can include swelling, tenderness, mood changes, reduced libido and nausea.

    Roaccutane

    Also called isotretinoin, roaccutane is often seen as a last port of call when less severe acne treatments haven’t worked. It can only be prescribed by a dermatologist in the UK but is highly effective.

    Roaccutane stops the sebaceous glands producing so much oil and increases the shedding of dead skin cells, however this can lead to dry, cracked skin as a side effect while undergoing treatment.

    Not all patients need to take a heavy dose though and most find that after six months of treatment their acne has cleared up and doesn’t come back.

    If you are interested in treating your acne, see the Acne Support website and make an appointment with your GP

    Why Age-Related Changes Are Making You Breakout

    It happens—one day you’re cruising through your 30s, not worried about the pimples and breakouts of your youth—and the next day, bang, a massive breakout. Some women in a certain age group, think Xennials and even some Millennials, are experiencing the early onslaught of dreaded menopause and it’s wreaking havoc on our skin. If you’re dealing with the kind of breakouts that give you flashbacks to life before junior prom, here’s what’s going on.

    You May Also Like: Does Hormone Therapy Fight Wrinkles Too?

    What Is Perimenopause?
    Harrison, NY dermatologist Jennifer S. Kitchin, MD says it’s those pesky male hormones doing a number on us: “Most people don’t realize that women have testosterone, the ‘male’ hormone, in their bodies. The level is low, but during menopause, as levels of the female hormones are shifting, the testosterone levels proportionally increase.”

    According to Bloomfield, MI dermatologist Linda Chung Honet, MD, that hormonal imbalance comes with a lot of side effects. “Our bodies become like aliens to us, and skin is a major victim to menopause,” she says. “It seems like all of a sudden, we need to navigate a health landscape that is completely foreign to us. It’s when our internal thermostats are randomly heating us up, leaving us a sweaty mess. It’s when our weight starts to creep up no matter what we do. It’s when our skin loses its glow and resiliency. It’s when our hair starts thinning on top while our chins start growing whiskers. Then to add insult to injury, it’s when we start to get acne when we may have never experienced it before.”

    Why Does Our Skin Freak Out During Perimenopause?
    Much like teenage hormones, Spring House, PA dermatologist Margo Weishar, MD says hormones are ramping up oil production. “The changing hormonal landscape upsets the balance between the estrogen (female) and androgen (male) hormones. A slight tip in that balance can lead to more oil production and especially deeper cystic acne that forms around the perimeter of the face. It can happen in women who have never before experienced acne.”

    New Orleans dermatologist Mary Lupo, MD says we can blame cortisol too: “The relative shift of hormones is a factor. The emotional stress increases cortisol which then stimulates the sebaceous glands. Cell turnover slows, so pores have more oil and that oil backs up from the abnormal cell turnover blocking the pore opening. Lastly, the flushing increases inflammatory mediators that trigger papules.”

    How We Can Fix It
    Unfortunately, the experts we spoke to say we may not have the power to complete stop perimenopausal outbreaks, but treatments and lifestyle changes can help keep them at bay. Birmingham, AL dermatologist Holly Gunn says, “Prevention can be difficult because genetics play a major role of whether or not you will get perimenopausal acne. But it can be made worse by stress and diets high in processed sugar, fat and cow’s milk. Sometimes even aggressive exercise can lead to more acne. A healthy diet and balanced exercise routine can help with all ailments of the skin.”

    Rutherford, NJ dermatologist Aanand Geria, MD, says, “Spironolactone is hands down the most effective treatment option. I also like SkinCeuticals Blemish + Age ($92) defense as a topical.” Astoria, NY dermatologist Lilly-Rose Paraskevas, MD says her go-to is the medication colloquially referred to as Accutane. “If the acne is very resistant to treatment, I like to use a short course of oral isotretinoin. Even at low doses, this drug is very effective.” Dr. Honet adds, “In-office treatments like LightStim, Dermal Infusion, microneedling, and chemical peels can be very effective adjuncts to prescription treatment and can directly address secondary scarring.”

    While the onset of perimenopause and menopause may be inevitable, so is the need for a qualified and experienced expert to help zero in on the right solution. “A board-certified dermatologist will become one of your favorite physicians because we are able to effectively help you with your perimenopausal skin and hair,” says Dr. Honet. “Perimenopause isn’t going away anytime soon, and dealing with it is far from easy. But with your dermatologist’s help, you can beat the myriad perimenopausal insults to your skin and keep those nasty zits away.”

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