Menopausal Acne Is Very Real, and It's Very Annoying

They once called it "the change," barely spoken above a whisper about among older relatives. Gossipy tones. Low. Grave. Secretive. But now, outside of conversations about vaginal dryness and hot flashes, we seem to rarely speak about acne during menopause, nor anything else related to menopause and skin care, for that matter — save for comments about wrinkles and fine lines and so on and so forth. The conversation we're not having enough leaves so many in the dark, especially when menopausal skin starts to act in a bewildering fashion — rashes, acne, rosacea, hormonal acne and pimples, and an overall sensitivity to, well, everything. Adult acne, in general, is bad enough, but these shifts are enough to leave anyone over a certain age wondering what the hell is going on.

That's why we've reached out to three prominent board-certified dermatologists to determine exactly why menopausal skin seems to simultaneously freak out and break down and what, exactly, we can do about it. It's not all about the wrinkles or hormonal fluctuations; it's about feeling comfortable in — and seeking some manner of control over — the skin you've got.

• Jeannette Graf MD, an assistant clinical professor of dermatology at Mount Sinai Medical Center.
• Mona Gohara MD, an associate clinical professor of dermatology at Yale School of Medicine.
• Michelle Henry MD, a clinical instructor of dermatology at Weill Cornell Medical College.

• How does your skin change during menopause?
• Does your skin tone play a factor in how menopause impacts your skin?
• Can menopause cause acne?
• Can menopause lead to body acne, too?
• What other inflammatory skin conditions can menopause trigger?
• How to change your skin-care routine during menopause

Essentially, what happens to the skin during menopause is a perfect storm of life events, which, when combined, cause major changes. The first of which is the change in our hormones. "Menopause equals low collagen," explains Jeannette Graf MD, an assistant clinical professor of dermatology at Mount Sinai Medical Center. "The skin's elasticity and collagen levels plummet, so skin becomes thinner and drier — and some women say it seems like it happens almost overnight," she says.

Estrogen levels drop, which also means there's less oil production. "We also have less of the dermis, which includes collagen and hyaluronic acid. As our collagen becomes depleted, our pores look larger."

Those hormonal changes cause more than just dryness and fine lines. "The biggest thing about menopause is that estrogen levels start to drop so you have this unopposed testosterone influence on your skin, and that manifests in many ways," says Mona Gohara MD, an associate clinical professor of dermatology at Yale School of Medicine. "That creates some of the things we see, like hair thinning, hair loss, facial hair, and even some acne breakouts." Yep, this combination of conditions results in a dry, compromised moisture barrier, the outer layer which protects our bodies from external invaders and irritants.

As a result, our hypersensitive, dry skin is prone to inflammatory skin conditions: rashes, rosacea, perioral dermatitis, contact dermatitis, and — for some of us — teen-angst-era acne breakouts or even severe acne.

It's important to note that perimenopause and menopause look a bit different in women of color. "In terms of sagging, we may look different because we're going to be less likely to have photo aging; we don't really get sunspots the way white skin does," says Michelle Henry MD, a clinical instructor of dermatology at Weill Cornell Medical College. "Ultimately, our melanin is beautiful and protective, but it's not permanent; at some point, we will see fine lines and wrinkles, just usually a decade later than our white counterparts."

But where skin of color may take longer to show sagging and volume loss, it has its own particular challenges. "We do get kind of a mottled pigmentation, we do get hyperpigmentation, and that uneven skin tone is part of our aging process." Skin of color can also be prone to DPN, or dermatosis papulosa nigras — papules of various sizes that appear mainly on the face.

But in the end, is all skin — regardless of skin tone — prone to hypersensitivity, dryness, and the hormonal imbalances which causes all manner of inflammation, including acne? "Yes, absolutely," says Henry. "The consequences can be a bit different because with melanin any inflammatory process – which acne absolutely is – can result in hyperpigmentation."

Now that we know we're all going to be impacted by menopause in some way, let's talk about what to do about it.

Graf says nondrying forms of topical antibiotics such as clindamycin, metronidazole, and azithromycin along with retinoids are helpful when managing acne in older skin. All three dermatologists interviewed are also fans of androgen-blocking spironolactone, which, according to Graf, also may help with hair loss in women. She's also a fan of topical sulfur, as prescribed or found in over-the-counter treatments (we like the new Topicals Faded). "It kills everything — bacteria, mites – so it's great for rosacea and acne as well," she advises. Gohara noted that another new androgen blocker, or anti-androgen treatment, Winlevi, also shows promise.

Your daily routine is critical, which means using the right cleanser, one formulated to exfoliate dead skin cells away and cleanse gently without stripping valuable moisture from the skin. Women of color might look for ingredients such as glycolic acid to help trap moisture while exfoliating and brightening dark spots; options abound from brands like Mario Badescu and Vichy.

Follow with a retinoid treatment like Differin Gel or SkinCeuticals Retinol 1.0 and a good moisturizer (plus sunscreen for the day like Unsun Cosmetics Mineral Tinted Broad Spectrum Face Sunscreen SPF 30.)

When it comes to the skin below the neck, remember to baby your barrier: use gentle, fragrance-free options for body washes such as the Dove Dove Sensitive Skin Body Wash. Keep showers short — five to eight minutes tops — using tepid water, not hot.

Wipe off excess water after bathing, then seal moisture in with a wet skin moisturizer like Jergens Weightless Wet Skin Moisturizer or follow Henry's trick for dry skin: mix a body lotion, like the  La Roche-Posay Lipikar Balm AP + Intense Repair Moisturizing Cream with equal parts Johnson's Baby Oil Gel. Also, mind your scalp: Use gentle shampoos to focus on cleansing the scalp without stripping the hair. Graf recommends applying conditioner to hair prior to showering as a protective layer before shampoo and water.

You want to protect menopausal skin from contact with harsh chemicals, fragrances, or any other irritants. All three dermatologists recommend soft cotton when it comes to fabric choices, as well as switching to gentle detergents. 

They also recommend drinking more water and watching caffeine and alcohol intake. "Alcohol is never going to make your skin look great, especially if you overindulge; it's just going to make you dehydrated," explains Henry. "Caffeine is the same: in moderation. It can really dehydrate you, which you want to avoid. It's all about keeping our skin well-hydrated."

As you get older, you may tend to bruise more easily because the skin is thinner, and Henry recommends paying attention to wounds. Using ointments, like the Aquaphor Healing Ointment, can be helpful. "It's not only going to keep the wound moist — because everything heals better in a moist environment — but because it's occlusive it's also going to prevent infection because it acts as a barrier," she explains.

Also, get plenty of exercise and relax: stress can harm the skin. "High cortisol levels are detrimental; they're pro-inflammatory, they can cause acne, aging — everything you don't want," warns Gohara. Besides deep breathing and yoga, consider sexual activity — alone or with partners. "Have it when you can," recommends Graf. "It helps everything, absolutely."

If the above protocol seems to make things worse, you might have rosacea or perioral dermatitis instead. A trip to the dermatologist and medical advice from your GP will confirm, and your doctor may advise you to stop retinoid and acne treatments immediately, as these protocols can irritate skin. Your dermatologist can prescribe antibiotics or anti-inflammatories to soothe facial inflammation.

Rashes and eczema are also common for menopausal women. Keep a tube of 1 percent hydrocortisone cream handy to soothe itching and irritation, but also investigate products formulated to soothe skin such as the Avene Cicalfate+ Restorative Protective Cream.

The best skin care for menopausal skin is founded on three core principles: be gentle, lock moisture in, and prevent moisture loss and further damage. All three dermatologists interviewed recommend starting with a gentle cleanser, regardless of skin type. When it comes to a nighttime routine, those with dry skin can follow Graf's advice to use a milky cleanser (we like Caudalie Vinoclean Gentle Cleansing Almond Milk), or a thick, tried-and-true cleanser (like Pond's Fragrance-Free Cold Cream Makeup Remover, to wipe off dirt and grime without using water).

If you prefer foaming cleansers, go for a gentle option like the Clarins Gentle Foaming Cleanser with Cottonseed. Graf also recommends keeping micellar water and cotton pads near the bed as a fast, easy, gentle cleansing solution for nights when you can't be bothered with a full routine. "If you do nothing else, at least you can clean your skin," she says.

Follow any cleansers with spot treatments, and then any number of nourishing, deeply hydrating serums packed benefits. Finish your nighttime routine with a moisturizer complete with hyaluronic acid, glycerin, or ceramides, like the CeraVe Moisturizing Cream or Tatcha The Dewy Skin Cream.

For day, protect your skin from moisture loss and environmental factors. Use your gentle cleanser again, boost the skin with free radical-fighting antioxidant serums — Graf recommends formulas made with ferulic acid, vitamin C, and vitamin E — and then another layer of moisturizer and sunscreen.

TL;DR

But the secret's out: No longer will we whisper about what's happening to us. In menopause, a number of changes combine to challenge our moisture barrier and the structural integrity of our skin, but there are just as many solutions to make our skin comfortable, alluring, and lovely for the rest of our lifetime.

Menopause, like many things in life, comes with challenges but with a plethora of solutions of which we may avail ourselves. "There are so many good things we know now," enthuses Graf. "By taking simple care of ourselves, we can look good and feel great for a long time. Menopause is not the end; it's just the beginning."

Now read more about skin-care solutions:

• The Best Eczema Products to Relieve Itchiness & Flaking
• The 22 Best Moisturizers for Dry Skin
• 14 Products That Are the Closest Thing to Botox in a Bottle

Done reading? Now watch a dermatologist's skin-care routine: