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general sensitive skin

Acne in Menopausal Skin

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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.   

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 labeled “Oil-free”, “Won’t clog pores”, or “Non-comedogenic”.

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). Be careful not to use exfoliating peels that are chock full of denatured alcohol, as these can be very drying to the skin.

  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.

References

  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.