Scarring acne at menopause – help!!

Hello Dr. Irwin. Your website is one of the best - and I've looked at them all recently. I am a 54 year old woman, who has been diligent about sunblock since I was 24. I have had facials, good skin care products, etc. for years and years. However, I had very bad cystic acne, had many injections throughout the years, was on Accutane, and still got cysts throughout my 40's - some in my 50's. So, I was happy with my skin (more or less) even though I had acne scars...then Menopause hit. OMGoodness. No one wants to listen to me. I feel like my skin is out of control. I now have recessions where there was any acne previously. I went to my dermatologist, who I have seen diligently for years and years, and she said it is estrogen loss (I'm on a low grade patch now, but it hasn't helped my skin) with collagen loss at the sites of the acne. I'm absolutely freaking out! I have white patches, odd shaped scaring (round, oblong, you name it). No one thinks this is unusual. They recommended their 1440 Fractional non-ablative laser. Of course, I am scared. I wanted to ask you what you thought. I'm actually losing skin volume in these areas which is really getting to me emotionally. I'm not sleeping at night, waking up anxious that my skin is going away! The big kicker is I am an on-camera promotional rep. Yes. On camera. I was looking good until last year. Now I think they are going to fire me if I don't do something about my skin. If you feel the 1440 is a good way for me to go, I will investigate it even further. The dermatologist is a great one. I do not have doubts about her - I just want another opinion. Are lasers really the miracle I read about? Thank you so much for your time. You are helping a lot of women deal with issues that most hold inside. I've never felt such a loss of self-esteem. That is really a bad feeling. Thanks. Patricia

Thank you for reading SkinTour!   I hope I’m not too late to help on this one.  I want to reassure you that although this is difficult now, it will get better and you’re skin will get good again (with a little work). 

A couple of thoughts:

  1. In general, most women notice changes in their skin at menopause including acne.  I agree with your dermatologist that stabilizing your skin with hormone adjustment to help control the acne makes sense;
  2. Also, ask your dermatologist if spironolactone would help you.  In low doses, it lowers your androgens (male hormones – all women have them) a little and can help with this kind of acne;
  3. Your acne must be in good control before doing any laser treatments;
  4. I’m not sure which fractional she has.   The Fraxel and the CO2s like the DEKA and Active/Deep Fx  (fractionals) have the most data behind them for acne scarring.  The Fraxel is a 1550nm erbium. 
  5. Lasers are not a miracle, require generally 2-5 treatments depending on the amount and depth of scarring, with some significant downtime.  They are the best non injectible option though and have a more permanent result (a good thing).  They also build collagen, help reverse sun damage, and tighten the skin a little. 
  6. For faster improvement while you are planning some time to do the laser work, Restylane injected in the scars really helps temporarily and there is small permanent improvement just from the injections themselves. 
  7. Make sure you are optomizing your topicals with your dermatologist! 

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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