On this week’s Skin Ageing Unlocked podcast episode, co-hosts Dr. Clare Kiely and Fiona Clarke were joined by renowned consultant dermatologist and founder of Harley Street Clinic Self London, Dr. Anjali Mahto to discuss all things adult acne and how this changes throughout life and what treatments are out there.
Dr. Mahto has been vocal about her own experiences with acne throughout her teens and adulthood, which has given her a unique perspective and deeper empathy for treating her own patients in clinic.
One stage of adulthood acne can present itself is during perimenopause and menopause; even if it was something a woman had never experienced previously. In this episode, we explore why this can occur for some and how to tackle it. The great news is, as skincare and technology advances, there are far more options out there for patients experiencing acne than ever before.
For insights that look into adult acne in all stages of life, listen to the podcast in full below.
Why acne occurs during menopause
As women move into perimenopause and menopause, acne can be an unexpected and upsetting occurrence. Dr. Mahto notes that both people who have acne their whole life as well as those who have never experienced acne before can experience prolonged blemishes during menopause.
“The main hormones driving acne are a group of hormones known as androgens; these are male hormones like testosterone and dihydrotestosterone, but even women have these,” explains Dr. Mahto. “What happens as we start to creep into menopause is our female hormones start to drop a little bit, so you start getting drops in hormones like oestrogen, but your male hormones remain relatively constant; so your androgen hormones remain about the same,” she adds. “The ratio that you've got between those male hormones and those female hormones that are dropping starts to change and that can trigger acne for the first time in people in their 40s.” Dr. Kiely explains that this can lead to other changes, including the development of facial hair.
“We’re blaming the hormones, but it’s not just the hormones,” Dr. Mahto says. It’s a multitude of factors, including the hormones, the way oil glands are fairly big, plump and juicy, it’s about skin cells not shedding as they should and instead becoming sticky and clumpy so your pores get blocked. “Then there’s also the issue of the skin microbiome; our skin has bugs on it, just like our gut goes and people who are acne-prone do have certain strains of skin bacteria that can cause acne itself,” explains Dr. Mahto.
How is acne during menopause treated?
As a general rule, acne is treated in a similar way, no matter your age. Although there are some differences due to factors like sebum levels, which generally decline as we age. The main takeaway is that treatment is multifactorial. The first — and perhaps most important step in treatment — is getting a diagnosis and plan from an expert. A consultant dermatologist should be your first port of call. Or using a plan like The Skin Diary’s Chapters, which is personalised to your specific needs by our dermatology team. This is important because there are many types of acne, which determines the treatment pathway.
Skincare at home
All skin types and concerns benefit from a consistent skincare routine at home. Alongside cleansing and moisturising, “the basics of a good routine are vitamin C in the morning, vitamin A [a retinoid] at night and sunscreen in the morning,” says Dr. Mahto. “If you’re acne-prone on top of that, you may want to add in a few other products like salicylic acid if you’re oily, or mandelic or lactic acid if you’re combination,” she adds. For the odd breakout, you can use a targeted benzoyl peroxide treatment. Dr. Kiely also recommends azelaic acid for its anti-inflammatory, anti-redness, and even anti-acne activity.
Stress management
The one everyone hates to hear but needs to be said. Dr. Mahto notes that while stress isn’t the cause of your acne, it certainly can make it worse. “As dermatologists, even when we were training, we recognise that there's absolutely no doubt that stress can aggravate chronic inflammatory skin conditions,” she says. “The problem is how does one remove stress from modern day life? It's impossible to do so. We don't live in a perfect world. So the next best thing is actually recognising and acknowledging that that can be a trigger,” Dr Mahto adds. At her clinic, Self London, a holistic approach is encouraged with support from a psychologist and dietician available, too.
Roaccutane
Isotretinoin capsules, sold under roaccutane is a vitamin A drug, which is very effective for treating acne. Generally, it’s reserved for acne that has failed to respond to other treatments. It comes with side effects, which is why patients are closely monitored, including blood tests, for the duration of treatment. It’s not for everyone but has been life-changing for many patients with severe acne.
Laser treatment
Laser treatment is another option for those struggling with acne. Dr. Mahto uses a new laser called Aviclear, a laser that specifically only targets the oil glands in the skin. “It fires the laser at the skin and shrinks down your oil gland,” says Dr. Mahto. “You shrink the oil gland down, your pores don’t get blocked and if your pores don’t get blocked, the bugs that live on your skin have got nothing to act on to create those deeper spots,” she adds.
The laser is FDA approved and licensed for treatment of mild, moderate and severe acne. The laser is also non-ablative meaning it doesn't break the skin, so there’s no recovery time. “It's not a replacement for isotretinoin, but it is an additional option for people that can't take the drug or don't want to take the drug,” Dr Mahto explains.
Diet
Now, diet and acne often get oversimplified (and we don’t yet have concrete answers) but as we’ve discovered, there’s not one factor at play here. Dr. Mahto’s top line advice is: “a diet that’s good for your skin is a diet that’s good for your general health.” Don’t cut out huge food groups without working with a registered professional to help determine any triggers first.
Watch or listen to the full episode here:
