Don't Forget Your Feet: How Menopause Can Affect Skin
How does the menopause affect the skin of the feet?
The menopause and perimenopause have been receiving increased coverage of late in the consumer and medical press. Western women on average spend over a third of their lives post-menopausal which has led to concerns regarding post-menopausal health care. Research into the topic has been slowly increasing – there has been a 20% rise in research published over the last decade. Consequently, women can access more information they need to manage the effects of this period of life as well as deal with the associated health concerns that can arise. But what about the effects on skin and particularly the skin of the feet? This blog looks at the available evidence to date.
Menopause, Marketing and Meno-washing
The increased interest in menopause has not gone unnoticed by commercial companies as a marketing opportunity. There has been a surge of "meno-washing," - where many products (face creams, skin care products, shampoos and many others) have been suddenly labelled and marketed as menopause “must-haves”.
Overblown marketing claims can leave people feeling confused as to what is best for their health. The British Skin Foundation has highlighted concerns about scaremongering and brands cashing in on women's anxieties. They've also given some great advice on what ingredients to actually look for to support skin health during menopause, rather than just buying anything with "menopause" on the label. Their blog is certainly worth a read – click here.
So how does the menopause affect health?
The menopause typically hits around the age of 51, with perimenopause occurring in the early to mid-40s (though this can vary). The drop in hormones (oestrogen, progesterone, and testosterone) which occurs can trigger a whole host of symptoms and increase the risk of heart disease, dementia, type 2 diabetes, osteoporosis, and even premature death.
Surprisingly, there's not a huge amount of research specifically on how menopause affects skin, and even less on the skin of the foot or leg. A survey showed that around 64% of women report skin problems during perimenopause/menopause, with dryness being the main complaint.
Menopause or natural ageing?
The challenge for researchers is to determine what the effects of the menopause are on the skin compared with the effects of general ageing, sun exposure, environmental factors and poor skin care practices. Well designed studies are required to answer this.
What we do know is that skin ageing speeds up during menopause. Skin becomes more saggy, thin, more delicate, and takes longer to recover from damage.
Women lose one third of skin collagen in the first five years of menopause as well as other structural fibres. These are the natural scaffolding of the skin providing strength, elasticity and resilience. But what skin effects can be directly attributed to the menopause alone?
Most research focuses on the drop in the hormone oestrogen during menopause. It has been shown that oestrogen stimulates the production of ceramides, sebum, and hyaluronic acid – these are the skins natural moisturising factors (NMFs) which keep skin soft, smooth and supple, as well as helping the skin form its job as a waterproof barrier.
Lower levels of oestrogen mean less of these natural moisturisers leading to dry skin. This can cause a build-up of dead skin cells - scale, a weakened skin barrier, and an increased risk of itch.
Existing eczema and psoriasis can also flare up during the menopause. Studies have shown how skin thickness is affected by the drop in oestrogen, as well as affecting the quality of blood flow to the skin and slowing down wound healing.
Interestingly, applying oestrogen directly to the skin has been shown to improve skin condition. Hormone replacement therapy (HRT) can also reverse some of these changes. However, HRT is not suitable for all women. Consequently, what about topical treatments like emollients (medical moisturisers)?
This is an interesting question, but should we be recommending special “menopause” foot creams? And if so, what ingredients should we be looking for? And do we really need separate "menopausal skin products" as has been suggested by some authors?
Emollients and menopausal skin
A recent study by researchers at the University of Manchester showed a direct link between low oestrogen in the menopause and reduced ceramide production in the skin. Ceramides are fats made in the skin, known as lipids, which influence the structure and function of the skin as a barrier. They act like a glue holding your skin cells together, locking in moisture and protecting the skin from irritations.
By comparing the skin of pre- and post-menopausal women, the study identified that menopause reduced the amount of ceramides in the skin. The research also showed that the ceramides produced during this period were structurally different (shorter) and therefore less effective, indicating they would allow more water loss from the skin resulting in dry skin and a less effective skin barrier.
Based on this evidence, emollients (medical moisturisers) containing added ceramides may be beneficial for skin during and after the menopause, especially for those women unable to use HRT. However, ceramide containing creams are generally more expensive, and in the UK, there are very few foot creams marketed with a ceramide content.
What research do we need?
Oestrogen deficiency seriously impacts skin health, affecting its function as a barrier, moisture levels, and healing. This makes people more prone to eczema, a common issue in older adults. We really need more research on how the menopause specifically affects the skin of the lower limb and foot.
More research is needed to see if the various forms of HRT have a long-term beneficial effect on skin, and if topical oestrogen cream has potential uses in skin care products. We also need more investigation into the best ingredients for menopause skincare, in addition to ceramides, and whether these would be beneficial specifically in foot emollients.
Conclusion
Based on the current evidence, the best advice we can give to those patients going through the menopause is to use emollients that closely resemble the oils and fats your skin should make. This means foot creams which contain ceramides, hyaluronic acid, urea (around 10% is usually sufficient for most people) and glycerine. In addition, we also advise against practices that degrease or dry out the skin, such as the use of soaps, overly hot showers, and products containing sodium lauryl sulphate (SLS).
If you are struggling with very dry skin on the feet and need help then please get in touch, Michelle and Lisa would love to meet you.
Make an appointment by emailing info@mrpodiatrist.co.uk or leave us a voicemail on 0161 427 4937.
This article was written by Michelle Reynolds and is based on a blog she originally wrote for Professor Ivan Bristow's website. You can read the original article here.