Your Ultimate Guide to Treating Menopausal Acne

Menopause can do a number on your skin, leading to a decrease in natural collagen production, declining moisture levels, slower cell turnover, and, the most surprising change, hard-to-treat breakouts. Those pimples you thought you left behind in high school might return, and this time around, they're back with a vengeance.

Unlike the breakouts you may have experienced as a young adult, menopausal acne looks and behaves differently. Decreased estrogen can leave the skin feeling bone dry, making this later-in-life bout of acne more painful, slower to heal, and more likely to scar. While middle-aged breakouts are hard to tackle, there are plenty of solutions to control these flare-ups once and for all.

Why Breakouts Happen During Menopause

Menopause causes changes to normal hormone levels, resulting in a barrage of side effects, such as brain fog, uncontrollable hot flashes, mood swings, weight gain, dry skin, and the progression of thinning hair and hair loss. But menopausal acne is one unexpected side effect that has many people in this stage of life trying to make sense of what is happening to their skin.

Acne during perimenopause or menopause reflects dwindling levels of female sex hormones, such as estrogen and progesterone. Gary Goldfaden, MD, says androgens (male hormones) can become imbalanced during menopause. "There's also high levels of cortisol, a stress hormone, during perimenopause. When it is elevated, it can cause excess oil production, leading to breakouts."

"You may not have had teenage acne but then get breakouts as an adult," says Anthony Rossi, MD. "But, on the other hand, a family history of acne may hint at a genetic preponderance to your acne."

What Menopausal Acne Looks Like

Menopausal acne appears as deep inflamed lesions that Dr. Goldfaden says occur on the chin, jawline, and upper areas of the cheeks near the nose.

If you're experiencing an onset of acne, it's important to diagnose it accurately. In menopausal people , there can be confusion between rosacea and acne since they look similar. But each condition is treated differently, so it's worth a trip to your dermatologist for a thorough diagnosis.

How to Treat Menopausal Acne

A healthy daily skincare regimen is imperative to help fight acne. Dr. Goldfaden recommends washing your face with cleansers that contain alpha hydroxy acids and using serums and moisturizers with salicylic acid to target bacteria in the pores. "Exfoliation, either physical or chemical, is a must to clear up existing oil and bacteria. It also removes dead, dry skin cells, inhibits future breakouts, and treats existing scarring," he adds. His favorite exfoliator for menopausal acne is Goldfaden MD Doctor's Scrub, a gentle yet effective exfoliator that replenishes skin hydration.

Medical-grade facials with chemical peels and lasers, like AviClear, may help improve acne if a cream or spot treatment doesn't cut it. Medication available through your dermatologist, like oral antibiotics or a cortisone injection (if you are experiencing pain), is another option for stubborn breakouts, which may be your saving grace.

Dr. Goldfaden says some people n need a topical antibiotic like Cleocin or Benzamycin when more than a few acne lesions are present. Dr. Rossi adds that medications such as spironolactone, which has an anti-androgen effect, can also help combat the androgen causation of acne. "Plus, it can also help with female pattern hair loss, which some women experience during this time."

In some cases, Isotretinoin or Accutane (prescription medication to treat more severe acne) is a must. Hormone replacement therapy (HRT), usually taken at the onset of perimenopause, can also significantly improve hormonal acne since the treatment balances hormone levels, specifically estrogen.

The Bottom Line

No matter the course of action your dermatologist recommends, it's critical not to pick the skin or try to pop the pimples. "Doing so will set off a cascade of inflammation and irritation that will cause further breakouts, hyperpigmentation and potentially scar the skin," Dr. Rossi says. Instead, reach for a pimple patch, like ZitSticka Killa Acne Extra Strength Patches, or zap them with a high-frequency wand. It's also important to wear sunscreen daily, like Dr. Rossi Derm MD THE DAY FORMULA. "During times of breakouts to prevent hyperpigmentation of inflamed skin by UV exposure," he adds.

Menopausal acne responds best to a well-devised plan when breakouts are constant. At the end of the day, once you find a routine that clears up menopausal acne, stick with it to put your skin on the path to clear.