Menopausal Acne – Challenges And Solutions

Figures & data

Table 1 Etiology Of Hyperandrogenism In Postmenopausal Women¹⁵

Endocrinopathies	Polycystic ovary syndrome
	Acromegaly
	Cushing syndrome
	Ovarian hyperthecosis
	Congenital adrenal hyperplasia
Metabolic causes	Obesity
	Metabolic syndrome
	Insulin resistance
Drug induced	Valproic acid
	Oxcarbazepine
	Testosterone
	Danazol
Neoplastic causes	Androgen secreting tumor of adrenal or ovarian origin

Figure 1 Inflammatory papules, deep-seated nodules and comedones on the lower cheek, mandibular area, extending to the neck in an obese perimenopausal woman.

Figure 2 Multiple comedones on the upper cheek and a solitary inflammatory papule.

Table 2 Comparison Of Clinical Features Of Adult And Postmenopausal Acne²

Clinical Features	Adult Acne	Menopausal Acne
Site	Mainly facial, mandible and chin truncal less frequent	Predominantly truncal, Can be panfacial
Severity	Moderate	Less
Types of lesions	Inflammatory papulo-pustules	Deep-seated inflammatory papules or nodules with a predominant perioral distribution
Comedones	May be present	Macrocomedones are commoner
Inflammatory papules	Common	Rare
Scarring	Common	Depends on severity of lesions
Sebum production	Increased	Can be increased
Treatment response	Resistant	Resistant
Other hyperandrogenic features	Less severe	Hirsutism, androgenetic alopecia, voice change more common
Associated with Photo ageing	Rare	Common
Stress/Depression	Less severe	More severe

Notes: Adapted from: Khunger N, Kumar C. A clinico-epidemiological study of adult acne: is it different from adolescent acne? Indian J Dermatol Venereol Leprol. 2012;78(3):335–341.² Copyright © 2012, Wolters Kluwer Medknow Publications.

Figure 3 Laboratory evaluation in menopausal acne.¹⁵

Box 1 Contraindications To Combined Oral Contraceptives In Menopausal Women

Absolute Contraindications Current breast cancer and estrogen dependent neoplasia Hypertension >160/100 History of cerebrovascular accident, ischemic heart disease History of prolonged diabetes or complications of diabetes Acute or recurrent deep vein thrombosis, Pulmonary embolism Known thrombophilia, antiphospholipid syndrome Known thrombogenic mutations Prolonged immobilization Smoking more than 15 cigarettes a day Migraine with focal neurological signs History of severe liver disease

Relative Contraindication Hypertension- Systolic 140–159, Diastolic- 90–99mm Hg Dyslipidemia Age>35 yrs Concomitant hepatotoxic drugs History of cholestasis or current gall bladder disease Migraine without focal neurological signs Past history of breast cancer more than 5 years

Table 3 Procedural Treatment In Active Acne

Indication	Procedure	Advantage
Comedonal acne	Comedone extraction Chemical peels	Hastens resolution of open and closed comedones
Persistent inflammatory acne	Chemical peels Laser and light therapy	Reduces inflammation and minimizes scar formation
Nodulocystic acne	Aspiration of cysts and intralesional steroid therapy	Hastens resolution of cysts and minimizes scar formation
Psychosocial distress affecting the Quality of Life	Comedone extraction Chemical peels Laser and light therapy	Reduces stress by quicker resolution of lesions and improves QOL

Markopoulos MC, Kassi E, Alexandraki KI, Mastorakos G, Kaltsas G. Hyperandrogenism after menopause. Eur J Endocrinol. 2015;172:R79–R91. doi:10.1530/EJE-14-046825225480

 PubMed Web of Science ®Google Scholar

Khunger N, Kumar C. A clinic-epidemiological study of adult acne: is it different from adolescent acne? Indian J Dermatol Venereol Leprol. 2012;78:335–341. doi:10.4103/0378-6323.9545022565434

 PubMed Web of Science ®Google Scholar