Acne and Menopause
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 acne, oily skin, and mature or perimenopausal 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 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 "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 Your Skin.
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 are to be effective. The deeper the acne (as in the small tender cysts), 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 Acne and Menopause
The main treatment options for acne in perimenopause are:
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 mature skin. If you have very oily skin still, they might be fine.
If you'd still like to try the drugstore route first, 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 mature skin, 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 the 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 you know when a skincare product is causing a problem? Using your name from a blog post! The melasma upper lip "moustache." Do microroller systems - like the Rodan and Fields AMP system work? Too much Voluma in the upper cheek area causing problems! Problems after a CO2 laser with scarring? Brown spots that appear after acne breakouts - what is causing these and how to treat.
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