Rosacea and menopause: what’s the link?

How to tackle triggers and avoid flare-ups

Redness and flushing. Sore, sensitive and thickened skin.

An estimated one in 20 people worldwide live with the skin condition rosacea [1].

But what causes rosacea? And can the menopause have an impact on the condition?

Here, Consultant Dermatologist and balance+ expert Dr Sajjad Rajpar tells us more.

What is rosacea?

Rosacea is a chronic, inflammatory skin condition that mainly affects the face.

It predominantly affects lighter-skinned individuals but can appear in all skin types. And while rosacea is more common in women, men tend to have more severe symptoms, according to the British Skin Foundation.

What does rosacea look like?

Dr Rajpar says rosacea can cause the following symptoms:

blushing, redness and flushing
bumps and pus-filled spots, known as pustules, that look similar to acne
stinging, sensitive skin
in severe cases, skin can thicken and form excess tissue, usually around the nose (known as rhinophyma).

‘There is a wide spectrum of rosacea ranging from mild to severe, and it can be a very distressing condition,’ adds Dr Rajpar.

‘For example, flushing can make feel people very self-conscious, particularly if it happens in social situations or in meetings at work and they can’t control it.

‘It can be upsetting to receive a diagnosis of rosacea, and while it isn’t something that can be cured, it can be very successfully managed with the right approach.’

What causes rosacea?

In rosacea, your blood vessels become dilated and your immune system responds by sending inflammatory cells to deal with a perceived threat.

While the root cause is not known, triggers can include:

sunlight
hot drinks
spicy foods
alcohol
hot or cold temperatures
foods containing niacin (Vitamin B-3), such as chicken, turkey, tuna or peanuts.

Is there a link between menopause and rosacea?

As the largest organ of your body, your skin is affected by the lack of estrogen during perimenopause and menopause. Estrogen helps maintain your skin’s natural hydration mechanisms, so when estrogen levels fall, this can lead to dry, itchy and sore skin.

‘Rosacea is most common in women around the ages of 35 to 50,’ Dr Rajpar says.

‘And while there are no studies to suggest that hormones play a part, there is an age overlap between when rosacea symptoms tend to start and the start of the perimenopause and menopause.

‘We often see patients dealing with the double impact of rosacea and menopause at the same time: their skin might already be compromised by rosacea, or the skin changes during perimenopause and menopause can lead to more irritation and flare-ups.’

However, Dr Rajpar points out there are key differences between rosacea-related flushing and menopausal hot flushes.

‘Rosacea mainly affects the central part of the face; the forehead, nose, cheeks and chin, and more rarely, the neck and ears, whereas hot flushes are a more generalised spreading of a feeling of heat throughout the body.’

Rosacea diagnosis

Rosacea can be diagnosed by its appearance, with specific tests not usually required.

Yet Dr Rajpar says it can be missed in darker skin types.

‘The redness won’t be present on dark skin, but patients will often have the pain, swelling and pustules,’ he says.

‘I see lots of people of colour who believe their skin is just “sensitive” or have been told they have eczema, but once after examining their skin and taking a history you realise it’s rosacea. Some people who have been mistakenly diagnosed with eczema are given steroids, which will initially calm the rosacea but this will only aggravate it in the long term and then they get into a cycle of steroid use.’

How can I manage rosacea?

Rosacea will require long-term management, and the first step is to manage your trigger factors and mitigate their effects.

‘Sunlight is the most common trigger factor,’ Dr Rajpar says.

‘UV light from the sun triggers the release of chemicals in the skin that lead to the redness and flushing of rosacea. Sun protection, in the form of a high level SPF, might be all you need to keep it under control.’

When it comes to other triggers like hot drinks, Dr Rajpar says it is less about the actual ingredients, and more about the temperature.

‘I’m not suggesting you cut out your morning cup of coffee altogether, but if you find it leads to flushing or other symptoms, don’t drink it just before a big presentation, or try having your drinks at room temperature instead.

‘And the same goes for other triggers like alcohol and spicy foods. If you know it if a trigger for you, avoid it in situations where you may feel self-conscious if you do experience redness or flushing.’

Simplify your skincare routine

Now is not the time to be trying the latest lotions and potions, says Dr Rajpar.

‘Your skin barrier is already compromised and not functioning properly, so if you suddenly start using strong chemical products or exfoliants this can be too aggressive for your skin and cause an acute flare, leaving you with redness, swelling and pain.

‘In fact, most people will come to see a dermatologist for the first time after suffering an acute flare.’

Aim to simplify your skincare routine using a gentle, non-foaming cleanser and a light moisturiser containing ceramides – oils that help to maintain the integrity of the skin’s barrier and keep out irritants.

In addition, azelaic acid cream or gel can help reduce inflammation in mild to moderate rosacea. It’s available over the counter, or a stronger formulation is available via prescription.

‘Rosacea is a chronic condition, sometimes just using the right skincare routine and avoiding triggers will be enough to reduce flares and keep things under control,’ Dr Rajpar adds.

Optimise your hormones

‘While not a direct treatment for rosacea, optimizing your hormonal status by replacing your hormones will improve the general condition of your skin during the menopause and could indirectly help with rosacea,’ says Dr Rajpar.

Topical and oral prescription treatments

In addition to azelaic acid, there are topical treatments available on prescription that can reduce inflammation and spots in moderate to severe cases.

Oral antibiotics may also be prescribed to reduce inflammation.

Laser treatments

Redness and dilated blood vessels can be treated with laser therapy by a dermatologist.

Lasers and intense pulsed light reduce the size and quantity of blood vessels, reducing redness, thread veins and spots.

Rhinophyma

For severe rhinophyma, you may be referred to a dermatologist or plastic surgeon to remove the excess thickened tissue.

References

1. Gether, L., Overgaard, L. K., Egeberg, A., Thyssen, J. P. (2018). ‘Incidence and prevalence of rosacea: a systematic review and meta-analysis’,The British Journal of Dermatology, 179(2), pp.282–89. doi.org/10.1111/bjd.16481