Acne during menopause

[Guest Posts]

On behalf of Sharon, a guest visitor:

I am 40yrs old and am in early menopause. I am taking HRT but my skin has breaking out in lots of spots. I know that menopause can cause this and I've mentioned it to my Doctor but she is not very helpful, in any matter. My skin is bad around my chin, nose and have even had spots between my eyes right at the top of my nose. I'm very aware of these when i go out and was wondering could you recommend something that i could moisturise, take care of my skin and keep control of these dreaded spots. Any help would be very appreciated.

Many thanks
Sharon

[Dr Anjali Mahto]

Dear Sharon,

Many thanks for taking the time to post a question. Acne during perimenopause (the phase leading into the menopause) is quite common and a well-recognised phenomenon. During this time, female hormones, in particular, oestrogen levels fall, but male hormones (androgens) that even women have remain constant. There is therefore a higher proportion of male hormone rather than female hormone during this time which can trigger acne.

Firstly, there are a number of lifestyle factors you may wish to think about:

DIET
There is emerging scientific data showing that consumption of foods with a high glycaemic index (GI) and certain dairy products (in particular, low-fat milk) can aggravate acne. These foods are rapidly absorbed by the body and result in raised blood sugar or glucose levels. Raised circulating blood glucose levels promote the release of the hormones insulin and insulin-like growth factor 1 (IGF-1). Both of these increase oil production and act on the body to produce more male hormones known as androgens (both men and women have androgens). All these factors together are thought to promote the development of acne. Therefore, in some individuals, it may help to limit refined sugar and to a lesser degree dairy in your diet.

Anecdotally, stress can aggravate many chronic inflammatory skin diseases, including acne, so finding methods of reducing this, e.g. through exercise or meditation, may indirectly have some benefit.

SKINCARE
It is important to cleanse the skin twice a day – morning and evening. This can be in the form of a rinse-off cleanser or micellar water. Choose a cleanser specially formulated for blemish-prone skin. These products often contain salicylic acid, zinc, or benzoyl peroxide.

After cleansing, use a light gel-based moisturiser that is “non-comedogenic”, i.e. prevents the formation of blackheads. Even oily skin needs moisturising as oils do not equate to hydration. Moisturising the skin will maintain the barrier function of the skin and is vital for good skin health.

Exfoliating the skin once a week is advisable, as this will immediately remove dead skin cells from the skin surface resulting in brighter appearance of the skin. Longer term, it will reduce the development of blackheads. It is important not to overdo this step, otherwise you will end up irritating the skin.

Finally, use a prescribed retinoid product on the skin at night before bed. This will help unclog pores, reduce the formation of blackheads and whiteheads, and calm inflammation.

MAKE-UP
Many people are incorrectly told to avoid wearing make-up if they have acne. Acne can cause profound effects on self-esteem leading people to feel extremely embarrassed or socially anxious about their skin. There is no need to avoid make-up if you have acne and many people choose to conceal their spots as it provides self-confidence. It is, however, important to choose the right cosmetic products. If you wear make-up, then opt for oil-free foundations or BB creams that will provide the coverage you need.

What to avoid:
It is best not to pick or scratch your spots. These all lead to skin damage and can potentially result in permanent pigmentation marks or scarring of the skin. It is better to apply a spot-directed treatment directly to the area, such as salicylic acid, tea-tree oil or prescribed agents such as benzoyl peroxide or retinoid. These will dry up the spot and settle inflammation.

If despite all these measures your spots are persistent, causing scarring, or stopping you from living your life the way you want then it is time to seek medical attention from your family doctor or dermatologist. General measures such as skincare advice and topical creams on the skin are usually tried first. If these fail, then there are a large number of treatments that can be tried including steam facials, chemical peels, laser, oral antibiotics, hormonal agents (e.g. spironolactone), isotretinoin, and light therapies. A dermatologist will be able to discuss all of these options with you in detail and cater treatment to you.

QUICK FIX
If you suddenly develop a large, stubborn, solitary acne cyst before an important social event, it is possible to inject deep spots with steroid. This results in flattening of the cyst within 42-72 hours and should only be done under the guidance of a dermatologist as there are potential risks associated with the procedure. This method should not be used on a regular basis, but is extremely effective if a rapid response is required.

Female adult acne is becoming very common in our dermatology clinics and please let me reassure you that you are not suffering alone. I hope this information is a good starting point for your daily activities and a discussion point if you see your GP or a dermatologist.

All the best,

Anjali