How can you tell if you’re having an allergic reaction or if you have rosacea? Why might your skin suddenly react to a serum you’ve used for a long time? Many people are unsure whether they have sensitive skin or need treatment for rosacea. Aesthetic medical doctor Dr Sophie Shotter explains why your skin can become extra sensitive during menopause and the difference between skin sensitivity and rosacea.
Find what you need quickly
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Why does menopause skin sensitivity happen?
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What is rosacea?
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How do you know if you have rosacea or just sensitive skin?
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What is the link between menopause and rosacea?
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What can you do if it is rosacea?
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Do antibiotics treat rosacea?
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What about your menopause skincare routine?
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What rosacea treatments can work?
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What can cause rosacea flare-ups?
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Does HT help menopausal rosacea?
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Final word
Why does menopause skin sensitivity happen?
As you approach midlife, your skin barrier integrity decreases and this means certain ingredients can penetrate the skin when they couldn’t previously – this might be why your favorite face cream can suddenly cause a reaction.
Skin sensitivity symptoms
The classic signs of skin sensitivity are things like redness, itchiness, and a feeling of dry or tight skin. You may find that the affected areas are those where you have applied a specific product – for example, a particular cream or serum.
What is rosacea?
Rosacea is an inflammatory skin condition and it is very common. It is one of the most under-diagnosed menopause skin conditions, often dismissed as skin sensitivity as it shares similar symptoms and you may have both.
This skin complaint mainly affects your cheeks, chin, nose, and forehead, but it can also affect your eyes (ocular rosacea), which causes redness, burning, itching, and swollen eyelids. Rosacea can make you feel very self-conscious.
Rosacea is most commonly diagnosed in those with fairer skin tones, and typically begins between the ages of 30 and 50.
The cause of rosacea is not yet fully understood, although it seems to happen for a combination of reasons. These include genetics, your immune system, and environmental factors – including sun exposure, triggers, and certain medications.
Read more about how alcohol can affect your symptoms.
Rosacea symptoms
- Flushing or redness, sometimes accompanied by painful, burning, or stinging sensations
- Rash
- Spots
- Red vein marks
- Thickened skin, especially around the nose
How do you know if you have rosacea or just sensitive skin?
If the flushing or redness flare-ups persist and are often accompanied by a rash or spots, then it could be rosacea. With rosacea, you may also see tiny broken blood vessels in the affected areas and residual redness even when the worst of the irritation is gone.
Rosacea can be set off by certain triggers that are not typically a problem for those with sensitive skin alone. Triggers for skin sensitivity can vary between individuals, but often cause a sudden onset of uncomfortable facial flushing and can include alcohol, spicy food, hot drinks, caffeine, and physical exercise.
It can be very difficult to tell the difference between sensitivity and rosacea. Talk to your healthcare provider if you are unsure or if your symptoms persist.
Read more about prickly skin in menopause.
What is the link between rosacea and menopause?
Rosacea and menopause are frequently considered to be linked, and it is easy to see why.
In rosacea, we typically see changes in both the blood vessels supplying the skin – which causes the flushing and thready (spider) veins – as well as inflammation in the skin itself, which causes residual redness and irritation. Menopausal changes can play a part in both of these.
Hot flashes are common and sometimes troublesome during menopause, when they can contribute to changes to the delicate blood vessels in the face. This flushing – just like flushing from other environmental sources – is thought to be a trigger for rosacea flare-ups.
Likewise, menopause can affect the skin itself. Reduced estrogen levels can bring with them lower levels of collagen, glycosaminoglycans, and natural oils. These can lead to a disrupted skin barrier and skin that is prone to irritation and inflammation as seen in rosacea.
What can you do if it is rosacea?
Your first port of call should be to see your healthcare provider. Don’t just head to the shops and buy every product for problem skin – save your money. It’s important to get a diagnosis and then follow that up with the correct medication and/or skincare.
Do antibiotics treat rosacea?
It depends on the severity and type of rosacea.
Some of the most common and effective first-line treatments include antibiotic creams and gels. One of the most popular and effective choices at the moment is Soolantra – also known as ivermectin. This cream works in a slightly different way to traditional antibiotics, but is proven to effectively treat rosacea.
Azelaic acid is a very commonly prescribed antibiotic cream that can help with rosacea. Stronger versions of this product are prescription-only, although milder forms are available to buy over the counter. Many people even without rosacea use this product for its anti-inflammatory and exfoliant properties.
In some cases, your healthcare provider may recommend antibiotic tablets. The most commonly used (and proven) is doxycycline.
What about your menopause skincare routine?
Ask your healthcare provider for recommendations if you are diagnosed with rosacea. It’s important to use products that do not strip or irritate the skin and focus on skin barrier repair. If your rosacea comes with spots as well as flushing, it can be tempting to reach for harsher products, but these can make the problem worse.
If you are using a retinoid – including tretinoin, adapalene, or retinol – you may need to rethink your routine. While these products are popular and effective, they can cause dryness, sensitivity, and rosacea flare-ups.
Rosacea skincare
A consistent skincare routine is vital to protect, restore, and calm the skin and help it become healthier over time, especially if you’re dealing with rosacea during menopause. Add these to your routine:
- Gentle cleanser – ideally a creamy one. Avoid balms or oily cleansers if you have any pustules (small, inflamed bumps filled with pus).
- Sunscreen – a daily sunscreen with a minimum SPF 30 offers protection against UVA and UVB rays from the sun and is vital in preventing flare-ups
- Moisturizer at night
Skincare ingredients to avoid for rosacea
If you are looking to replace your skincare products, make sure they don’t contain the following ingredients to avoid worsening the condition:
- Alcohol
- Witch hazel
- Menthol
- Camphor
- Fragrance
- Peppermint
- Eucalyptus
- Propylene glycol
- Sodium lauryl sulphate
- Salicylic acid
What other rosacea treatments can work?
Treatments sometimes recommended include:
- Soothing redness – LED Light therapy
- Removing red vein marks – IPL laser and V Beam laser treatments can help but it’s advisable to wait until the pustules have gone before beginning treatment. Usually, a series of treatments is necessary
Your healthcare provider will be able to guide you on the best choice for your needs.
What can cause rosacea flare-ups?
Common triggers for rosacea and flushing include red wine, caffeine, spicy food, sunlight, and stress. Obviously, some of these are easier to avoid than others!
Does HT help menopausal rosacea?
We know that HT is the most effective way to treat many menopausal symptoms. However, that doesn’t necessarily mean that it is the best choice for treating the rosacea that tends to flare in midlife. This is because of the risks that come with HT, as well as the fact that it hasn’t been shown to help.
In fact, one research group recently found that those taking HT may actually be more prone to rosacea. That said, questions remain about these conclusions. Was the rosacea really due to HT use? Or was rosacea more likely in this group because those taking HT were more prone to hot flashes, which are known to make rosacea worse? It’s an interesting debate and more research is needed.
Having said that, we don’t know how taking HT affects rosacea if you already have this skin condition. Having rosacea doesn’t mean that you should avoid HT if it would otherwise be the best menopause treatment for you – but keep an eye on your skin and monitor any changes.
Your healthcare provider is the best person to advise the best treatment for you.
Final word
Rosacea and sensitive skin are common problems and can be really tricky to manage. However, with the right skincare and medical help, it is possible to achieve clear, flush-free skin.
Find out more about menopause on our blog or in our symptoms library.
- Thornton, M. J. (2005). Oestrogen functions in skin and skin appendages. Expert Opinion on Therapeutic Targets, 9(3), 617–629
- Wu, W.-H., Geng, H., Cho, E., Eliassen, A. H., Drucker, A. M., Li, T. Y., Qureshi, A. A., & Li, W.-Q. (2022). Reproductive and hormonal factors and risk of incident rosacea among US White women. Journal of the American Academy of Dermatology, 87(1), 138–140
- Zouboulis, C. C., Blume-Peytavi, U., Kosmadaki, M., Roó, E., Vexiau-Robert, D., Kerob, D., & Goldstein, S. R. (2022). Skin, hair and beyond: The impact of menopause. Climacteric, 25(5), 434–442
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