Written by Bonny Osterhage
Of all the things a woman might want to reclaim from her teen years, such as a perky posterior or luxurious locks, it’s probably safe to say that no one looks back and wishes they could deal with breakouts and acne again. Yet 30 years later, many women may find themselves reaching for the pimple cream, again.
As if wrinkles and greying hair weren’t enough to deal with during menopause, Mother Nature has one more trick up her sleeve, which comes in the form of menopausal acne. And the pimples you get during menopause may not always resemble what you’ve experienced in the past. According to Dr. Elizabeth Hughes, MD, FAAD, menopause acne can appear as sometimes large, usually painful cysts often referred to as "undergrounders," that typically appear along the lower half of the face and jawline. And while they are inconvenient at best and painful at worst, they aren’t untreatable. There are plenty of options from over-the-counter solutions to prescription medications that can help. But first, let’s talk a little bit more about the connection between acne and menopause.
Does Menopause Cause Acne?
Well, not exactly, but fluctuating hormones can certainly take some of the blame. Dr. Hughes explains that in the teen years it is the increase of hormones in general, along with genetics, that come together to cause acne. This teen acne manifests as an excess of blackheads, whiteheads, clogged pores, and oily skin and scalp. With menopause acne, it is the change in the balance, or ratio, of the hormones that cause the cysts to crop up. Specifically, less estrogen with unchecked testosterone says Dr. Hughes. That means that even if you sailed through your teen years blemish-free, you could still find yourself suffering from face breakouts during menopause.
“In menopause, the decrease of estrogen relative to the testosterone can unmask the side effects of testosterone, one of which is cystic acne,” Dr. Hughes explains.
She continues by stating that she sees an uptick in this type of acne in a woman's late 30s, with a gradual decline in the mid-40s, and by the mid-50s, only approximately 10% of women have a regular pimple or two.
In addition to hormones, another contributing factor to an increase in acne during menopause can be related to skincare says Dr. Hughes. Anti-aging products designed to target dry skin are often formulated with pore-clogging ingredients like silicone, mineral oil, or coconut oil, which can all add up to one big pimple.
How to Treat Menopause Acne
The best defense for acne during menopause is a good offense. As mentioned above, avoiding oily or silicone-based anti-aging serums and creams is a good place to start. Dr. Hughes recommends washing with a gentle, over-the-counter cleanser such as Dove or CeraVe and using your fingertips rather than a loofah, washcloth, or other abrasive material to massage it in. She also recommends following that immediately with a simple moisturizer containing salicylic or lactic acid, which are available in many over-the-counter brands.
“Hydrated, clean skin is healthy and less likely to break out,” Dr. Hughes says.
When over-the-counter products aren’t enough, prescription creams like Retin-A, applied topically, not only work to prevent acne but may also minimize fine lines. Talk about a win/win! Dr. Hughes advises that oral prescriptions including Spironolactone can block the testosterone activity and prevent lower facial acne, while oral antibiotics can be a godsend for treating a huge cyst quickly or as a preventative to keep one at bay before a big event.
She continues by explaining how acne that doesn’t respond to traditional therapies can often be treated with the highly potent Accutane. Taken daily, this oral medication usually clears up severe acne in four or five months. When it’s time to call in the big guns, a steroid injected directly into the acne bump will typically take care of the offending cyst within 36 hours she says.
Plenty of dermatologists and medical spas offer in-office procedures that are not only effective but can also feel like a luxury. Chemical peels are a go-to for many women (although some peels may require downtime), while Broad Band Light (BBL) therapy offers a chemical and medication-free alternative.
“A chemical peel with 30% salicylic acid is one of my favorites for preventing and treating acne,” says Dr. Hughes.
Pick Your Battles, Not Your Pimples
As tempting as it may be to squeeze at acne bumps, it will only make matters worse. Dr. Hughes equates it to trying to smash a water balloon between your hands.
“You don’t know if it will pop up or down,” she cautions. “It’s the same with a zit and a ruptured cyst beneath the skin; it’s now a bigger problem and can lead to scarring.”
Picking at pimples won’t help either since there is no liquid in the middle of a “undergrounder.”
"It is solid tissue with lots of inflammation on top, kind of like an anthill," describes Dr. Hughes. Scratching the surface will do nothing but leave a wound on top of an already angry zit, and the scratch is more likely to leave a scar than the cyst in the first place."
Dr. Hughes says that while all acne is considered ‘abnormal,’ it’s part of being human and it’s not uncommon to get a pimple here and there as the body adjusts to the changing hormonal levels that occur during menopause. It’s usually nothing to stress about.
“Skin is a living organ and sometimes a pore just doesn’t behave,” she says.
It’s when the problem becomes consistent that daily treatment or an appointment with a healthcare provider is warranted. Consider talking to a dermatologist to discuss the most effective options and to develop a personalized treatment plan to keep skin looking its best.