Ask dermatologist Dr. Joseph Bikowski what causes acne, and he’ll start by listing what does not: “Dirt, grease, grime, oil, soft drinks, nuts, chocolate, pizza or sin.” Everything parents through the ages warned their teenagers would cause pimples, Bikowski says, aren’t the real culprits. “It’s all been a myth,” he says.
But one thing really can trigger acne, and it’s what every older woman faces during her lifetime: menopause. Many people think acne is just a teenage problem, but research shows the changes that happen in a woman’s body during menopause can trigger an acne comeback.
For Ramona Sangermano, 48, an administrative assistant from Baden, Penn., her teenage acne was typical. “It started when I was 16, and responded pretty well to antibiotics and Retin-A,” she says.
During her 20s, she took no acne medications as she went through three pregnancies, and experienced occasional break- outs. When she was still dealing with acne in her 30s, it seemed to Sangermano that everyone else her age had outgrown it. “I never moved past that oily skin phase of my teenage years,” she says.
She consulted Bikowski about a course of treatment, and he prescribed Accutane, a drug used to treat severe acne, which cleared up her face. But the results didn’t last long. Just as Sangermano thought the aging process might work in her favor, her reprieve from acne came to an abrupt halt. By this time, she was in her late 40s, entering perimenopause, and she’d grown tired of oily skin and breakouts. “I really thought I’d get a break between acne and wrinkles,” she says.
Bikowski told her that hormones were to blame. According to Bikowski, whose Pittsburgh area practice is comprised of 25% acne patients, acne during puberty is caused by elevated levels of androgen. This male sex hormone, which everyone has, triggers excess oil production.
Teen acne begins when androgen-stimulated oil glands come to life, producing sebum, an oily liquid that carries dead skin cells through hair follicles to the skin’s surface, where they clog pores, producing pimples. Women can see a resurgence of acne later in life, Bikowski says, because of the changes happening in their body. “As a woman enters perimenopause, her estrogen levels drop while her androgen levels remain constant,” he says. “Essentially, her body experiences a relative increase in the effect of the male hormones, similar to the teenage acne scenario.”
Bikowski prescribed Sangermano an anti-androgen medication called spironolactone. Originally developed to treat high blood pressure, it has become a commonly prescribed for women whose acne is caused by hormonal fluctuations. And evidence shows prescription medications are usually the best form of treatment for hormonal acne.
These days, Sangermano is pleased with what she sees in the mirror. “My skin is finally smooth because it’s oil free, and my pores aren’t enlarged any more,” she says. She has her own theory of why she’s dealt with oily skin and acne most of her life. “I believe I have high testosterone levels for a woman,” she says. “Along with my skin issues, I’ve always had very defined muscles.”
