Introduction
Ageing is a natural occurrence that affects us all; and let me start by saying that there is absolutely nothing wrong with choosing to embrace this process! It is a process that can be modified both by lifestyle intervention or medical treatments however and whilst it is impossible to completely stop it, there are ways to slow it down and minimize its effects on how we look and feel. Aging is affected by both intrinsic and extrinsic factors, and understanding these will help us better understand how to best care for our skin. Additionally, hormonal changes that occur during menopause can induce changes in the skin; how it appears and how it behaves – problems such as rosacea, hyperpigmented spots and adult-onset acne occur frequently as we age and our hormone balance changes. To better understand these processes, we will explore the factors that cause aging, the hormonal changes that affect skin aging, and how to best care for our skin during menopause.
Click to see New England Journal of Medicine picture showing skin ageing in a truck driver of 25 years. Note the difference in the left compared to the right from constant UV exposure.
Intrinsic Causes of Aging
Intrinsic ageing (inside the body), also known as chronological ageing, is the natural process that occurs as we get older. It is affected by factors such as genetics, ethnicity, lifestyle choices, and environmental exposure. As we age, our cells begin to lose their ability to regenerate and repair themselves effectively; imagine, for example, an old computer and how it may crash more often as time goes on – this is like DNA replication of cells; things get a bit lost in translation! Protein and collagen stop being replicated as efficiently and the rate of replication slows down.
From the early 20s, collagen production slows by 1% of total porduction each year; by the mid 40s, almost no collagen is regularly generated which leads to wrinkles, volume loss and sagging skin. Melanocytes (the cells responsible for your skin’s ability to tan and protect itself from UV rays) become affected by extrinsic (outside the body) factors and begin to function improperly causing age spots. Essentially, the scaffolding structures holding your skin in place become less able to keep things steady, and physiological fat pads descend (thanks gravity!) causing volume loss and as a woman, during the pei-menopausal period, bone turn over is affected, causing bone resorption to outdo bone production which further affects volume loss and fat pad descent. Additionally, the ability of a woman’s skin to retain moisture decreases, leading to dryness and dullness.
Extrinsic Causes of Aging
Extrinsic ageing is caused by external factors such as sun exposure, smoking, blue light (from electrical screens such as TVs, laptops etc) and pollution.
- UV RAYS FROM THE SUN can cause free radical damage and alter DNA causing deposition of a disorganised collagen and elastin matrix, affecting the skin’s ability to repair and produce elastin and collagen, leading to wrinkles and age spots. We call this photoageing (sun damage to you and I).
- SMOKING can cause premature ageing by narrowing blood vessels and reducing blood flow to surface skin cells. Collagen and elastin are degraded by free radicals and chemicals found in, and caused by, the smoke which reduces the skin’s ability to retain moisture and elasticity.
- POLLUTION can also cause premature ageing by clogging pores and leading to inflammatory changes.
- NUTRITION has been shown to play a big factor in extrinsic ageing. Those who have a good intake of fruit and vegetables and a low fat and red meat intake have been shown to have greater skin elasticity and more youthful skin appearance for longer than those age-matched with a diet which is higher carbohydrate and fat content. It has long been recognised that fruit and vegetables are packed with antioxidants, vitamins and minerals and these help mop up those pesky free radicals whilst feeding our skin cells with the good stuff needed to keep us looking younger.
So what intrinsic/extrinsic factors put you more at risk of photoaging? Well, I’m glad you asked. The following information, taken from DermnetNZ (a wonderful dermatology resource), gives a concise description of those who may be higher risk:
“People who typically present with marked signs of photoaging include those who:
- Have Fitzpatrick sun-reactive skin types I-II (with red/blond hair and blue eyes)
- Live in the tropics or subtropics
- Live at high altitudes
- Work outdoors or spend long periods outdoors for recreation
- Have sometimes been exposed to artificial sources of UV radiation, such as indoor tanning
- Have a genetic predisposition to premature ageing (eg, progeria which is rare)”
Hormonal Changes Affecting Skin Aging
The ageing process of the skin generally happens at an earlier age in women compared to men, this is due to the reduced oestrogenic effect on cells. Hormone changes that occur during menopause can therefore also affect the skin in women aged 45-50 (average age of onset of menopause).
As oestrogen levels decrease, the skin’s ability to retain moisture decreases, leading to dryness, itch (occasionally the sensation that feels like creeping under the skin) and wrinkles. Reduced oestrogen can also slow down the process by which the top layers of skin are shed, which again increases skin dryness and dulls the overall appearance of skin. That crepe-like skin on your lower cheeks and neck – that is sun damage, reduced hydration and slowing down of skin shedding!
Additionally, hormone imbalances resulting from a decrease is the oestrogen:testosterone ratio can lead to increased hair growth on the upper lip, chin and chest area and also an increase in oil production and bacterial overgrowth which in turn, often leads to a new onset of acne in adulthood and worsening of rosacea (think puberty only backwards). Oestrogen replacement may not always help here.
Rosacea and Adult Acne Causes in Relation to Menopausal Hormone Changes
Rosacea is a skin condition that is characterised by redness, inflammation, and bumps on the face. It most commonly occurs in women aged 35-55 and appears to be caused by an increase in oil production. Whilst not proven to be directly related to hormone imbalances noticed during menopause, there is definitely an overlap in these groups and hormonal flushing may well exacerbate symptoms making the condition more noticeable around this time. Rosacea is more common in women, but it is often more severe in men. There are many triggers that may make rosacea worse. These include alcohol, exercise, high and low temperatures, hot drinks, spicy foods, some medications and stress. Rosacea patients can be sensitive to the sun.
There are 4 subtypes of rosacea:
ERYTHEMATOTELANGIECTATIC ROSACEA – Typically causes central flushing to the face and is often associated with a burning, stinging or itching sensation. Scaliness of the skin may also be seen, which is due to a mild dermatitis. Creams and gels may worsen the discomfort due to their higher water content.
PAPULOPUSTULAR ROSACEA – This is associated with redness and small pustules in the central area of the face and may look a bit like acne. There may be a burning and stinging sensation to the skin – a bit like sunburn.
PHYMATOUS ROSACEA – This type of rosacea causes the skin surface to become thickend and uneven. Most often, it affects the nose (this is known as “rhinophyma”), but it can also affect the chin, forehand, one or both ears and/or the eyelids.
OCULAR ROSACEA – In ocular rosacea, the patient’s eyes or eyelids are also affected. It is commonly associated with blepharitis, conjunctivitis, inflammation of the eyelids and meibomian glands (causing styes). Symptoms may include a stinging or burning sensation in the eyes, dryness, sensitivity to light or the feeling of having something in your eye.
In roughly one in five cases, symptoms occur in the eyes before the skin is affected. Ocular rosacea may therefore be difficult to diagnose before skin symptoms occur
Adult acne is also caused by hormone imbalances, and is characterised by redness, inflammation, and breakouts on the face. It is possible that the drop in oestrogens during menopause may cause a relative increase in testosterone levels (increased testosterone to oestrogen ratio) which can cause breakouts. Oestrogen replacement may not resolve these acneic breakouts and typical acne treatment (such as antibiotics, topical and oral retinoids) should be used.
How to Best Care for Your Skin During Menopause
- The best way to care for your skin during menopause is to be consistent with your skincare routine. Use gentle, non-irritating products such as cleansers, moisturisers, and sunscreens that are specifically formulated for mature skin. Keep it simple with a robust, targeted skincare routine that you will be likely to stick to. A good vitamin C serum is key to helping reduce damage by free-radicals and sun damage.
- Eat a healthy diet that is rich in fruit and vegetables, pulses, legumes, olive oil and fish which are all rich in antioxidants, b vitamins, vitamin A and essential oils.
- Stay hydrated by drinking plenty of water.
- It is important to limit sun exposure and wear protective clothing when outdoors. A daily SPF of 30 or above should be used – rain or shine!! – to help reduce UV damage and help reduce bacterial oxidation which can cause spots.
- It is always worth trying a collagen supplement but ensure that it is of good quality and tastes good so you will actually use it! And you are looking for collagen peptides (broken down/damaged collagen) to trick your body into thinking it is damaged and so go into ‘repair’ mode to produce more collagen. My favourite by far is Skinade which contains all of the vitamins, mineral complexes and peptides I have mentioned above and it tastes delicious!
- Treat adult acne like any other ance – your doctor should be able to suggest either topical (creams or lotions which may contain antibiotics or retinoids) or oral treatmennts (tablets containing antibiotics, retinoic acid or things like spironolactone).
- Rosacea can be treated with topical or oral antibiotics and also with retinol creams or tablets. It is important to think about environmental triggers also and try to avoid these where possible.
- Don’t smoke! It smells bad, is no longer fashionable, ruins your skin, puts your life at risk from its many other side effects (lung cancer, bladder cancer; I’m looking at you) and it is really expensive – you could put this money towards a banging skin routine (see point one).
- Waxing, plucking, electrolysis, shaving and depilatory creams are safe to use on any excess, unwanted hair growth. It may improve with oestrogen replacement anyway.
- If it is a little too late and the damage is already done, fear not. There is always something that can be offered. My top 5 treatments currently: botox to relax lines, hyaluronic acid fillers to address volume loss, chemical peels to clear up acne, tighten skin and improve pigmentation, microneedling to tighten up crepey skin and improve skin tone, texture and pigmentation and finally, Profhilo or Belotero Revive to stimulate collagen production and hydrate skin.
conclusion
Ageing is a natural process that will affect us all, and while it’s impossible to completely stop it, there are ways to slow it down and minimise its effects. Ageing can be caused by both intrinsic and extrinsic factors, and understanding these factors can help us better understand how to best care for our skin. Additionally, hormonal changes that occur during menopause can cause changes in the skin, such as worsening rosacea and causing adult acne. By understanding the causes of ageing and the hormonal changes that affect skin ageing, we can better care for our skin during menopause and minimise its effects on our appearance overall.
Keywords: Aging, Intrinsic Aging, Extrinsic Aging, Hormonal Changes, Menopause, Rosacea, Adult Acne, Skin Care.
Referennces
www.changingfaces.org.uk/advice-guidance/condition-specific-information/rosacea
www.dermnetnz.org/topics/ageing-skin
www.ncbi.nlm.nih.gov/pmc/articles/PMC3583890
Skin changes during menopause, Dr Louise Newson