Dermatologist Karan Lal has warned women over the age of 40 that teenage-style acne can return during perimenopause as shifting hormones alter the skin.
Speaking to Cosmopolitan, Lal explained that adult breakouts frequently strike during this transitional period because estrogen levels fluctuate and ultimately drop, giving male hormones a greater influence over the body's oil glands.
According to Lal, the relative impact of androgens on the sebaceous glands becomes much more pronounced as female hormone levels fall. He explained that some women develop new pimples or experience a worsening of existing acne, even if their skin has been relatively clear for many years.
Perimenopause is the natural biological transition leading up to menopause, typically beginning in a woman's 40s as the ovaries gradually reduce estrogen output. While estrogen helps preserve moisture and collagen, androgens such as testosterone stimulate the sebaceous glands to produce sebum, the skin's natural oil. When the balance between these hormones changes, excess sebum can combine with dead cells to block pores and trigger painful inflammation.
Hormonal changes and sensitive skin
Lal pointed out that skin also frequently becomes drier, thinner, and significantly more sensitive during menopause. As a result, any targeted acne treatment must be handled carefully so it does not compromise essential hydration or damage the natural skin barrier.
To manage this increased skin vulnerability, Lal said he typically advises older patients to choose less intensive applications of retinoids, apply therapeutic products less frequently, or establish a more intensive moisturizing routine.
Retinoids are derivatives of vitamin A widely used by dermatologists to treat acne and stimulate collagen production by speeding up cell renewal. Although they are highly effective at clearing blocked pores, potent formulations can cause noticeable peeling, dryness, and redness, particularly on mature skin that already produces less protective oil.
The skin barrier is the outermost protective layer, composed of lipids and skin cells that prevent moisture loss and shield tissue from environmental irritants. When aggressive acne treatments strip this delicate defense, the skin can become chronically inflamed, leaving it more prone to further irritation and breakouts.
Sleep habits and facial skin
Lal's warning comes alongside earlier advice from general practitioner and cardiologist Elena Savchenkova-Belyatko, who cautioned that sleeping in a single position can harm facial skin over time.
According to Savchenkova-Belyatko, the habit of sleeping face down against a pillow can have a particularly negative effect on the skin.
Medical specialists note that resting the face directly against bedding creates sustained physical pressure and friction across delicate facial tissues throughout the night. Over years, this mechanical stress can contribute to sleep creases, weaken collagen structure, and transfer surface oils, dead skin cells, and bacteria from pillowcases back onto the complexion.
