“Acne is the number
one complaint I get from patients going through menopause,” says New York City
dermatologist Francesca Fusco, M.D. “Estrogen opposes testosterone, so when
your ovaries stop producing estrogen, your relative testosterone levels rise,”
she explains. This can cause many women to suddenly develop severe acne,
particularly around the jaw and chin.
How is perimenopausal
acne different than acne in the teens?
Here are the unique characteristics of the perimenopausal
acne, comparing with the similar acne in teens.
* Small tender
bumps
There are fewer
blackheads than whiteheads and more of what one of my patients calls
"undergrounders." Those small, tender cysts are most often found
around the jaw line, around the mouth, and sometimes on the neck.
* Less T-zone acne
There’s less acne in the T-zone and the cheek area and
more acne around the chin, mouth, and upper neck.
* Cysts last
The lesions last longer, sometimes taking 2 to 4 weeks to
resolve rather than a few days to a week.
Unpredictability—sometimes menopausal women will be clear
for months and then suddenly break out again.
Note that because the acne is different in perimenopause,
most of the medications, both oral and in a form of cream, which are made
specifically for teenage acne, do not work particularly well in perimenopausal
women.
Medications
Specifics
Medications, generally formulated for the teenagers’ symptoms,
target the very oily skin of that age group. Most of the time, they appear as
way too drying for the skin of women over 40. This may cause substantial skin
redness and irritation after using that particular cream. Many of you have
heard of using Renova for wrinkles but don’t know it was originally made for
acne in teens in the form of Retin-A. Both have anti-aging, anti-wrinkle
effects, but both also help acne by unclogging pores and preventing clogs
(comedones) from forming in the first place.
Renova is better for menopausal skin because it is
formulated in a moisturizing base that is made specifically for older skin. If
you are trying to use Retin-A gel or cream or, for example, Tazarac gel or
cream, these can be often too irritating because they were put in a base for
teenage skin.
The acne is deeper
and not superficial
Creams, gels, and lotions that are put on the skin work
well for blackheads and whiteheads but do little for the deeper cystic-type
acne that goes along with the changing hormones in the peri-menopausal woman.
If you do have blackheads and whiteheads, the Renova .02% cream will help
remove those, while also preventing wrinkles—an added bonus!
Oral Contraceptives
The dermatologists may sometimes recommend an oral
medication, like an oral contraceptive, for a younger woman with acne. Because the risk of blood clots increases
significantly after the age of 35 and particularly in smokers, this is not a
good option for most women in their forties and fifties. Women over 35 shouldn't be on oral
contraceptives except when recommended by a gynecologist.
Oral antibiotics
Many dermatologists are avoiding oral antibiotics for
long periods unless they are absolutely necessary. When oral antibiotics are
used too freely in conditions where they are not absolutely needed, bacteria
can become resistant. For example, most people now know that trying to treat a
common cold, which is caused by a virus, with an antibiotic is not helpful at
all and just breeds bacterial resistance.
Also, oral antibiotics can change the "good
bacteria" in our intestinal tracts, mouth, and vaginal area. This can lead
to the overgrowth of yeasts and "bad bacteria." But, if necessary,
oral antibiotics can work well. It’s fine to use antibiotics for acne for a
month or two to control a severe flare. Since it takes prescription creams and
lotions eight to ten weeks to kick in, an oral antibiotic will control your
acne while the topicals have a chance to start working.
What works for
perimenopausal acne?
Renova
First of all, definitely consider prescription creams
like Renova .02% cream, if you have a tendency to blackheads and whiteheads.
Again, you get a bonus with this in that it helps to treat wrinkles and sun
damage as well as helping to prevent the acne. If you have a lot of those
deeper cysts, particularly on the jaw line, Renova won’t do much.
Spironolactone/aldactone
This medication has been around for more than 30 years
and was originally used to treat kidney patients and high blood pressure. But,
it is very effective in low doses for treating acne. It works by reducing
androgens, which are the "male" hormones that are also present in
women.
In perimenopause, the amount of androgen stays about the
same. But because estrogen and progesterone are decreasing, the
"male" hormones are relatively higher than they were. This can cause
breakouts. Spironolactone controls that imbalance of male and female hormones.
It can also reduce facial hair growth and control PMS-type symptoms as well.
Don’t take spironolactone if you have low blood pressure
because you may get dizzy. This won’t happen for women with normal or slightly
elevated blood pressure—lower blood pressure is a positive side effect. Also,
don’t take it if you are pregnant. Remember, it is possible to get pregnant in
the perimenopausal period if you are not using birth control and you are
sexually active. If you are not actively preventing pregnancy, spironolactone
is not for you because it could affect the development of a male fetus’s
genitals.
Otherwise, it is safe and has been around for many years.
In low doses it may help not only to reduce acne, facial hair growth, but also
lower blood pressure a bit and prevent fluid retention with PMS.
Lasers for acne
There are main two types of laser systems being used to
treat acne. They are the ong wave lasers and the blue and red light systems.
It is fair to say that the protocols for treating acne
with these lasers are still evolving—some get a great result with them and
others get not as much as we would hope for.
With the long wave lasers there is usually a series of
four or five treatments. If you are significantly improved after a short
series, don’t expect it to last forever: you will definitely need maintenance
treatments two to four times a year. Examples of these lasers are the
Smoothbeam, Cooltouch, the Aramis and others. Lasers are often used in
conjunction with other acne treatments, like topicals.
The other form of laser treatment for acne is often called
Blu-U or sometimes referred to as photodynamic therapy. A clear liquid is
painted on the skin and is left on for 30 to 60 minutes. Then a light is used
to activate the clear liquid. In one system, a blue light (thus the Blu-U) is
used, and in the other system, an IPL-type laser is used to activate the
liquid. Some centers use red light instead.
The downside to these blue and red light treatments is
that there is often redness and peeling for 3 to 10 days, which is similar to
the peeling you might expect after sunburn. Be prepared for some inconvenience
if you sign up for this type of laser.
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.
* Close your
pores. Try using a toner or cool water to help your pores close up.
* Home remedies.
There are many home remedies that help to dry up the acne without causing
irritation to skin. It helps treating the issue and also clears up the spots
and left over blemishes. Apply aloe to dry up the acne on skin and give you
glowing skin. Create a paste of baking soda by mixing it with water; apply it
and leave it for twenty minutes. This eliminates the acne causing bacteria and
provides you clear, radiant skin. Dipping cotton ball in coconut oil is
effective for retaining healthy skin.
* Watch what you
eat. Being older, you are probably already eating healthier, but be even
more attentive. Higher in fiber and calcium and lower in fat and carbohydrates.
* Take
supplements. Not just vitamins, but herbal and dietary supplements. Vitamin
B and C are necessary for healthy skin as well. Add flax seed to your diet. You
can grind it or buy it already ground up. Flax seed helps with the menopause
and with the acne.
In addition to proper skin care, you may need 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.
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