Tuesday, 26 September 2017 11:33

A Step-By-Step: Menopausal Skin

Written by   Erin Lucie, DNP, APRN, FNP-C

Menopause brings about a series of hormonal changes that transform skin physiology in many ways. Even if skin care professionals have been treating the same client for many years and know their skin care routine inside and out, they can be caught off guard with unexpected changes brought on by menopause. Traditionally, menopause is associated with a decline in all hormones across the board; however, it is an imbalance between hormones that creates issues.


The three main hormones affected in menopause are estrogen, progesterone, and testosterone. Estrogen has several forms and effects on the body. For example, an elevation of estrone, a form of estrogen, is related to breast cancer and states of disease, as well as obesity. A decrease in the other form of estrogen, estradiol, can result in very thin tissue and fragile bones, leading to osteoporosis. This process is what creates a sunken, sallow look where fat pads and cheek bones once resided, having provided clients with a plump, healthy, youthful look. If progesterone levels get too high or out of balance, the client may start to experience fullness and puffiness around the eyes and face and the rest of the body as well. Often times, when both estrogen and progesterone levels drop, testosterone levels take the lead, creating a surge in breakouts. As testosterone becomes more out of balance, the skin’s sebaceous glands go into overdrive, producing excess sebum that can clog pores.

Menopause typically starts around 50 years of age and, as the skin starts to age and lose its hormones, the collagen production and integrity of the skin will slow and break down. Collagen works as a scaffolding to hold the skin together and keep the pores tight and closed. As collagen production slows down, wrinkles will quickly start to appear and pores will begin to lose their strength and open, allowing more susceptibility to breakouts. As a result, clients may have dry skin with breakouts, enlarged pores, and more prominent fine lines. If clients have a history of sun exposure, menopause is when they will start to see more hyperpigmentation showing up on their skin.

Ultimately, menopausal clients have a little bit of everything going on and it can be confusing and frustrating when their skin starts to change. It is possible to treat all their concerns in one session if skin care professionals customize treatments to balance their skin and add enhancements to prevent future issues. The expected result of the following treatment is improved skin texture and clarity and increased moisture and hydration.



Start by cleansing the treatment area thoroughly with a lactic acid cleanser. Lactic acid is a gentle alpha hydroxy acid that hydrates while it exfoliates; it is appropriate for menopausal skin.


Completely rinse off the cleanser and pat the client’s face dry.


Using a cotton pad, degrease the skin with toner and allow a few minutes for it to thoroughly dry.


Pre-treat the client’s face with a 10 to 20 percent salicylic acid mask. Salicylic acid is a beta hydroxy acid that acts as a keratolytic, causing softening and sloughing of the top layer of skin cells. Apply the mask slowly with a small fan brush and leave it on for the recommended amount of time, usually five to 10 minutes.


Fan the skin to keep client comfortable and then remove the mask with wet, warm cotton pads, starting in the areas of most sensitivity to least sensitivity (first around the nasal folds and eyes and then move to the cheeks, chin, and forehead.


Remove any leftover traces of mask with another pass of toner and let it dry.


If the client has edema or puffiness, perform a manual lymphatic massage by stimulating the lymphatic glands of the face to help carry away excess lymph into the bloodstream where it can be broken down and removed.


If extractions are necessary, perform gentle extractions now, after the salicylic acid and massage has helped purge impurities from the pores. This step will help resolve and prevent breakouts.


After extractions, perform another pass of toner to remove any residual congestion and bacteria from the skin. Allow a few minutes to thoroughly dry.


Treat the skin with a blended lactic acid and trichloroacetic acid chemical peel. One to two layers of six to 10 percent trichloroacetic acid and 10 to 20 percent lactic acid peel can be applied with a cotton pad. Fan the skin between and after each layer to keep the client comfortable. This treatment step is ideal for menopausal skin since lactic acid is a hydrating alpha hydroxy acid and trichloroacetic acid stimulates collagen production.


After the peel is absorbed, apply topical corrective serums to spot-treat areas of concern. Using a fan brush is a soft and deliberate technique that shows the client that the professional is customizing their treatment.


For hyperpigmentation, use serums that have hydroquinone, azelaic acid, kojic acid, or arbutin to lighten existing pigment and prevent future hyperpigmentation.


For acne, a spot treatment with salicylic acid is appropriate for areas prone to open and closed comedones and for areas with under the skin or cystic acne. Benzoyl peroxide works best as it can kill the P. acnes bacteria.


For areas of wrinkling, do not forget to use a serum rich in vitamin C, peptides, growth factors, and antioxidants. These serums may be used as spot treatments or as all over serums, depending on the client’s skin.


For added exfoliation, apply a layer of retinol-based serums or peel. This peel will accelerate the client’s results by increasing their cell turnover, collagen production, and moisture-binding properties.


Apply a hydrator and broad-spectrum sunscreen to the skin. The client will leave with a healthy glow. Remind them not to wash their face until the next morning. They will experience mild, visible exfoliation in 48 hours and radiant skin in five to seven days.

Erin Lucie, D.N.P., FNP-C is a Stillwater, Oklahoma native, where she obtained a Bachelor of Arts from Oklahoma State University and an aesthetics license. She also obtained a Bachelor of Science in Nursing from The University of Oklahoma Health Sciences Center in Tulsa. Her doctoral residency was obtained at The University of South Alabama, where she focused on the prevention and treatment of obesity, diabetes, and metabolic syndrome and used bio-identical hormone replacement therapy in the prevention of heart disease. Prior to her career in family practice, Lucie had 14 years of experience in the aesthetic industry.

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