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7. 15-Minute Consult: Acne and Facial Hair in Perimenopause & Menopause with Dr. Melissa Mauskar
100 Plays12 days ago
As a board-certified OBGYN, I’m the first to admit: while I’m an expert in hormones and menopause, I am not a dermatologist. Yet, my patients come to me every day with skin concerns that feel like "cruel and unusual punishment." You’re already dealing with hot flashes and night sweats—why are the cystic acne and chin hairs back too?
To give you the answers you deserve, here is a "15-minute consultation" with my go-to expert and dear friend, Dr. Melissa Mauskar.
Dr. Mauskar is a double-threat: a Dermatologist and Associate Professor in both the Departments of Dermatology and OBGYN at UT Southwestern. She is the Director of Genital Dermatology and Women’s Health and a leading expert in vulvar dermatoses.
In this episode, we dive into the "Big Three" of menopausal skin:
1. The Return of the Adult Acne
Why are we getting "teenager" pimples in our 50s? Dr. Mauskar explains the "hormonal dance" of perimenopause—specifically the relative androgen excess that happens when estrogen dips.
- The Gold Standard: Why retinoids (like Tazarotene) are the "heavy hitters" for both acne and aging.
- The Spironolactone Debate: We discuss why this anti-androgen is a first-line treatment for skin, but why I, as a sexual health expert, have some serious reservations about its impact on libido.
2. The "Wisdom" Hairs (Chin Beards & Upper Lips)
Dr. Mauskar breaks down why terminal hairs start popping up on the chin and why you need to act before they turn white if you want laser hair removal to work. (Plus, I share a quick story about why chin hairs are actually a sign of wisdom in Sub-Saharan Africa!)
3. The Widening Part: Hair Thinning
It is incredibly frustrating to see your hair density drop just as your hormones shift. We discuss:
- Topical vs. Oral Minoxidil: Which one is right for your hair-washing routine?
- The 6-Month Rule: Why patience is the most important ingredient in any hair growth protocol.
- Red Light Caps: Are they worth the investment, or should you stick to the basics?
Connect with Dr. Melissa Mauskar
- Professional Profile: UT Southwestern Medical Center - Dr. Melissa Mauskar
- Specialty: Genital Dermatology, Lichen Sclerosis, and Women's Health.
Key Resources Mentioned
- Tazarotene: A potent retinoid Dr. Mauskar prefers over traditional Tretinoin for better tolerance.
Spironolactone: A common oral medication for hormonal acne (use with caution regarding sexual side effects!).
Recommended
Transcript
Introduction to Dr. Melissa Moskauer
00:00:00
Speaker
Melissa Moskauer.
00:00:12
Speaker
but this is not my area of expertise but i do want to help my patients so for that reason i'm doing a fifteen minute consultation with dr melissa muskco She's a friend and colleague and an expert in dermatology. So Dr. Moskauer is a dermatologist and associate professor in the departments of dermatology and OBGYN at UT Southwestern in Dallas, Texas. She's the director of genital dermatology and women's health and is an expert in lichen sclerosis and vulvar dermatoses. She's my go-to dermatologist as you will see. And I'm so excited to have her on today for my 15 minute consult. Listen in.
00:00:48
Speaker
I'm calling this our 15-minute consult because my patients going through barry menopause and menopause ask me these questions all the time, and I don't have the answers for them, to be completely honest.
00:00:59
Speaker
And sometimes I say, okay, we can try this, we can try that, or go see a dermatologist. And sometimes they want to make sure that, is it worth making an appointment for, or is it something that's going to get better with time, or should they not stress
Why Does Acne Return During Menopause?
00:01:12
Speaker
about it? you know So anyway, let's just jump in The first one is acne.
00:01:16
Speaker
why does acne come back to bite us in the ass? in here makeon type but a on giving you know it really i like speaking of like It's very frustrating. And even if you didn't have bad acne, like in your teens, honestly, in your forties and fifties, sometimes it comes out. And a lot of it has to do with hormonal shifts, you know? And I do think that around menopause and perimenopause, your hormones are like this, right? We know they're doing dances. Then during menopause, you do have that you know, slight relative androgen excess. And so the estrogen kind of dips down and the testosterone does too, but we know it goes a little bit slower. And so um we know actually that testosterone is made by skin.
Testosterone's Role in Skin Health
00:01:59
Speaker
So your skin does make its own testosterone around the hair follicles and the sebum, right? We also know that testosterone actually helps regulate staph aureus. And one of my colleagues here at IU Southwestern actually showed that in really cool ways by measuring hormones on the skin. And she did it in men and women and saw that when you block testosterone, you don't get as much acne and not as much step aureus.
00:02:21
Speaker
And so that's why we we love retinoids, okay, for acne, whether you're in your teen years or in menopause, perimenopause age. We like them because it treats acne, prevents acne. It also helps turn over your skin cells faster. And so it helps reduce fine lines, wrinkles, and dark marks.
00:02:37
Speaker
okay All good things. Retinoids are my go-to for acne, no matter your any age. We also like anti-androgens like spironolactone. And so it's spironolactone by mouth.
00:02:51
Speaker
is actually a first line treatment for hormonal acne. okay If you're in your 30s, 40s, 50s, or above. Now, because it's an anti-testosterone, right? I hate ferrolactone. I'm just going tell you, hate ferrolactone as a second. Well, as you say, theoretically, it has the potential to decrease libido. i don't know how much we actually see that in practice. And I don't think there's been a placebo controlled study looking at libido and the effects of spironolactone. Right,
The Impact of Spironolactone on Libido
00:03:22
Speaker
right. And that's a great point because I see women for low libido, hypoactive sexual desire disorder. If they're on spironolactone, I might take them off of it.
00:03:31
Speaker
and see if that helps. But it's not like everyone on spironolactone is automatically going to have a decreased libido. So, and honestly, like in Durham, we actually just submitted a a letter to the editor because I don't think dermatologists are asking their patients, for right? When we put them on spironolactone, like it's candy.
00:03:48
Speaker
Yeah. Well, it's affecting their libido. Right. But I also don't think it's good that a lot of people are, we'll talk about hair, I i hope, because that's another thing. But I have a lot of patients that are actually on, you know, testosterone transdermal gel. Right. But then their doctors will put them on spironolactone to block the effects that you can have on the hair.
00:04:09
Speaker
yeah And then like, those two then are just canceling each other out. so kind know I'm like, what's the point? What's the point? Yeah. Okay. I'm glad we agree on that because I feel like I've seen that as well. And I'm like, I don't think that's going to work. And I'm like, maybe there's something I don't know, you know, but i'm I'm glad we agree on it. Okay. So I love that idea.
Benefits of Retinoids for Acne
00:04:29
Speaker
like retin-a tretinoins right hazaratine is actually in my mind better than either of those two oh okay so and honestly for myself personally it's a much better tolerated than tretinoin or some of those ones that have been around for a while it's also a bigger hitter and so it's a little bit stronger and i use mine without moisturizer And so I do a little pee of the retinoid. I like the tazeratine with like a dollop of a moisturizer with ceramides, mix them together, dot dot dot, dot, dot, rub them in. It also works on hands and arms, but the more places you use it, the faster you go through it.
00:05:06
Speaker
There's also over-the-counter retinoids, like a dappling or different. he mean Those are not as strong, right? Not as strong, but I mean, you know, some people like to ease into them. Yeah.
00:05:16
Speaker
And I remember as a teenager using Retin-A and the, I think the dermatologist told me it's going to get worse before it gets better. Is that true? It's like, it kind of brings out some crap underneath your skin before it clears it up. Is that true? Or like, would expect menopause too? We typically change the way we use those, or I personally, because I don't know if you remember, but like, you know, we used to just turn red, right? everyone knew when you were on a retinoid, because you were bright red. If So now what we like to do is I like to start off every other night and ease my patients into it, but it's a slow peel of your face. So yes, in the first four weeks, you may notice a little bit more of those milia or comodon, closed comodones, but this is really my long-term
00:06:01
Speaker
yeah patientian So, I mean, I think for the acute, like deep pimples, right. That we talk about with hormonal acne, right yeah can really help those really spironolactone is one of the only things control pills. Right. And so a lot of perimenopause patients will be placed on birth control pills.
00:06:18
Speaker
So i think that's another option, but the retinoids are not going to get those deep seated pimples. painful. spot Oh, that I'm really glad that you mentioned that. Because yeah, I do. i do hear my patients say specifically that they feel like it's their cystic hormonal acne that they remember from their youth that's coming back and perimenopause. And it's different for everyone. Sometimes just, you know, acne here or there. Okay, so you talked about the androgens decreasing slower.
Managing Facial Hair Growth During Menopause
00:06:44
Speaker
is that also why women get like the hair and the upper lip?
00:06:48
Speaker
Yes. And all the terminal hairs. so here sha upper lip Sorry, motioning to my chin, but the hair on the chin and the upper lip. Yes, all in this area. And I will say, like, as someone that is entering perimenopause and dealing with these things, and we see a lot of ladies that are in their 70s and 80s, and they have just these white beards, right? Because I think if you have those, like, one or two annoying hairs on your chin, electrolysis is a really good, like, long-term option.
00:07:17
Speaker
But so is laser hair removal, like, when you can prevent it. Because once the hair turns white, laser hair removal does not work, and you have to do electrolysis. okay I lived in sub-Saharan Africa for a while and hairs on the chin are a sign of wisdom. and Let's go there then. It's like all a great thing. And there's a completely different cultural expectation, like cultural appreciation for hairs on the face for women. I'll rock that with you. If you, if you put yourself out there, I mean, I'll let the one grow curly. Cause my husband's like, I've got one right here. I just like literally right here. My husband yeah missed it.
00:07:54
Speaker
You missed it. It's really into a curly cute. I could never get with it. I'm like, my brain is too North American. I can never get over it. and i Like I can't help but almost stare when I see you putman with a full on goatee. I don't think I can rock a goatee. I can't do it, Melissa.
00:08:12
Speaker
He's like, literally, you can't. was like, I can't see it. So if you want to get it for me and you want to do that, Neil. Oh my gosh. Yeah. I just feel like it's kind of, you know, what my patients say. It's like cruel and unusual punishment. Like they're going through perimenopause and menopause. They're not sleepy. Well, their mood is changing. They're having vaginal dryness and pain with sex. And now they're growing a full beard and getting acne. It's just like, what
Understanding Hair Thinning in Menopause
00:08:35
Speaker
the hell? So my last question in our 15 minute consult is hair thinning. Right. Is this just an age thing? And it's a coincidence that as women are going through perimenopause and menopause, they start to also notice it because I see like their male counterparts also are having hair thinning. So maybe it's not hormonal, but you tell me like what do I tell my patients about hair thinning. I feel i feel awful about it.
00:08:56
Speaker
I think it's incredibly frustrating for patients and for providers. And so there are so many people looking into this right now. It's super important. I think some people and some families are more susceptible to this than others. Okay. And we noticed like at first the widening part and hair loss honestly could be its own like one hour segment, right? But I do think that very slowly as you go through kind of hormonal changes, and again, some people it's time and some it's like chronological,
00:09:27
Speaker
menopause. But I think the first thing is the widening of the part, right? And the lower density. But I do think some women go through that, you know, actually in their late thirties and earlier than others. So there's two options. Well, there's tons of options now that we can do. Okay.
00:09:40
Speaker
I personally don't recommend red light caps because I think that there's a lot more things we can do that are less expensive and more beneficial. So if you are noticing a little bit of widening of the part and you are, you know, someone that washes your hair like every one to two days, topical minoxidil works almost, actually there was a study that showed it works exactly the same as oral minoxidil. Oral minoxidil grows hair Right.
00:10:06
Speaker
Right. But so um I tell patients, especially men, and then some of my perimenopausal women, when you're brushing your teeth, just dab some on, do it twice a day, make it part of your routine. It's very good at growing hair.
00:10:17
Speaker
Okay. Now, if you are, you know, post-menopause and a lot of our patients only wash their hair once a week, or they go to their salon to wash their hair or, you know, because of their hair type, they're only washing their hair every other week. That's when oral minoxidil, I think works incredibly well. It's actually blood pressure medicine that then You know, we found out know hair. I start my patients at half of a tap because it's also that blood pressure medicine. And that's enough that in six months, when you come back, you can actually see a lot of hair growth.
00:10:44
Speaker
Okay. I take a picture here at one visit and then six months, because that's how long it takes us for to see those
Treatments for Hair Thinning: Minoxidil and Spironolactone
00:10:49
Speaker
benefits. I take another picture. Patients are amazed. We actually use a lot of spironolactone also.
00:10:54
Speaker
And so again, i like spironolactone because it helps with this acne and the hair. Okay. Both of those. Antigens that also cause that like male pattern balding, right? So that's why the spironolactone would make sense. Okay. And then for those patients, you'd see more of the forehead receding. Don't look at mine. I think it's happening. but So there's another type called frontal fibrosing.
00:11:16
Speaker
Okay. There's about probably 25 types of them, but the androgenetic is yeah the one we're mostly talking about. but then you can have traction and you have lichen planopilaris. There's like cicatricial CCCA, central cicatricial secretizing alopecia. But I do like the minoxidil. I think that's always a good step over for patients, either topical or oral. So what I do when my patients are having hair thinning, I'll recommend that topical minoxidil. We'll talk about if they're starting hormone therapy, how the estrogen should stabilize their follicles. But if they're having bald patches or any or like clumps of hair, I send them to derm.
00:11:54
Speaker
i think soundss are right here I think that's I think that's fair. And I will, you know, I think telogen effluvium is that thing, you know, we've talked about this before, like after pregnancy, we have it, you can have that with hormonal shifts, stress, you know, surgeries, car accidents, where you have these things. So you can have the telogen effluvium and the androgenetic alopecia kind of together. That can also be frustrating. that's when definitely send them away.
00:12:15
Speaker
Thank you so much. I so appreciate your time. Yeah, of course.