<p>Menopausal Acne – Challenges And Solutions</p>

Abstract

Although acne is a disease predominant in adolescence, it is being increasingly observed in adult life, including the menopausal period. The etiology of menopausal acne is multifactorial, with hormonal imbalance being the major culprit. There is a relative increase of androgens in the menopausal female that leads to clinical hyperandrogenism manifesting as acne, hirsutism and androgenetic alopecia. Other endocrine disorders including thyroid abnormalities, hyperprolactinemia and insulin resistance also play a role. Genetics, stress, dietary changes, lack of sleep and exercise and other lifestyle changes are implicated as trigger factors. Most menopausal women with isolated few acne lesions have normoandrogenic serum levels and do not require extensive investigations. However, baseline investigations including total testosterone are useful. Patients must also be evaluated for associated comorbidities such as obesity, diabetes, hypertension and dyslipidemia. A detailed history can help to exclude polycystic ovarian syndrome, late-onset congenital adrenal hyperplasia or medications as a cause of acne. The evaluation of menopausal acne and the approach to treatment depend on the severity of acne and associated features. In patients with mild acne without virilization, prolonged topical therapy is the mainstay of treatment. Though combined oral contraceptives are effective, they are relatively contraindicated in the postmenopausal period. Spironolactone is the first choice of therapy in the subset of patients that require oral anti-androgen therapy. Procedural treatment can be useful as it can also help in the treatment of associated acne scars and concomitant skin aging. It is also important to focus on lifestyle changes such as reducing stress, controlling obesity, having a healthy diet, exercise and proper skin care routine to reduce acne. The focus of this article is on the clinical presentation and management challenges of menopausal acne, which represents a special subtype of acne.

Once-Daily Polymeric Tazarotene 0.045% Lotion for Moderate-to-Severe Acne: Pooled Phase 3 Analysis by Sex

“…5 In addition, older, menopausal females are more likely to experience erythema and hyper-or hypo-pigmentation. 6 Even though tazarotene-treated females in the current analysis had higher TEAE rates than males, these rates were similar to those reported in the tazarotene-treated overall population pooled from the two pivotal phase 3 studies (females in current analysis 30.8%; overall pooled population: 26.8%). 16 This may be a result of the larger number of female than male participants in the current analysis.…”

“…On average, the female participants were almost 5 years older than the male participants, with an age range of 10-65 years versus 10-44 for males. Female patients commonly experience dry and sensitive skin, 6 especially at older ages when sebum production decreases. 5 In addition, older, menopausal females are more likely to experience erythema and hyper-or hypo-pigmentation.…”

“…5 Along these lines, females are more likely to report dry, sensitive skin, 4 which may become more apparent with age. 6 These differences between female and male patients with acne could affect treatment efficacy, tolerability, or adherence.…”

Acne is a disease of civilization

“…В ряде случаев (иначе это противоречит высказыванию, что более 50% женщин старше 25 лет страдают акне) к 18-20 годам жизни начинают отмечаться признаки спонтанного регресса заболевания. У некоторых пациентов заболевание приобретает хронический рецидивирующий характер, в отдельных случаях -с формированием к 30-40 годам «поздних акне» (acne tarda), причем число таких пациентов с каждым годом растет [11,12].…”

Androgen synthesis in menopause and diagnosis of causes of hyperandrogenism in menopause

“…В той же час до 41% жінок в менопаузі страждають через втрату волосся [12]. Незважаючи на те, що акне розглядається як патологія, притаманна пубертату, частота даного стану в дорослих жінок, старших від 25 років, складає загалом від 20 до 40% (26% -серед жінок віком 40-49 років і до 15% -серед жінок, старших від 50 років) [13][14][15]. Точні дані щодо розповсюдженості гірсутизму в менопаузі відсутні, проте відомо, що близько 15% жінок згаданої вікової групи звертаються за лікарською допомогою через ріст жорсткого волосся на обличчі [16,17].…”