Acne treatment differs before, after menopause

September 1, 2006

Chicago - Acne, common in women of all ages, can be treated differently depending in part upon age, according to Julie C. Harper, M.D., assistant professor of dermatology at University of Alabama School of Medicine, Birmingham.

Chicago - Acne, common in women of all ages, can be treated differently depending in part upon age, according to Julie C. Harper, M.D., assistant professor of dermatology at University of Alabama School of Medicine, Birmingham.

One study shows that 12 percent of women at the age of 25 have clinical acne, compared to 3 percent of men, and at age 45, 5 percent of women still have acne, compared to 3 percent of men.

"Both of those numbers are higher than what we would usually see in men patients," Dr. Harper tells Dermatology Times.

"For most of us in our clinical practice it is not a big surprise that we see more women than men have acne, but we really don't know why," Dr. Harper says.

One obvious difference between men and women is the hormonal fluctuations that women experience throughout their lifetimes. In addition, women also often use cosmetics and oral contraceptive pills (OCP), and frequently suffer from chronic stress.

In one study that looked at the effects of the menstrual cycle on acne, of the 400 women surveyed, 44 percent reported a premenstrual worsening in their acne.

In another study, 63 percent of women evaluated showed a 25 percent increase in acne lesion counts premenstrually.

Hormonal changes

"Unfortunately, there is not a lot of data out there to explain why a women has acne - better or worse - during pregnancy or during menopause," Dr. Harper says.

In her practice, she observes that acne often flares when an OCP is discontinued. It also may either worsen or improve during pregnancy.

"Some acne may worsen during pregnancy as a result of discontinuation of acne medications," she says.

Hormonal treatments

Dr. Harper notes that considering hormonal treatments is a reasonable approach for women with acne. However, treatment varies based on a woman's age.

In general in a younger woman who is premenopausal and has acne, a birth control pill is a reasonable place to start, especially for a woman under the age of 35.

"Just about any birth control pill can help, as long as it is a combination estrogen/progestins. OCPs that are only progestins - for example, Depo Provera - might actually make acne worse," Dr. Harper says.

The risks of oral contraceptives include venous thromboembolism, stroke, heart attack and breast cancer. Side effects for oral contraceptives include irregular bleeding, nausea, weight gain, mood changes and breast tenderness.

A female patient who is postmenopausal and has acne may have good results with a product such as the aldosterone antagonist spironolactone. Side effects for spironolactone include polyuria, menstrual disturbances, gynecomastia, dizziness, headache and weight gain.

Postmenopausal women will not need to be concerned about the potential spironolactone side effects related to pregnancy. Use of the drug can also lead to abnormal periods, but that won't affect postmenopausal women either, Dr. Harper says.

Postmenopausal patients often complain of increased facial hair (hirsutism) and hair loss on the scalp (alopecia).

"If hirsutism and alopecia are not a problem, traditional treatment with topical retinoids, antimicrobials and systemic antibiotics can be used when needed. If hirsutism and alopecia are a problem, spironolactone may be very helpful," she adds.

Dr. Harper uses low doses, such as 50 mg to 100 mg per day, coadministered with an oral contraceptive pill if the patient is of child-bearing potential.

Continued research is warranted in this area, Dr. Harper says.

"More still needs to be learned about the development and treatment of acne throughout a woman's life cycle," she says.

Disclosure: Dr. Harper reports no conflicts of interest related to this article.

References:
Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999;41(4):577-580.
Stoll S et al. J Am Acad Dermatol. 2001;45(6):957-960.
Lucky A. Arch Dermatol. 2004;140:423-424.