*Content reviewed by HotPause Health Medical Advisor & Board-Certified Dermatologist Dr. Marisa Chapman

Acne In Menopause

Plain and simple, menopausal acne is acne that occurs around the time of menopause. This symptom is often also referred to as “hormonal acne”. Menopausal acne can appear similar to the type of acne experienced during adolescence. It may have both inflammatory and non-inflammatory lesions, including whiteheads, blackheads, pustules, and even deeper cysts. The main difference is that menopausal acne often occurs on the lower face, particularly around the jawline and chin. Additionally, it can be more challenging to treat due to the aging skin’s decreased ability to regenerate and heal quickly. Menopause skin care expert and board-certified Dermatologist, Dr. Marisa Chapman breaks down everything you need to know about acne, since you were a teenager.

Why Does Acne Happen in Menopause?

Menopause brings about a significant decline in estrogen levels, which impacts many areas of the body, including the skin. This decrease in estrogen can make the skin thinner, drier, and less elastic, with a reduced ability to retain moisture, as a result of diminished collagen levels. For those already prone to acne, these changes may exacerbate their skin issues during menopause. At the same time, the levels of testosterone decrease more gradually than estrogen during perimenopause. This results in a relative increase in testosterone, which can lead to various symptoms, including hair loss, the growth of facial hair, and more prominent acne problems. The link between increased testosterone and acne centers around its effect on sebum production. Testosterone is thought to stimulate the overproduction of sebum, an oily substance that protects the skin from external damage and microorganisms. However, excess sebum can clog pores, attracting dirt and bacteria that lead to inflammation and acne. Moreover, hormonal changes during menopause can weaken the skin's natural barrier, making it more vulnerable to environmental stressors and further inflammation. This susceptibility can aggravate acne, creating a challenging cycle for those dealing with skin issues during menopause.

What Can You Do About Acne in Menopause?

Dealing with acne during menopause can be frustrating, but working closely with a dermatologist can help you create an effective skin care plan tailored to your needs. As hormonal changes alter your skin's condition, you might need to adjust your usual skincare routine to manage acne effectively. Here are some recommended strategies:

• Choose Gentle Cleansers: Use mild soaps or cleansers that don't irritate your skin. Harsh products can aggravate acne and dry out your skin.
• Avoid Overwashing: Washing your face too frequently can actually worsen acne by stripping the skin of its natural oils. Aim to wash your face no more than twice a day.
• Moisturize and Protect: Incorporate a daily moisturizer to keep your skin hydrated. Ensure it includes sunscreen to protect against UV damage, which can exacerbate skin aging and acne.
• Consider Acne-Care Products: For acne-prone skin, look for products containing ingredients like hyaluronic acid, glycerin, and dimethicone. These can help maintain moisture without clogging pores.

Acne Treatments You can better manage your skin's health during this transitional period by adopting a skincare routine and consulting with a dermatologist. Menopause-related acne can be stubborn, but several treatment options are available to help manage and mitigate breakouts effectively. For topical acne treatment, consider these options:

• Salicylic Acid: This over-the-counter ingredient can be found in cleansers, lotions, and other products, and helps minimize acne by exfoliating dead skin cells and decreasing inflammation (redness and swelling).
• Benzoyl Peroxide: Another over-the-counter treatment, it is effective for reducing acne by killing bacteria and removing excess oil and dead skin cells.
• Clindamycin or Dapsone Gel: For more severe cases, these prescription medications offer antimicrobial and anti-inflammatory benefits and have been proven to effectively combat acne.
• Topical Retinoids: These medications promote cell turnover, unclog pores, and have anti-inflammatory effects, all of which can improve skin appearance and prevent future breakouts. They also help improve the appearance of surface wrinkles and dark spots, as an added benefit. Adapalene 0.1% gel is a topical retinoid that is available over-the-counter. Prescription-level retinoids include tretinoin, tazarotene, and adapalene 0.3% gel.

Other treatment options include:

• Topical or Oral Spironolactone: This prescription medication has anti-androgen effects and works by targeting the hormonal pathways involved in menopausal acne.
• Consider Oral Antibiotics: In some cases, oral antibiotics might be appropriate, due to their anti-microbial and anti-inflammatory effect. Always use them under the guidance of a healthcare provider.
• Hormone Therapy: Utilizing estrogen in Hormone Replacement Therapy (HRT) not only addresses common menopausal symptoms like hot flashes, but also enhances skin elasticity, thickness, hydration, and collagen quality. By rebalancing hormones, MHT can potentially prevent acne outbreaks. [1]
• Choose the Right Cosmetics: Opt for non-oil-based makeup to avoid clogging pores. Look for products labeled as "oil-free" and "non-comedogenic." Keeping makeup applicators and brushes clean, and removing makeup before sleeping also helps minimize bacterial buildup.
• Avoid Picking at Pimples: While it might be tempting, picking or popping pimples can cause further irritation, lead to scarring, and spread bacteria. For persistent pimples, it’s better to consult a dermatologist who can provide professional extraction or treatment.

Each of these options has its own set of considerations, and what works best can vary from person to person. Consulting with a healthcare provider can help you determine the most effective acne management strategy for your specific needs during menopause.