Menopausal Acne- Best Treatments According to Dermatologists

Menopause brings about a lot of changes to the body. In addition to the typical night sweats, hot flushes, trouble sleeping, and mood changes, hormonal changes can also lead to skin and acne breakout changes. Hormonal acne tends to be stubborn and challenging to get rid of, so treating it correctly and consistently is essential.

For many women, hormonal acne continues to be a struggle well beyond their teenage years. Adult acne is also much more common among women than men. Dermatologists find that acne in perimenopausal and menopausal women has increased for the last 10-20 years. Recent studies have shown that 26% of women in their 40s and 15% aged 50 or older reported experiencing acne. Interestingly, pre and post-menopausal acne can happen in women who have never had acne in their teens.

What are the symptoms of menopausal acne?

Menopausal acne is a kind of adult hormonal acne. Like hormonal acne in younger women, menopausal acne usually appears as painful red pimples around the mouth, jawline, and chin. Many women will also have deeper under-the-skin cysts, blackheads, and whiteheads in their face's oily areas.

What are the causes of menopausal acne?

Many women begin to experience menopause in their 40s and 50s. This causes a natural decline in your reproductive hormones, resulting at an end to menstruation—menopausal acne results from a drop in estrogen levels parallel to the increase in the androgen hormone testosterone.

You may still experience menopausal acne even if you use hormone replacement therapies (HRTs) to ease your menopause symptoms. This is because some HRTs use an influx of the hormone progestin to replace the estrogen and progesterone your body loses. Introducing this hormone to your system can cause your skin to break out.

According to a 2019 study, the oil-producing glands' activity in the skin (sebaceous glands) depends on the estrogen/androgen ratio. Testosterone stimulates sebum production, while estrogen inhibits the glands' function. Thus, an increase in androgens, such as testosterone, and a decrease in estrogen, leads to higher oil production, which, in turn, causes acne.

According to a different study, other critical possible causes or aggravating factors of menopausal acne are stress, diet, obesity, smoking, certain cosmetics or medications, endocrine deficiency disorders, genetic predisposition, and excessive skin washing. These factors may play a role in the increase in sebum, follicular hyperkeratinization (when skin cells don't shed naturally, which may clog pores and create comedones), and inflammation of acne breakouts.

Another critical factor is the weakening of the skin's epidermal barrier function. In menopause, the skin often gets drier due to decreased estrogen production since estrogen stimulates collagen production and increases humectants like hyaluronic acid. This damage to the skin barrier causes an increase in transepidermal water loss, which leaves the skin flaky and dehydrated and may play a role in the inflammatory process.

What are the best treatments for menopausal acne?

Since menopausal acne has different causes, it should be treated differently than typical acne breakouts. Adult female acne tends to relapse, so maintaining treatment is essential. It's essential to wash the skin daily with a non-drying cleanser and invest in ingredients that control oil production and strengthen its outer barrier to reduce water loss.

Topical treatments are widely used and very useful, but oral supplements are also a good option.

Retinol for menopausal acne

Retinol is a derivative of Vitamin A, and you have seen it hailed as a miracle ingredient in skincare products. It is one kind of retinoid, more potent than retinyl palmitate, also found in many cosmetics. Retinol stimulates the shedding of dead skin cells, helps clear clogged pores, and boosts collagen production.

Retinol helps treat menopausal acne because it helps control sebum production--which, as we've mentioned, is one of the leading causes of acne during menopause. Like other retinoids, retinol improves the appearance of wrinkles and dark spots associated with aging.

By boosting collagen production in the dermis and increasing skin cell turnover in the upper layers of the skin, cell turnover and retinol help regenerate skin tissue and improve skin texture and glow. Look for retinol creams with 0.25% to 0.5% retinol for optimal efficacy. A higher percentage is usually too fitting for women with adult or menopausal acne. Adding niacinamide to the retinol will allow increased effectiveness on both acne and skin aging to reduce skin irritation further. Always remember to wear SPF while treating the skin with retinoids (well, you should always wear SPF anyway!).

Benzoyl Peroxide for menopausal acne

According to the American Academy of Dermatology acne treatment guidelines, benzoyl peroxide is the most effective single anti-acne ingredient. While prescription benzoyl peroxide is known, irritating new benzoyl peroxide formulation provides the same efficacy, significantly less irritation. This improvement is achieved using a micronized small molecule of benzoyl in a cream base. The newest formulation of benzoyl peroxide, used by MDacne, contains, in addition to, micronized benzoyl peroxide anti-inflammatory plant extract that further reduces skin redness and irritation.

Niacinamide for menopausal acne

Niacinamide is another prevalent skincare ingredient that can help with menopausal acne. Niacinamide, also known as nicotinamide, is a water-soluble form of Vitamin B3 and a versatile ingredient found in serums, toners, exfoliants, and creams. This ingredient will not only help treat menopausal acne, but it will also even out skin tone and texture, decrease hyperpigmentation and redness associated with inflammation, and help keep your skin hydrated and protected.

The primary way in which niacinamide helps ward off breakouts is by regulating sebum production. It also has antimicrobial and anti-inflammatory properties. In addition to that, and similarly to retinol, it decreases the appearance of fine lines and wrinkles and protects the skin from oxidative stress by environmental stressors. Niacinamide further protects the skin by stimulating keratin and ceramide synthesis, according to a 2004 study. This stabilizes and improves the skin's epidermal barrier function, helping it retain moisture, which is excellent for aging skin!

The best way to add niacinamide to your skin care regimen is by applying leave-on products to clean your skin. Niacinamide is tolerated even by sensitive skin. It works great in conjunction with other ingredients, like retinoids, hyaluronic acid, and vitamin C—more info on niacinamide's effects on acne and skin aging.

Anti-androgen drugs for menopausal acne

Anti-androgen drugs work by decreasing the male hormone androgen. Both men and women have natural levels of this hormone. Too much androgen can contribute to acne issues by interfering with hair follicles that regulate skin cells and increasing oil production. Although Spironolactone (Aldactone) is primarily used to treat high blood pressure, it has anti-androgen effects. In other words, it can prevent your body from producing more androgen and allow your hormone levels to stabilize.

DIM Supplements for menopausal acne

While you might not have heard about DIM before, it's a great natural option for treating hormonal acne. DIM, or diindolylmethane, is a natural substance generated when we digest cruciferous vegetables like broccoli, kale, and Brussels sprouts. It's formed when the body breaks down indole-3-carbinol, a compound found in those foods. DIM is recommended for treating menopausal acne because it helps with the hormonal imbalances that cause acne in the first place. DIM is an androgen antagonist, preventing certain androgens from binding to their receptors. When androgens (like testosterone) bind to receptors, it can increase oil production in the skin and other changes that can cause acne. This directly fights the acne-causing increase in androgens that occurs in menopause. DIM also improves estrogen breakdown, which supports detoxification in the liver—more info on DIM for women with adult acne.

What is the best daily skin care for women with menopausal acne?

Choosing the wrong makeup or skincare products is a common cause of more acne breakouts in adult menopausal—women with menopausal acne should look for oil-free or non-comedogenic skincare makeup. The skin is drier as we age. Look for a mild acne cleanser hydrating cleanser that is not overdrying.

What should you do when you have menopausal acne?

1. Avoid soap. Instead, wash your face daily with a mild cleanser with salicylic acne.
2. Use an oil-free moisturizer with niacinamide regularly.
3. Apply a thin layer of topical benzoyl peroxide, retinol, or salicylic acid to the whole face, not just spots. This can help prevent future breakouts.
4. Invest in oil-free products – water-based products – including sunscreen and foundation.
5. Wear an oil-free SPF30 sunscreen. Not only is sun exposure aging, but its drying effect can also cause sebaceous glands to produce more sebum, which causes more acne breakouts.

What not to do when you have menopausal acne?

1. Do not over-wash or scrub your skin; this can irritate the skin, damage the natural protective barrier, and trigger more.
2. Avoid oil-based serums or exfoliating scrubs.
3. After three months, discard mascara, foundation, and lipstick after a year, and eyeshadow and powder after two years.
4. Do not sleep with your makeup, even if it's non-comedogenic.
5. Do not touch or pick at your skin. However tempting. It may be a stress reliever, but it can turn into an acne excoriée. Also known as 'picker's acne,' it's a condition where you feel compelled to pick your skin, resulting in scarring.

What is the best diet for women with menopausal acne?

Most dermatologists agree that diet plays a role in acne. Although the exact effect of food on acne is not apparent, it is disbelieved that reducing cow's milk, dairy, high glycemic food, and refined carbs can help with acne treatment and reduce the frequency and severity of acne breakouts.

Try to limit alcohol and caffeine and ditch junk food. To improve your skin and reduce your acne breakouts, look for foods rich in the fatty acids omega-3 and 6, such as oily fish (three times a week) and chia and flaxseeds, and fill your diet with whole-grain, fiber-rich products. Cruciferous vegetables such as spinach, cabbage, broccoli, and cauliflower are beneficial because they contain a DIM compound that helps with hormonal balance. You can also look for DIM supplements (currently getting rave reviews to clear up hormonal spots).

Drink a lot of water. Dehydration makes your skin rough and dry. When the skin is too dry, the skin oil glands produce more oil to moisturize the skin. The excess of skin oil mixed with the dead skin cells clog the skin pores and can cause more acne.

Hormonal acne: Best treatment according to Dermatologists

FAQs on menopausal acne:

1. What is menopausal acne, and how does it differ from typical acne? Menopausal acne is a type of adult hormonal acne due to hormonal changes during menopause. Unlike regular acne, which is often associated with puberty, menopausal acne is caused by decreased estrogen levels and increased testosterone. This hormonal imbalance leads to increased oil production, which can result in acne breakouts.
2. What are the symptoms of menopausal acne? Menopausal acne usually appears as painful red pimples around the mouth, along the jawline, and under the chin. Women may also experience deeper under-the-skin cysts, blackheads, and whiteheads in the oily areas of their faces. Acne is often more stubborn and challenging to eliminate than typical acne.
3. What causes menopausal acne, and why does it occur during menopause? Menopausal acne is primarily driven by hormonal changes during menopause, specifically a drop in estrogen levels and a rise in testosterone. This imbalance stimulates the oil-producing glands in the skin, leading to increased oil production and acne. It can occur even in women who have never had acne in their teens.
4. Can hormone replacement therapies (HRTs) cause menopausal acne? Yes, hormone replacement therapies can potentially cause menopausal acne. Some HRTs use progestin to replace the estrogen and progesterone the body loses during menopause. Introducing this hormone to the system can stimulate the skin to break out.
5. What factors can aggravate menopausal acne? Several factors can aggravate menopausal acne, including stress, diet, obesity, smoking, certain cosmetics or medications, and excessive skin washing. These factors can increase sebum production, disrupt natural skin cell shedding, and cause inflammation, leading to acne breakouts. A weakened skin barrier due to decreased estrogen production can also contribute to the problem.
6. What are the best treatments for menopausal acne? Menopausal acne can be treated with topical treatments, oral supplements, and lifestyle changes. Topical treatments like retinol, benzoyl peroxide, and niacinamide can help control sebum production and strengthen the skin's outer barrier. Oral supplements like DIM (diindolylmethane) can help balance hormones, and maintaining a healthy lifestyle can also contribute to managing acne.
7. How does retinol help in treating menopausal acne? Retinol, a derivative of Vitamin A, stimulates the shedding of dead skin cells, helps clear clogged pores, and boosts collagen production. It is beneficial for treating menopausal acne as it helps control sebum production, a leading cause of acne during menopause. Additionally, retinol improves the appearance of wrinkles and dark spots associated with aging.
8. How can benzoyl peroxide and niacinamide help in treating menopausal acne? Benzoyl peroxide is an effective anti-acne ingredient that can help treat menopausal acne by reducing inflammation and killing acne-causing bacteria. Niacinamide, a form of Vitamin B3, can regulate sebum production, decrease hyperpigmentation and redness, and help keep the skin hydrated and protected, making it a versatile ingredient for treating menopausal acne.
9. What are anti-androgen drugs, and how do they help treat menopausal acne? Anti-androgen drugs decrease the male hormone androgen, which can contribute to acne by increasing oil production. Drugs like Spironolactone can prevent the body from producing more androgen, stabilizing hormone levels and potentially reducing acne breakouts. These drugs are beneficial for treating menopausal acne, often caused by increased androgens.
10. What lifestyle changes and skincare routines should be followed when dealing with menopausal acne? Maintaining a healthy skincare routine is essential, including washing the face daily with a non-drying cleanser and using oil-free or non-comedogenic skincare products. Avoiding oil-based serums, exfoliating scrubs, and not sleeping with makeup on can also help prevent breakouts. A balanced diet rich in omega-3 and 6 fatty acids, whole grains, and cruciferous vegetables can help manage menopausal acne.

References:

1. American Academy of Dermatology. "Women More Likely Than Men To Be Affected By Acne As Adults." ScienceDaily. ScienceDaily, Oct 20, 2007.
2. American Academy of Dermatology. "Hormonal factors key to understanding acne in women." American Academy of Dermatology. Mar 13. 2012.
3. Adult female acne: a guide to clinical practice. An. Bras. Dermatol. 2019 Jan-Feb;94(1):62-75.
4. Retinoic acid regulates cell cycle progression and cell differentiation in human monocytic THP-1 cells. Exp Cell Res. 2004 Jul 1;297(1):68-81.
5. Nicotinic acid/niacinamide and the skin. J Cosmet Dermatol. 2004 Apr;3(2):88-93. Khunger N, Mehrotra K.
6. Menopausal Acne - Challenges And Solutions. Int J Women's Health. 2019 Oct 29;11:555-567.
7. Plant-derived 3,3'-Diindolylmethane is a strong androgen antagonist in human prostate cancer cells. J Biol Chem. 2003 Jun 6;278(23):21136-45.
8. Estrogen and skin. An overview. Am J Clin Dermatol. 2001;2(3):143-50.

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