“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, 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 Many of you have heard of using Renova for wrinkles but don’t know it was originally made for acne in teens in the form of Retin-A. Both have anti-aging, anti-wrinkle effects, but both also help acne by unclogging pores and preventing clogs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!
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.
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?
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.
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.
Sources and Additional Information: