In this episode of unPAUSED, Dr. Mary Claire Haver sits down with her friend and colleague Dr. Erica Kelly, a board-certified dermatologist at the University of Texas Medical Branch, to explore how perimenopause and menopause affect the skin. Dr. Kelly explains the roles of estrogen, collagen and the skin barrier, and why women may notice dryness, sensitivity, easy bruising and changes in texture. The conversation also covers hormonal acne, facial hair, sagging, pigmentation and rosacea, along with the effects of sun exposure and aging.

Dr. Kelly walks through the research on systemic hormone therapy and topical estrogens for skin, including the limitations of small studies and the questions that remain. She discusses differences between sun-protected and sun-damaged skin, her approach to topical products and the changes patients may notice over time.

The conversation then turns to skincare ingredients. Dr. Kelly explains prescription retinoids and over-the-counter retinol, how she approaches irritation and tolerance, and the roles of hyaluronic acid, ceramides and niacinamide. She also discusses vitamin C formulation and stability, chemical exfoliation and the risk of over-exfoliating. The episode closes with a look at peptides and growth factors, separating promising evidence from marketing claims.

Guest links:

• Dr. Erica Kelly (LinkedIn)
  
• Dr. Erica Kelly (University of Texas Medical Branch)
  
• UTMB Plastic Surgery & Aesthetics

Recommended Books:

• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause,” by Dr. Mary Claire Haver

Articles:

• Postmenopausal skin and estrogen (Gynecological Endocrinology)
  
• Skin Rejuvenation in Women using Menopausal Hormone Therapy: A Systematic Review and Meta-Analysis (Journal of Menopausal Medicine)
  
• The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? (Menopause)
  
• Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin (Dermatology and Therapy)
  
• Assessing the recent real-world trend of topical estrogens for skin rejuvenation: A systematic review on its safety and effectiveness (Canadian Dermatology Association)
  
• Effects of topical estradiol on the facial skin collagen of postmenopausal women under oral hormone therapy: a pilot study (European Journal of Obstetrics & Gynecology and Reproductive Biology)
  
• Treatment of skin aging with topical estrogens (International Journal of Dermatology)
  
• Induction of Collagen by Estradiol - Difference Between Sun-Protected and Photodamaged Human Skin In Vivo (JAMA Dermatology)
  
• Topical estrogen therapy for aging skin: Current evidence and clinical considerations (JAAD Reviews)
  
• Systemic estradiol levels with low-dose vaginal estrogens (Menopause)
  
• The effect of topical oestradiol on skin collagen of postmenopausal women (British Journal of Obstetrics and Gynaecology)
  
• Collagen concentration on the facial skin of postmenopausal women after topical treatment with estradiol and genistein: a randomized double-blind controlled trial (Gynecological Endocrinology)
  
• Estrogens and aging skin (Dermato-Endocrinology)
  
• Two concentrations of topical tretinoin (retinoic acid) cause similar improvement of photoaging but different degrees of irritation. A double-blind, vehicle-controlled comparison of 0.1% and 0.025% tretinoin creams (Archives of Dermatology)
  
• Topical L-ascorbic acid: percutaneous absorption studies (Dermatologic Surgery)
  
• Induction of collagen synthesis by ascorbic acid. A possible mechanism (Archives of Dermatology)
  
• Topical L-Ascorbic Acid Formulation for a Better Management of Non-Melanoma Skin Cancer: Perspective for Treatment Strategies (Pharmaceuticals)
  
• Peptides: Emerging Candidates for the Prevention and Treatment of Skin Senescence: A Review (Biomolecules)
  
• Topical palmitoyl pentapeptide provides improvement in photoaged human facial skin (International Journal of Cosmetic Science)
  
• Skin ageing and topical rejuvenation strategies (BJD)
  
• Upregulation of Extracellular Matrix Genes Corroborates Clinical Efficacy of Human Fibroblast-Derived Growth Factors in Skin Rejuvenation (JDD)
  
• Fibroblast-derived growth factors and exosomes as cosmeceuticals (Dermatological Reviews)
  
• Biology of estrogens in skin: implications for skin aging (Experimental Dermatology)
  
• Synergistic effects of retinol and retinyl palmitate in alleviating UVB-induced DNA damage and promoting the homologous recombination repair in keratinocytes (Frontiers in Pharmacology)
  
• Topical retinoids in the management of photodamaged skin: from theory to evidence-based practical approach (British Journal of Dermatology)

Other Resources:

• Caring For Your Skin In Menopause (American Academy of Dermatology Association)