Understanding Menopausal Acne and Rosacea
An Integrated Approach combining the best of Orthodox Medicine and Traditional Therapies: Marilyn Golden
Menopause is a time of change for women, a time when some feel overwhelmed by the unwanted changes in their energy, libido and in the appearance of their skin, hair and body.
In addition, some women experience hot flushes, sleeplessness, vaginal dryness, vision changes and emotional fragility.
To add insult to injury, some unfortunate women suffer from Acne and Rosacea which is exacerbated by the hormonal changes they experience.
These women may have suffered from Acne in their teens and after a period of relief, they are faced with a recurrence of Acne or Rosacea or a combination of both afflictions in Adulthood which is understandably a cause of anxiety and depression at a vulnerable time of life.
Rosacea can vary in its expression from Redness and dilated veins (Telangiectasia) to papules and swelling or nodularity of the nose
(Rhinophyma) and Ocular Rosacea may present with inflammation of the eyelids, eyelashes and dry, stinging eyes.
What are the underlying causes of Rosacea? Still partly guesswork, it is thought to have a Genetic predisposition and it is said to be associated with the hormonal changes of menopause, exacerbated by heat, including hot flushes, hot drinks, the Sun, spicy food and alcohol. Stress plays a role and it may be associated with auto-immune disease which needs to be excluded as a differential diagnosis.
In Traditional Chinese Medicine, the Gut (Large Intestine Meridian System) is associated with the Lung system. The Skin is considered to be a “Third Lung”. Interestingly, Rosacea is also thought to be linked with Helicobacter pylori infection of the stomach. Dysbiosis is a term for disordered bowel bacteria and intestinal environment and in my personal experience of Clinical Practice, supporting a healthy intestinal environment expresses as improvements in the condition of the skin.
In Rosacea, there is increased vascularity in the skin with new blood vessels being made which are larger and closer to the surface of the skin. There may be infection with the mite called Desmodex which is associated with the hair follicle. The lining of the blood vessels ( endothelium) is damaged with leakage of proteinaceous material, inflammation and an immune response which perpetuates the damage.
In contrast, Acne is a disease of the pilosebaceous unit where there is disturbance of the normal sequence of cell turnover of specific skin cells called keratinocytes and corneocytes which line and are associated with the follicle. Increased sebum production due to increased Androgens ( Male hormones ) associated with blockage of the follicle by delayed death of the keratinocytes and the stickiness of the corneocytes, leads to secondary infection with Propionebacterium Acnes, which is a bacteria that normally lives on the skin as a commensal without causing harm.
There is a Genetic predisposition to Acne and it is exacerbated by dietary intake of Dairy products and processed carbohydrates which stimulate the production of Insulin in the pancreas. Insulin Growth Factor (IGF-1) stimulates the production of excessive keratinocytes. Insulin also causes the production of another nuisance protein called IGFBP 3 which lowers SHBG, the hormone binding protein that keeps the level of Androgens stable in the bloodstream. When SHBG is lowered, there is more free circulating Androgen available to stimulate secretion of sebum in the follicle.Polycystic ovarian syndrome is an example of excess circulating Androgens which leads to Acne and hirsutism in some women.
Other dietary influences on Acne include the intake of excessive vegetable oils and omega 6 fatty acids which are pro- inflammatory. Lectins in Wheat and legumes disrupt the enzymes that dissolve the connections between the corneocytes and as a result, they are stickier, enabling the blockage of the pore or follicle. Dairy products also impair zinc absorption and zinc is needed for the enzymes that dissolve the corneocyte connectors.
Nutritional deficiencies of zinc, vitamin A, vitamin D and iron may predispose to delayed skin healing. I have found that many of my patients with Acne have the Gene for Coeliac disease.
Medications may be implicated in causing both Acne and Rosacea – commonly lithium, steroids, anti-epileptic drugs and antiarrhythmic drugs.
Acne may be classified as Mild, Moderate or Severe and Graded 1 to 5, depending on the presence of comedones, papules, pustules, nodules and cysts.
The Medical (Allopathic) treatment of Rosacea includes oral antibiotics such as Flagyl and Tetracylines, beta blockers that reduce flushing and Oral contraceptives to suppress the hormonal fluctuations.
Topical Medical treatments for Rosacea include topical Flagyl, Tretinoin, Azelaic acid, Tacrolimus ( Immunosuppressant) and Sunscreen.
The Medical Treatment of Acne consists of a choice of antibiotics ( Erythromyctin, Doxycycline, Clindamycin, Trimethoprim), topical tretinoin or adapalene, benzoyl peroxide and a combination of benzoyl peroxide and Clindamycin. Oral contraceptives, Aldactone and Isotretoin ( Roaccutane ) are commonly prescribed.
The Integrated approach to treating both of these disorders begins with restoring the health of the cell at a nutritional level, replacing nutritional deficiencies, supporting nutrition with fresh, organic, raw fruit and vegetables and concentrates of Super foods such as Blue green Algae, G3 Juice which contains 4 Super fruits that act at the mitochondrial enzymatic level of the cell, namely Gac fruit, Seabuckthorn, Cili fruit and the Goji berry, and concentrates of Green Tea which is antiinflammatory and anti-oxidant.
An Integrated detoxification programme targeting the Intestinal flora, digestive enzymes and restoration of the integrity of the Intestinal lining is effective in treating both Acne and Rosacea. If antibiotics are needed, their effect on gut flora is minimised by replacing appropriate probiotics.
Support for Liver detoxification and drainage with Homotoxicology remedies targeting lymphatic drainage and detoxification of the extracellular matrix is highly beneficial.
Supporting and managing stress is important to stabilise Cortisol, a hormone that may exacerbate both Acne and Rosacea.
Effective topical agents for Acne include salicylic acid, ZincPCA, benzoyl peroxide,Glacial marine mud and tretinoin.
In practice, the use of the Galvanic Spa with AgeLOC gels provides a highly effective method of deep cleansing and restoring damaged collagen and elastin to minimise scarring. It can be easily integrated into any treatment regime both in the clinic situation and at home in an affordable way.
In summary, the patient’s total health needs to be restored. The skin is only one part of the whole, not a separate organ to be treated in isolation. An Integrated approach includes restoring health at a cellular level with nutrient dense, whole foods, supported by a diet that excludes inflammatory foods such as those listed above and a modified lifestyle that includes stress management, exercise, sunshine and appropriate treatment selected according to the Individual patient.