Jackie Clancy (Host): Welcome to HealthWorks Here. I'm Jackie Clancy with Emerson Health. And today, we're exploring a topic that every woman will face at some point, how your skin changes as you age. From your 30s through post-menopause, hormonal shifts and aging can bring new challenges that may call for different approaches to skincare.

So today, we'll cover what's happening beneath the surface and what you can do to support your skin's health. Joining me is Dr. Eileen Deignan from Dermatology Associates of Concord, a leading dermatologist who has guided so many women through the years through these various challenges, and I'm thrilled to have her here with us.

So, let's dive in. Dr. Deignan, can you just please start by introducing yourself and sharing some background as a dermatologist?

Dr. Eileen Deignan: Yes. Thank you, Jackie, for having me. I am a board-certified dermatologist. And we as dermatologists are the expert in the skin, hair, and nails. So, I'm happy to be here today to talk to you about our skin as we age, particularly as women. I graduated from Yale Medical School and then did my Dermatology residency training at the Harvard Medical School hospitals, including the Massachusetts General Hospital, the Brigham and the Dana-Farber Cancer Institute. And I've been practicing here in Concord and on the staff at Emerson Hospital for 26 years. Perimenopause and menopause can make up approximately a third of a woman's lifetime. So, I think it's very important that we talk about what we can do to support our skin during this time.

Host: That's great. Thank you so much. And so, maybe we can start, what are some of the most notable skin changes women can expect as they're aging, as they're entering perimenopause and through menopause? And why should we treat our skin differently than we did when we were younger?

Dr. Eileen Deignan: There are some really predictable changes we can expect in our skin as we get older. Of course, there are some factors that will be different for every person including genetics and a smoking history and sun exposure. But we can all expect that we will notice some changes in our skin, the underlying connective tissue, our subcutaneous fat that's underneath our skin, as well as some of the supporting bone structure.

Over time, particularly when we do not have the support of estrogen in our skin, it's interesting, skin is a hormonally responsive organ, and we may not think about that, but what estrogen does is it really enhances and it's important for maintaining our skin quality. It promotes collagen synthesis, it promotes skin elasticity, and also maintains the hydration of our skin. So as we enter the perimenopausal time, as well as the menopausal time, we do not have that same support from estrogen.

Host: So, these declining estrogen levels, what type of impact do they have? Is it more cosmetic? Is it medical? Is it both? And what are some of the visual cues you can see that you might realize you have a declining estrogen level?

Dr. Eileen Deignan: You may notice dryness of the skin, scaliness. You may notice that the skin seems to be wrinkling more, and also a loss of elasticity that the skin does not seem to bounce back the way that it did before. Of course, some of these changes that a person might notice are cosmetic, including fine lines, wrinkles, dark spots on the skin. But one of the things that I find is the most important thing that I try to tell my patients about are the functional changes that happen in perimenopausal and postmenopausal skin, where the skin barrier function is less effective, that there's slower wound healing. And sometimes skin is more easily torn because it becomes more atrophic or thin.

Host: So these changes, do these happen gradually? Or can they sometimes seem to appear overnight?

Dr. Eileen Deignan: They can sometimes appear to change very quickly. Because as we enter the perimenopause era and then into menopause, in the first couple of years of menopause, some women can lose up to 20% of their underlying collagen in their skin, and then thereafter are losing a certain percentage. But that is why the skin can appear to really change overnight because it does change very rapidly.

Host: So now, that we are understanding a little bit more about what could happen, I'm curious about what we can do maybe to help slow the process or to prevent some of the changes that we're seeing. In today's world of constant social media and information overload, it feels like every day, there's a new miracle product or trending treatment. And personally, my feed is filled with women sharing their so-called secrets. And honestly, it can be extremely overwhelming to know what's real and what really makes an impact and what doesn't.

And so before we dive into your recommendation, I'd love for you to share your perspective on some of the trends that we've been seeing lately and how women can separate fact from fiction. But let me start with one I've heard, as it relates to lowering estrogen levels, is topical estrogen on the skin? Is that something you recommend patients?

Dr. Eileen Deignan: As a matter of fact, I don't. The data really is not there, and I might say the data is not there yet. There is some information that shows that hormone replacement therapy may improve some of the changes that happen with the skin with menopause, enhancing the skin quality, promoting collagen synthesis, increasing the elasticity and the hydration, and the ability of the skin to remain hydrated.

But for topical estrogen, the data is not there. A decision whether a person should have system-wide hormone replacement therapy is very important for person by person, depending on a person's underlying health issues. And so, I won't go into that, but I am not going to recommend that a person spend her efforts or her money applying topical estrogen to her facial skin. Of course, there is a role for applying topical estrogen to the perineal and vaginal area to help with atrophy that can occur in that area, but not necessarily for the, for example, facial skin.

Host: Interesting. Thank you. That's very helpful. I also see a lot of information about different types of supplements and collagen supplements. Do you ever recommend taking certain supplements or eating certain foods to help with your skin health?

Dr. Eileen Deignan: Again, I am pessimistic about that for any particular supplement or food having a really dramatic effect on the skin. There is some spotty data about certain oral collagens perhaps being helpful for overall skin health in the menopausal era. But I would be very careful with a supplement about making sure that what is in the supplement is really what's in the bottle.

One of the things about supplements and collagen supplements and several others is that they're not FDA-regulated. And so, it is sometimes challenging to know exactly what is in a supplement. If a person does choose to, for example, have a collagen supplement as part of their regimen, I would buy it from a very reputable store or internet site where it can be very clear that what is in it is what you want to take as your supplement.

But for me, I think of what we actually do to the exterior of our skin as being much more important than something that we ingest, and then hope that it makes its way to the surface of our skin to help us with our skin health.

Host: Interesting. Thank you. Another thing that I've seen a lot of is folks using yoga therapy as a form to relax fine lines and improve skin. Can you talk about that a little bit?

Dr. Eileen Deignan: I would be skeptical that that would be helpful. I think of yoga as something that is going to have some effect on the underlying musculature. But the effects that estrogen is going to have on the skin and that menopause is going to have on the skin is more towards the surface of the skin. And I would be, again, working on things that are promoting and preserving the elasticity of the skin itself as opposed to the underlying musculature.

To have an effect on the musculature underneath the skin, it's necessary to actually inject something underneath the skin. For example, a neurotoxin such as Botox can temporarily decrease the ability of the muscles to create some of those dynamic lines in the skin. By dynamic, I mean, the lines that only happen as the underlying muscles move.

Host: Thank you. So, my takeaway from this is I'm going to stay away from a lot of the trends I'm seeing online. I'd love your perspective on what should we be doing? What can we do? What are the daily habits or routines that are most effective for keeping our skin healthy environment, starting in our 30s and all the way through our menopause years?

Dr. Eileen Deignan: I want women to have good, healthy skin that will stick with them through their whole lives, and be healthy, functional, and look great all day long. I talk to women about protecting the skin that they were born with. I promote people to use SPF sun protection, at least an SPF 35; to reapply SPF every two to three hours, particularly when outside and more often when doing, for example, a sport or an activity where the sunscreen will wash off.

I'm a big believer in physical blockers such as wide-brimmed hats, UPF, that's ultraviolet protective factor, clothing, umbrellas, all of these ways to physically protect the skin. I also ask my patients to think about the time of day that they're doing their activities and try to avoid outdoor activities when the sun is highest in the sky between 10:00 AM and 2:00 PM. And also for those who go to high altitudes, keep in mind that the ultraviolet light is much stronger at altitude than it is closer to sea level here in Massachusetts where we live.

Host: So in addition to the importance, sun protection, sun protection, sun protection, what are some other products you recommend for just daily skin treatment and skin health?

Dr. Eileen Deignan: A lot of my menopausal patients really complain about skin dryness and skin itchiness. And as we get older, our ability to make ceramides and sebum and hyaluronic acid in our skin is reduced. And so, I find that it's very important that my patients take care of their skin by using mild cleansers that don't tend to strip the oils off of skin; to take cooler, shorter showers and to choose a moisturizer that they like. And what I mean by that is a moisturizer that they feel comfortable applying to their skin, that they like the smell or the lack of smell, and that it comes in an easy-to-access bottle. For example, a pump top or a big jar.

I'm specifically looking for moisturizers that have ceramides in them. Ceramides you can think of as these lipids or fats that fill in the intracellular spaces in the skin, and they're kind of like the cement between the skin cells and they prevent the moisture loss from our skin, and then they also prevent these external irritants that can sometimes get into our skin and create some of that itchiness and eczema and redness and irritation that happen in our skin.

And another important ingredient to look for is hyaluronic acid. I mentioned earlier that we make both ceramides and hyaluronic acid. And fortunately, we can put them on our skin and they can be helpful. The hyaluronic acid, what that does is it helps us to absorb and retain moisture in our skin. And it also makes a moisturizing film that locks in the moisture into our skin, but this hyaluronic acid helps us to absorb the water from the environment. And ultimately, what these do is they make the skin firmer and appear less wrinkled, and make our skin a better skin barrier to protect us from external irritants that happen in our environment and get on our skin and make it dry and more irritated.

Host: Are there other treatments you recommend to help with fine lines and wrinkles? I've heard a lot of folks using retinol. I've heard tretinoin thrown around. Is there one that you recommend?

Dr. Eileen Deignan: I am a big believer in vitamin A. And when you mention retinol and you mention tretinoin, those are vitamin A products. As a matter of fact, if you were to line them all up, after sun protection, vitamin A is the number one most effective agent to use. Let me explain a little bit. Vitamin A helps increase collagen synthesis when applied to the skin. If you think about retinol, that's the naturally occurring vitamin A moiety. And then, tretinoin, which you mentioned is a manufactured vitamin A. And the brand name for tretinoin is Retin A, which you may have heard of using that for acne, but it also is very effective for a number of the changes that happen in menopausal skin, specifically in helping with fine lines.

Host: This is so helpful. So, it sounds like we want to make sure we're protecting our skin with SPF, we're looking for something with ceramides in it, hyaluronic acid, and then something including vitamin A, retinol or tretinoin. Are there any products or ingredients women should avoid as they're aging?

Dr. Eileen Deignan: Women will find as they approach menopause and postmenopausally that their skin is more sensitive. They'll find that soaps that normally their skin could tolerate well will be more drying. They will also find that perhaps they were able to use, for example, something that was exfoliating or a scrub in the past that now is irritating. I often suggest that women avoid these types of products and instead look for gentler cleansers and more hydrating topical products rather than scrubs or exfoliants.

Host: Are there any common mistakes you see women make when caring for their skin as they age?

Dr. Eileen Deignan: An issue that I frequently say to my patients is find a routine that is sustainable for you and stick with it. I do not have any treatments that are an overnight fix in terms of topical treatments for aging skin. And so, I ask my patients to think about a routine that they can fit into their schedule.

Sometimes we may hear about, say, a seven-step beauty routine. Personally, I think, I would never be able to do that, and I wouldn't expect my patients to do that either. So, I ask people in the morning that they think about putting on a moisturizer, perhaps an antioxidant, vitamin C or vitamin E-containing product and then sunscreen. In the evening, a gentle cleanser, make sure to remove any makeup before going to bed, moisturizer, and then perhaps a vitamin A retinol or tretinoin-containing product. This sort of simple routine is the sort of thing that a person might be able to do over the sustained period of time that is necessary to really implement changes in the skin.

Host: That's great. So, it sounds like consistency is key. Sometimes less is more. We don't need to overwhelm ourselves with product, which is really helpful for me to hear. It's a good reminder that nothing's going to be an overnight solution and to give things time and that's really helpful. Thank you so much.

Before we wrap up, I wanted to ask if listeners remember just one thing about caring for their skin through perimenopause and menopause, what should it be?

Dr. Eileen Deignan: Sometimes my patients say to me, "Boy, I spent my entire childhood out in the sun, having a lot of ultraviolet light exposure, and now does it matter still? Does it matter that I need to protect myself from ultraviolet light exposure?" And the answer is yes. There's very good data to show that being careful about protecting ourselves from the sun in our 40s, 50s, 60s, 70s, and 80s will have a sustained effect on our skin. So, I am always a big proponent about sun protection and sun avoidance. When we look in the United States, we see an epidemic of skin cancer. And over the course of our lifetime, our risk of skin cancer increases.

So, my takeaway is to always protect our skin, it's our largest organ, it's a precious organ. We only get one set for our entire lifetimes, so take care of it, and it's always a good time to start taking care of your skin.

Host: That's such great advice. So, it's never too late, regardless of your age. If you've never worn SPF in your life, today's the day to start and keep it consistent. Dr. Deignan thank you so much for sharing your expertise with us today. This is a topic that touches every woman in some way, and your insights on both prevention and treatment give us the tools to take better care of ourselves.

And so, to our listeners, remember, while changes in your skin are a natural part of aging, there are steps you can take to feel confident, supported, and in control. Thanks for listening to Emerson's HealthWorks Here podcast. And make sure to catch the next episode by subscribing to HealthWorks Here podcast and Apple Podcasts, Google Podcast, Spotify, wherever podcasts can be heard. You could also visit emersonhealth.org for more information about our Dermatology services and Dr. Deignan. Thank you so much.