92: Menopausal Skin Care: A Dermatologist's Guide

Welcome to Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. Today, I'm chatting with Dr Shreya Andrik. Shreya is a fellow of the Australasian College of Dermatologists and she has several subspecialty interests, but the area that is of most interest to us is vulvar dermatology. That's right, Shreya and I chatted all things vulvas, vaginas and general skin conditions during perimenopause and into postmenopause. I hope you enjoy this chat, shreya. Thank you so much for joining me on today's episode. Thank you for having me. Ah, my absolute pleasure. So, Shreya, why don't we kick off by you introducing to our listeners who you are and what you do?

Sure, so my name is Shreya Andrik and I'm a dermatologist based here in Sydney. Dermatology training is a bit of a process, and so basically you start off, you do medical school initially and then you move on and become an intern and do a year of residency, so you kind of do two general years and then for myself, the journey was that I then did two years as a dermatology research fellow. So I was working at Royal North Shore Hospital and my supervisor mentor was Professor Gail Fisher, and so Gail is well-known very pediatric and vulva dermatologist, and before then I probably didn't really know what vulva dermatology was. But after spending time with her attending her clinics, and not only worked with her at that point in time, but then once I got onto the dermatology training program, I came back to spend my final year of training it's four years Then my final year with back at North Shore, and I was doing the vulva dermatology clinic then as well, and I get that that point I realized what a significant impact we could have on people's quality of life. Women are amazing and we put up with a lot and yeah, sadly, you know we would be seeing people who would come to us after putting up with symptoms for years and so I guess, you know, once I went on and became a vulva dermatologist, I kind of could have left it there, but I have continued that work throughout my practice and I do get a lot of satisfaction out of it because it's so nice being able to help people who have, just, you know, put up with these symptoms for so long. And obviously there's a lot that can happen, you know, in that perimenopausal and menopausal stage of life, and not only affecting the vulva but affecting other parts of the body. So women are amazing. So I've got fantastic patients and, yeah, I have a lot of satisfaction from that.

That's amazing and I love that you were moved to transition into that side of dermatology because I get the sense that you could really see how much help that you could be and how much you can stop the suffering for women that do tend to put up with symptoms, because we are amazing and we have these really high thresholds of just going. You know it's annoying, I'll just put up with it and particularly when we're talking about an area of the body that for some women there's a lot of embarrassment there's, I guess, maybe some shame and stuff as well attached to having a condition in the vulva or vaginal area and needing to seek help for that. Yes, yeah, so it PCs Of and młostful. So let's talk then. What I'd love to start off talking about is maybe something a little bit more generic, and that is the changes that our skin goes through as a result of heri menopause, the fluctuation of the hormones moving into postmenopause.

Yeah. So I guess firstly starting with estrogen. So estrogen is responsible for collagen and elastin production. It also plays a part in hyaluronic acid production, and so when we start to lose the estrogen we start to notice changes in the skin. Fine lines and wrinkles start to come out. The skin starts to for one to the better word, I guess sag. And progesterone as well is responsible for sebum production, so oil production, and so both of those together. If we're losing the estrogen and progesterone, then all round there's pretty much dryness.

Yeah, you're looking at saggy dry skin, really aren't you?

Exactly. So you know, and that can affect, you know, obviously we have skin everywhere, so it can affect anywhere on the body. So again, you know, being generic, we do notice, you know, people start who may have never had eczema before, for example, they start to develop eczema. We also see, and you know, I don't think the hormones necessarily play a role in it, but rosacea does come up in that perimenopausal stage of life and things like the hot lashes can really affect lashing that we get in rosacea. So you know that's something that I see a lot of as well. And then obviously you know vaginal dryness and there are other conditions that tend to present around that age and stage of life.

Okay, cool. So let's dive a little bit deeper into just the general dryness of our skin. So, obviously, yes, linked to the fluctuations in the estrogen and the progesterone. What can be done to work with that and to you know, without going out and buying ridiculously expensive cosmetics that will tell you that they will solve all these problems and you don't think you can Start with pillors and chemicals and everything else. What is your go-to remedy for general skin dryness?

So, keeping it simple, everyone loves their, especially in winter. It's always worse in winter. Everyone loves their long, hot showers and, as mean as it is, I tell people to try and keep your cap on it. So three to five minute pool showers. Use a soap free wash and you know like a liquid soap is not a soap free wash, if you know what I mean. People say, yeah, I use palm, olive or whatever and know that Still got soap in it. Yes, yes, there's something like QVs, setafil, avino, any of those. As soon as you get out of the shower, pat your skin dry, don't rub it dry. You know you want the skin to still be a little bit damp and then put moisturizer on top to toe. Okay, great, so you don't need to spend a lot of money. I, like any of those kind of bland chemist brands are quite good and you know just doing those things. That's what we kind of refer to as general skincare measures. So, yeah, doing that will certainly help.

Yeah, I think that's a good place to start. So, once we perhaps some dry skin has moved into more of the eczema, perhaps more of a condition, how do you know when that's the case, if it's something you haven't suffered with before, and what are the next steps that you take from there?

Yeah, so look, if you're starting to notice itch, redness, you know scaly or flaky patches on the body, then that's probably a good indication that you've developed eczema. So it might be worthwhile just having a chat to your GP GP is very good at managing eczema and you know having a chat to them about whether some topical steroids would be helpful. People are really scared of topical steroids From everyone thinks that you know they're going to thin the skin and long term damage of trouble. That's right, yeah, but ultimately, when you're using topical steroids on inflamed skin, you and you're using them appropriately, you shouldn't be developing side effects, and so the way I guess to manage eczema is just to hit it hard with us. Do you know what I mean? Just so I would be using, you know, an appropriate strength topical steroid two to three times a day, and you may only need to do that for you know, four or five days or so and it should come down, keeping in mind that eczema is one of those things. unfortunately, that is a chronic skin condition and so we can't cure it, but we can manage it.

Okay, and is that a that topical steroid that you're referring to? Is that something you would need to get on prescription from a GP? Is it something you can go and talk to a pharmacist about?

But you can get some mild topical steroids over the cancer and you know. And if you have mild eczema, then that may be all that you need. But I guess if you're, if you tried one of those and you're not getting on top of it, then yeah, your GP could write your script.

Perfect, absolutely good, okay. So then, moving on to the next kind of, I guess, elevation from there. So what if somebody? What are the other sort of skin conditions that people might develop? Or like, let's talk about the rosacea, things like that, yeah, so, rosacea again.

I feel like I'm talking about these, all of these chronic skin condition. Unfortunately, as dermatologists we can't cure a lot of things Not really anyone in medicine can, I guess. But rosacea is a chronic skin condition and often develops between the ages of 30 and 60. And so people will say, you know, oh, my skin suddenly become really sensitive. These products that I was using before without any issues are now causing me trouble. So it presents with kind of skin sensitivity, redness and some people might notice kind of pimply spots coming up as well.

And is that predominantly on the face? Like my ex, I haven't experienced it, but I know people that have, and it is predominantly a face. That's right.

Yeah, yeah, so it's on the face and and it can be, you know, quite debilitating for some people. You can get lushing and you know it can be triggered by things like spicy foods, hot drinks, heat in general. Yeah, it can be quite a frustrating skin condition, and so I guess, for these people, I would just recommend, you know, because when your skin is feeling sensitive, I guess you start to try to find things to try and calm it down. Do you know what I mean? Yeah, but we need to be doing almost the opposite and just stripping it right back, so just using very gentle products and, you know, not putting anything on the skin. That's going to make it worse. If there are triggers that you know of yourself, then avoid trying to. Is this ever done? Trying to avoid those?

Yeah, Alcohol can be a really big trigger for so many things. Sometimes part of the process can actually be even just identifying what those triggers are Exactly. That's right, yeah.

So yeah, and and again. Then, if you're struggling to get on top of it, we do have quite effective treatments with creams. We have some tablet treatments, and laser treatments are really effective as well.

Now, while we're on the face, an area that I get asked about a lot, and I wasn't even aware that this was something that can happen as a part of perimenopause until I heard a few people talking about it, and it may not be your area. So if it is, totally, tell me and I'll go phone someone else to talk to about it. But that is dry, itchy eyes, yes.

Yes, so again, I guess I eyes in general, eyelid skin, it's all very the eyelid skin is very thin and and again, things like nail polish fragrances, things like that. They're quite common allergen which can cause, you know, contact allergies on the skin. Yeah, and so if I have someone who comes in with eyelid dermatitis, for example, those are always the things that I ask about the eyes itself, something like that. Again, if you can try and get on top of it with preservative free eye drops and using that those regularly, then fantastic. But if not, you'd probably want to see an optometrist or an ophthalmologist. Yeah, of course.

So a little bit, like we talked about with you know, general dryness of the body and the skin, it's that. It's that moisturizing, but with an appropriate unscented kind of played with product. Okay, awesome, thank you. So any other conditions that you would kind of like to bring to people's attention or have a chat through while we're talking just about kind of more general skin conditions?

Look, I guess those are kind of the most frequent ones that we see. You know, if we're thinking about what's happening around menopause, the exhalerosacea yeah, they would be the most frequent ones we see.

Okay, so then let's move into the vulva health. I would love to know, and I'm pretty sure my listeners would as well, because I do know that personally. This was something that I was dealing with and struggling with, and I've spoken to a number of women in the same situation, and you know when you talked about the fact that we put up with it for far too long before we go and see somebody. So let's talk about you know what to look out for, what changes to pay attention to, and at what point is it that you should be speaking to? Obviously your GP, I would imagine, in the first place. Yes, you get that referral onto someone like yourself is a dermatologist.

You can get skin conditions that would present elsewhere on the body, in the genital area. So, again, things like eggs, my things like psoriasis, we think, quite frequently in the genital area. But then there are also some conditions that have more of a pre-delection for genital skin and so things like like and sclerosis like, and then there's. These are conditions that we see most frequently in the genital area. So I guess, firstly, if you're noticing any color change down below, if you're noticing symptoms like itch, if you're getting pain with sex, then those are kind of signs that you should probably go and see your doctor and have a chat to them about it. You know abnormal discharge or anything like that. You know, yeah, yeah, most people in that carry more perimenopausal stage will notice dryness and that can make sex uncomfortable and if that's case, you know you would probably want to think about different lubrication. You can use HRT can be helpful for that as well. Need to use topical HRT couple of times a week, but yeah, but I think that if you're feeling uncomfortable, you know anything that something might be up, there's no shame in going and having a chat to your GP.

Yeah, no, that that's such an important message and as much as there will be women that do feel shame about it and that they will feel that they've done something wrong and that you know it's an embarrassing yeah, perhaps to go and raise with it with your GP, you really need to kind of put all of that aside, pull on your big girl panties for want of a better expression and and really go and have that conversation, because one of the things I'd like to talk to you about is that what the evolution of some of those skin conditions can actually be when they're left untreated.

Yes, yeah, just going back to feeling embarrassed we have seen it all. Like, honestly, I have people apologizing that they haven't shaved their legs and I don't care, I'm sure that I've seen worse. So don't never feel embarrassed to show you doctor anything. But yes, going back to that, so essentially some skin conditions like I mentioned before, like and splerosis, like and plainness If these are left untreated, that chronic inflammation in the skin can result in development of skin cancers. So untreated, like and splerosis has a five percent risk of developing a spamous cell cancer in that area and this can easily kind of be reversed and that risk brought down to zero just by having that treated. When Lycanesluorosis is treated, you can't really change scarring but you can get the skin looking back to normal and making the area feel more comfortable, reduced, getting rid of that itch and also minimizing your risk of skin cancer in the area. Nobody wants to have a skin cancer cut out from that area.

No, and you know in full transparency you are my dermatologist and I personally was that woman. That left the itching and the discomfort for way too long before I went to see my GP and then I ended up in your beautiful clinic that I will also share with the ladies that as a result, I did have to have a biopsy done from that area to check for Lycanesluorosis that had developed. And that, ladies, is fucking uncomfortable. So I am here to tell you that if you have any itching or discomfort down there, please go and see somebody before you get to that point, because you know, look, I was lucky. I was clear my Lycanesluorosis hadn't developed into that, but the thought that it could have actually scared the pants off me I have a cancer history anyway and the discomfort of having that biopsy Sorry, no, actually you know what I should clarify. The actual process of having the biopsy was painless, except for maybe having the Local Local. You were beautiful and very gentle and made me feel very, very, very comfortable. It was the discomfort afterwards of which is natural. You know biopsies done on all sorts of parts of my body now, but that was probably the most discomfort that I've ever had in a healing process afterwards. Yes, yeah. So that's my takeaway message for every woman listening today Try not to getlet yourself get to that point. Hi, buddy Beautiful. So let's talk a little bit more about If you do get a diagnosis of the Lycanesluorosis, like complainers. Is that the second?

one, lycanesluorosis. Yeah, that's a different type of inflammatory skin condition that can developyou can get patches on the body as well. This one tends to involve the vagina as well, okay, and so it tends to be more internal, and you can develop ulcers within the vagina which are very painful. It sounds really uncomfortable. Yeah, it can also affect inside the mouth. It can affect the fingernails as well, the toenails. So those are kind of all the areas that we examine If we have a bit of a suspicion that that's what's going on.

Okay, Okay, and is that again something that can be treated and managed? And then just kept an eye on long term.

Exactly, yeah. So the aim of the game, I guess when we're treating Lycanesluorosis like complainers, is we want to just get it under control and then, once a year, we would see you to examine the area and make sure that everything's doing well, cracking well.

Yeah, amazing. Are there any other conditions or tips that you would like to share with anyone?

while we're talking about that area, One thing that I see a lot of as well is what we call chronic vulva vaginal candidiasis, which is chronic thrush, mm-hmm. So this is something we do, tend to see it in younger people. But because it's estrogen-driven for people on HRT, it still can happen, okay. So this is so. Chronic thrush is different to having a one-off kind of episode of thrush. These people tend to have symptoms that recur relatively frequently. They get itch, they get swelling, they get splits in the skin, intercourse is uncomfortable and discharge as well. So with these patients, I guess we often we always do a swab to see if that's what's going on. But you don't necessarily need to have a positive swab because people often self treat in between as well.

Okay, that may kind of you know SQ, the results of a swab yeah.

Yeah, patients with this. We generally tend to do longer courses of oral antifungal treatments and that you know they get a lot of relief with that. It's something that we would normally treat orally for, say, six to 12 weeks, and then the aim would be to reduce the dose and get it right down to the lowest possible dose. To keep it all clear, but generally after menopause, provided you're not on HRT, you shouldn't really be getting thrush.

Okay, cool, that's really good to know. One of the areas that I was wondering if you could also just share a little bit of information about is I feel like there is this push in influences probably across social media, things like that to be douching to be. You know, cleaning out your vagina with all of these amazing, centered and wonderful products that probably cost a bomb. I've never looked at them, but I know that they're out there and people talk about them. Yeah, where do you sit with those sorts of products Like? What are the odds? It's really what I want to know, because I know there's a whole lot more gods than there is pros of falling into the trap of thinking that you need to clean your vagina.

No, no, no need to douche. You know we need that normal flora, that normal bacteria that exists within the vagina, that exists on the skin and by doing, you know, by douching and overcleaning, that can really disrupt that. So I wouldn't say any of that.

Yeah, I think that's a good tip. Yeah, yeah, the thought of it horrifies me, but I know that there are others out there that you know feel perhaps a need to do that. So cool, I think that's really good advice. Guess that my biggest takeaway from today is and the message that I hope that our listeners get is that if you have any level of discomfort or itching, dryness in any area of your body is a change that is something that you haven't experienced before that your first protocol is always to go and see your primary health care, Absolutely, and then they'll make that decision if they think that you need to be referred on to a dermatologist. And then I think the second thing would be to not do what I did and to not wait and put up with it and think it'll clear itself up, or you know, it's just an annoying thing that I'll put up with because it is much more important. There are ways that we can manage the conditions. We can clear the conditions up if they're caught early enough. Those sorts of things, as opposed to letting something you know evolve into a bigger condition that it doesn't need to be.

That's right. Yeah, and it can be, you know, unsafe to do so as well.

Yeah, yeah, and we want to keep everyone safe and healthy. Amazing, shreya, this has been really informative. Thank you so much. I have one question for you, which I ask all of my guests at the end of our chat, and that is what are you reading, watching or listening to right now?

that is bringing you joy, so I don't know if you've heard of the show, but it's on Disney Plus. It's called Only Murders in the Building. I love it.

And I'm waiting for the next episode to drop.

I think it's done now. I think it's out.

Well, I thought there was one more, unless it's oh, I don't know.

No, but the reason that it's bringing me joy is because it's very hard for my husband and I to agree on a TV show to watch together. But he is also into it, so I love that. Like you know, we hang out for the newest episode and we watch it together.

It's such a great show and, right, I've founded our house as well, so I have, you know, grown, grown young men that still live at home and my husband and I have been watching it together and then my baby who's 19, was sitting on the lounge, was like, oh, watch an episode of this with you. And then he was like totally hooked and went right back and what has like binged all the way up to where we were at so we could then sit down and watch the last few episodes together. It's a brilliant show. I love it. Yeah, good fun. It was good fun, but the quality of also the cast and the script and you know there's that you can put them in a button short together.

I just always, you know, Amazing.

And I love Selena Gomez. Yeah, I have such a girl crush on her. She's so cute. But I also like it also feeds me my bit of New York porn that I like to get you know. Most shows.

Yes, love these.

Oh my God, living in New York. Yeah, it's cool. Great, great suggestion, and I will link through to that in the show notes for anybody that is not familiar. Gotta watch it. Yeah, it's a must watch for sure, and I'll also link through. You have an Instagram account, don't you? I do? Yeah, beautiful, I'll have it for Shreya and Andrea Fantastic. So I'll make sure I link through to that as well, so that in any women have any questions or not necessarily questions, but if they want some more information, they can go find you and they can get that through your Instagram account.

It's great and working on a website.

it's just not quite there yet. Websites are tricky things. Amazing, Shreya. Thank you so much for your time today. I'm super appreciative. Thank you.

Thanks for having me.

Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of dare men a pause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you, because you are my biggest driver for doing this work, if this chat went way too fast for you and you want more. Head over to stellarwomencomau slash podcast for the show notes and, while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.