Recent studies have shown that adult acne in women is on the increase, with perimenopausal acne in women over the age of 45 – one of the sharpest rises over the last five years.

The latest research suggests that almost 30% of women will experience perimenopausal acne in the run-up to menopause, even if they have never had acne before.

Contrary to the assumption that like teen acne, perimenopausal acne is directly caused by the hormonal flux leading up to menopause, in fact, it’s the changes in the skin as a result of hormonal flux that leaves the skin more vulnerable or susceptible to perimenopausal acne.

The main cause of changes in the skin in perimenopausal women is a shift in balance between oestrogen and androgens, and in the perimenopausal phase androgen levels tend to be higher, which is what is primarily responsible for the changes in the skin of perimenopausal women.

Perimenopausal acne is also often accompanied by underlying redness and inflammation, called acne rosacea, which is most common in women aged 45 plus.

We asked consultant dermatologist, Dr Eva Melegh, to identify four changes in perimenopausal skin that can leave it more susceptible to perimenopausal acne – and how to fix it.

1. Weakened skin barrier function
   

In perimenopausal skin, the skin barrier function becomes weaker due to the drop in oestrogen, which is what gives skin its elasticity.

 A weakened skin barrier function leads to dryness and more gaping skin pores, which causes microdamage to the skin’s surface and allows external bacteria to enter more easily, causing infection and acne. So this is acne not caused by too much sebum, as with teen acne, but in fact not enough moisture in the skin.

How to treat it?
Perimenopausal acne-prone skin needs to be moisturised. Washes and products for acne that are aimed at drying up sebum are the worst thing for perimenopausal acne. Instead, overnight serums with intensely hydrating ingredients and preferably one containing a skin prebiotic to help repair damaged skin barrier function. Kalme TeQ Serum is a super hydrating and skin-repairing prebiotic serum containing extracts of blue agave and pure plant-based squalane as well as an anti-redness ingredient from capers and is designed for maximum skin hydration and skin repair of red, dry, spotty and sensitive skin.

2. Decrease in good skin bacteria
   

This is still a relatively new area of research, but studies suggest that during perimenopause declining oestrogen levels lead to changes not only in the gut’s microbiome but also in the skin’s microbiome (the bacteria living on the skin’s surface. Menopausal change has been observed to influence the number of good bacteria living on the skin’s surface, with reductions in the diversity of these beneficial bacteria. A decline or change in levels of good skin bacteria means, conversely, that levels and diversity of bad skin bacteria can start to multiply. It’s the bad skin bacteria that leads to acne.

How to treat it
Effective treatment of perimenopausal acne needs to address this bacterial imbalance by promoting increased growth of good skin bacteria. Clarol Silver Serum is a skin serum containing a targeted micronized silver ingredient that directly feeds good skin bacteria while repelling bad skin bacteria. This can quickly and effectively address this tendency towards bacterial imbalance in perimenopausal skin to help reduce perimenopausal acne and redness.

3. Skin Sensitivity
   

With less good skin bacteria plus weakened skin barrier function, perimenopausal skin becomes more sensitive and prone to reactions to chemicals and perfumes in normal skincare and cosmetics products. With skin reactions, the skin becomes inflamed and red, which stretches open the skin pores and allows external bacteria to enter the skin pores more easily leading to infection and acne.

How to treat it
A key to controlling perimenopausal acne is to keep skin inflammation to a minimum and that means controlling sensitivity. The first step is to reduce the use of skin care products that contain large amounts of chemical ingredients, preservatives and perfumes. Products need to contain more naturally sourced ingredients, be suitable for sensitive skin and contain no perfumes. Kalme Undercoat is a base coat product to be worn under other skincare products, cosmetics and sunscreens that contains a specific de-sensitising ingredient to reduce the skin’s reactivity.

4. Increased Facial Hair
   

Due to a period of higher androgen levels in perimenopausal skin, hair growth on the face (hirsutism) can increase during perimenopause. An increase in facial hair growth can cause the hair follicle to become more easily blocked and inflamed, leading to folliculitis acne, which is when external bacteria gets into the hair follicle and inflames the hair root.

How to treat it
Exfoliation is the single most effective way to reduce acne related to infected hair follicles while also increasing skin cell turnover. However, exfoliation in perimenopausal skin must be gentle with a fine and natural exfoliant as the skin is more fragile. Manual exfoliation every 1-2 days plus an acid exfoliation once every 3-4 days is a good routine for skin prone to perimenopausal acne and should keep hair follicles uncongested.

Clarol Silver & Birch Exfoliation Wash contains an extract of birch bark, that contains natural equivalents of both salicylic acid and methyl salicylate, two synthetic chemicals commonly used in anti-acne products. Birch Bark also contains betulin to help reduce inflammation. Pumice stone and rice bran provide gentle manual exfoliation in this natural exfoliating wash. Products containing alpha-hydroxy acids (AHA and beta-hydroxy acids (BHA’s) help exfoliate multiple layers of the skin and are good for use 1-2 times a week for a more profound acid exfoliation and to help brighten the complexion and accelerate skin cell turnover.