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Menopause and Your Skin: The Pilocutaneous Syndrome of Menopause · The Science of Skin

• 0:08
  SPEAKER_00: Hi, I'm Dr.
• 0:09
  SPEAKER_00: Patty Farris.
• 0:10
  SPEAKER_00: I'm a board certified dermatologist, and I am your host for this episode of the Science of Skin Podcast.
• 0:16
  SPEAKER_00: And for those of you who are regular listeners, just a reminder if you like our podcast and if you listen regularly, I hope you do, please give us a good review and subscribe.
• 0:27
  SPEAKER_00: And also we're finding that our growth is really coming from people sharing the podcast.
• 0:31
  SPEAKER_00: And so we would greatly appreciate if you would do that as well.
• 0:35
  SPEAKER_00: So that brings us to the subject today, which is the hot, hot, hot topic of menopause.
• 0:41
  SPEAKER_00: And I could not have a better expert on this show than Dr.
• 0:46
  SPEAKER_00: Corrine Erickson.
• 0:47
  SPEAKER_00: And I'm going to tell you a little bit about her.
• 0:49
  SPEAKER_00: She is a board-certified dermatologist, but also menopause society certified practitioner.
• 0:56
  SPEAKER_00: She's the owner of Georgia Skin Specialists and Clear Aesthetics MD in Atlanta.
• 1:00
  SPEAKER_00: She completed her DERM residency at the University of Maryland.
• 1:04
  SPEAKER_00: She's a member of the AAD, ASDS, Women's Derm Society, and the Menopause Society.
• 1:10
  SPEAKER_00: She has clinical and academic focus in the science of skin and hair changes across the menopause continuum, from the perimenopausal shifts that patients notice first to the structural and barrier changes of the postpartal years, of postmenopausal years, and the evidence-backing medical and aesthetic management of both.
• 1:32
  SPEAKER_00: You have an expertise that is so unique, and so I just cannot wait to hear your take on how the dermatologist approaches the menopausal and perimenopausal patient.
• 1:44
  SPEAKER_00: Also, she writes the skin pause on Substack and has a huge social media presence.
• 1:49
  SPEAKER_00: I am one of your followers and I love your content.
• 1:52
  SPEAKER_00: Thank you.
• 1:52
  SPEAKER_00: Thank you for being such a straight shooter and giving us all the things that we need to know as dermatologists.
• 1:58
  SPEAKER_00: She publishes, she lectures internationally, and her mission is to better menopause skin health education for women navigating it.
• 2:07
  SPEAKER_00: So welcome to the Science of Skin podcast.
• 2:10
  SPEAKER_01: Thank you so much for having me, Patty.
• 2:12
  SPEAKER_01: I'm excited to be here.
• 2:14
  SPEAKER_00: Such a great topic.
• 2:16
  SPEAKER_00: And I'm going to start with the fact that you were way ahead of your time.
• 2:21
  SPEAKER_00: So menopause is definitely a thing right now.
• 2:24
  SPEAKER_00: You know that, Corinne, but you were into this long before anybody else was looking at it in terms of dermatology.
• 2:32
  SPEAKER_00: And so, how did you become interested in menopause?
• 2:36
  SPEAKER_02: You know, I think we really have to go back to kind of my origin story as a physician, Patty.
• 2:43
  SPEAKER_02: And it really started that I became passionate about the intersection of hormones and health when I was 12 and diagnosed with type 1 diabetes.
• 2:53
  SPEAKER_02: And from that moment on, I had a very personal appreciation for the interplay between what was happening within our bodies with the varying hormones that were happening, type 1 right at puberty, and the way that we were living our life and things like our exercise and our diet had this interplay.
• 3:13
  SPEAKER_02: So this has been a recurring theme for me ever since I went to medical school.
• 3:17
  SPEAKER_02: So fast forward into, you know, now I'm a 46-year-old dermatologist.
• 3:23
  SPEAKER_02: I'm not recognizing certain things happening in my own body to my own skin and hair at the same time.
• 3:29
  SPEAKER_02: And I'm recognizing similar patterns within my patients.
• 3:32
  SPEAKER_02: And more and more people want to understand why.
• 3:36
  SPEAKER_02: Why am I doing the same things?
• 3:37
  SPEAKER_02: I'm exercising, I'm eating well, I'm trying to get good sleep, I'm trying to manage my stress, but I'm falling off this cliff.
• 3:45
  SPEAKER_02: What is going on?
• 3:46
  SPEAKER_02: And just being able to say, here's a prescription for this cream or this pill is no longer enough for people.
• 3:54
  SPEAKER_02: And it led me to understanding that this new transition of life, this par this menopause continuum, is really something that we need to understand and educate ourselves about, and our patients want to know about to better address the skin and hair changes that they're facing through this time.
• 4:13
  SPEAKER_00: That's such an interesting journey.
• 4:14
  SPEAKER_00: And you're right, our personal journeys definitely guide our professional life, especially in medicine, I think.
• 4:20
  SPEAKER_00: So you went on and got certified in hormone replacement therapy.
• 4:26
  SPEAKER_00: So, you know, again, taking a leap that nobody else I know as a dermatologist has even done.
• 4:33
  SPEAKER_00: Are you the only certified person that's a dermatologist?
• 4:37
  SPEAKER_02: There are several other dermatologists who are menopause society certified.
• 4:41
  SPEAKER_02: And I think that we actually will see more join this group.
• 4:46
  SPEAKER_02: And it really just happened, Patty, with trying to answer a question for a patient.
• 4:51
  SPEAKER_02: She was sitting in my exam room.
• 4:52
  SPEAKER_02: I was doing her skin exam, and she said, Dr.
• 4:54
  SPEAKER_02: Erickson, can I put my vaginal estrogen cream on my face?
• 4:59
  SPEAKER_02: And as we know, this is a good way to go viral on Instagram, is talking about putting your vagina cream on your face.
• 5:06
  SPEAKER_02: And I said, you know what?
• 5:07
  SPEAKER_02: A lot of this makes sense.
• 5:09
  SPEAKER_02: I'd started reading about menopause and estrogen and the impact on the skin.
• 5:13
  SPEAKER_02: I said, let me let me get back to you when I have a better answer for this.
• 5:17
  SPEAKER_02: And as things do when you have a curious mind, it led to reading more and reading more and taking courses and studying and finally saying, I think there's really a role for this in dermatology.
• 5:28
  SPEAKER_02: This is clearly a need that women have.
• 5:31
  SPEAKER_02: They want to know the answers to what will help them age better, feel better in their own skin, but they also just want to understand what's going on and what's driving these changes.
• 5:42
  SPEAKER_02: And getting the menopause certification initially was just to help me discuss that with patients.
• 5:47
  SPEAKER_02: I actually didn't intend to become a prescriber of hormone therapy at that time, as it's off-label for skin and hair.
• 5:55
  SPEAKER_02: But as you know very well, we'd never get anything done in dermatology if we didn't prescribe off-label and if we wait for an on-label indication.
• 6:04
  SPEAKER_02: So it's just been really meeting a need that I see for my patients.
• 6:09
  SPEAKER_02: It's not every woman who comes in and menopause or in that continuum who I prescribe hormone therapy for, but it's been a really important tool to have, even if it's just a conversation and it doesn't end in an actual prescription.
• 6:23
  SPEAKER_00: So when patients are coming into your practice, are they coming in for dermatologic problems or are they coming in for other menopausal symptoms and looking for your advice on that?
• 6:35
  SPEAKER_02: So the vast majority are still coming in to get their skin exams, to come in and have a worrisome spot checked, or they're they're itchy, or they need to know what to use on their face because they're not tolerating it anymore.
• 6:48
  SPEAKER_02: So the reason for their visit with me for the most part hasn't really changed.
• 6:52
  SPEAKER_02: It's the way the visit takes shape in the exam room and the lens through which I look at the women who generally are somewhere between their early 40s and beyond.
• 7:04
  SPEAKER_02: And it's just taking one of the symptoms or signs and saying, this is actually a piece of a larger puzzle, right?
• 7:14
  SPEAKER_02: You know, you you've, I'm sure, been in the situation where the woman in room three is here for her skin exam, hair loss, acne, and unwanted hair on her chin.
• 7:22
  SPEAKER_02: She's itching all over, and she would like her jawline back.
• 7:26
  SPEAKER_02: You have 10 minutes, go.
• 7:28
  SPEAKER_02: And so what's happened is that instead of such a true, such a true scenario, we see.
• 7:35
  SPEAKER_02: It's everything.
• 7:36
  SPEAKER_02: And but in the woman, by the way, she feels like she's falling apart because all of these things are not working out for her right now.
• 7:43
  SPEAKER_02: So, what it's helped me do by becoming menopause certified and really understanding the biology of estrogen and androgen impact in the skin and hair and how that changes when those shifts occur, is I'm able to take this laundry list of concerns and build a framework by which I can talk with my patients and say, listen, this is not that you have 12 new things that are wrong with you.
• 8:10
  SPEAKER_02: This is you have an un you have these two key underlying hormonal drivers going on estrogen decline and relative androgen excess.
• 8:21
  SPEAKER_02: And then we look at what's playing the bigger role in that patient.
• 8:25
  SPEAKER_02: And we determine where we need to focus our treatment efforts.
• 8:30
  SPEAKER_02: And again, sometimes it's just that she wants to understand that she's not losing her mind and that what she's feeling is real and to feel validated.
• 8:40
  SPEAKER_00: So to sort of take us through a scenario if you have like a, you know, woman in her 40s who's perimenopausal and they're having a lot of symptoms.
• 8:51
  SPEAKER_00: So how do you decide to pull the trigger and go to HRT?
• 8:54
  SPEAKER_00: Is it symptom-based or is it laboratory-based, or is it the combination of the two?
• 9:02
  SPEAKER_02: I would say it's symptom-based almost all of the time, especially in a 45-year-old, which would generally be in perimenopause.
• 9:13
  SPEAKER_02: So in perimenopause, I think is more challenging even than postmenopause, because we still have this potential issue of fertility that we need to address and menstrual cycles.
• 9:26
  SPEAKER_02: So a very common scenario I see, Patty, is a 45-year-old woman, I could even describe myself, coming in with irregular, extremely heavy menstrual cycles.
• 9:36
  SPEAKER_02: She's complaining of a telaginopluvium picture that's kind of unmasking a female pattern hair loss pattern, as well as some kind of erratic oiliness in the T zone and dryness and sensitivity on her cheeks.
• 9:52
  SPEAKER_02: And what we put this together as, and we may have labs that help indicate this, is well, there could be some iron deficiency that's related to these heavy erratic menstrual cycles.
• 10:02
  SPEAKER_02: There's this relative androgen excess that's starting to emerge more in that T zone and in the female pattern hair loss.
• 10:09
  SPEAKER_02: And then there's the estrogen decline of that heightened sensitivity and skin barrier impairment.
• 10:15
  SPEAKER_02: And so we have to really look at the hormones and at the underlying issues, not just the skin, but what else is happening internally that's driving some of those changes, like getting the cycle regulated and under control?
• 10:28
  SPEAKER_02: Do we want to do an oral contraceptive pill as part of the management?
• 10:32
  SPEAKER_02: Not because the oral contraceptive pill helps the hair loss, but it may sure as heck help the iron deficiency that's resulting and give her some relief.
• 10:41
  SPEAKER_02: Do we need to go down another avenue of more androgen blockade?
• 10:47
  SPEAKER_02: So it really, and it happens all the time.
• 10:51
  SPEAKER_02: It's net when I see women in this age group, it's never just a conversation about acne or hair loss anymore.
• 10:57
  SPEAKER_02: There's a lot more to it once you really start to dissect into the underlying components of what's happening with her hormones.
• 11:04
  SPEAKER_00: Yeah, and I love the way you frame it, that drop lowering of estrogen with that relative androgen excess, because that really explains so much of what we see in the hair in the skin.
• 11:15
  SPEAKER_00: And so, what about the skin?
• 11:18
  SPEAKER_00: You know, there's so much discussion about you lose so much collagen after you go through menopause, you know, whatever it's supposed to be, 20% in the first five years.
• 11:26
  SPEAKER_00: I can't remember all the stats, but so what kinds of things are people complaining of?
• 11:31
  SPEAKER_00: I mean, there's so many things going on with these patients.
• 11:35
  SPEAKER_00: And you mentioned skin sensitivity and things like that, which I think are less common than dry skin and the things that we typically associate with menopause and perimenopause.
• 11:46
  SPEAKER_02: Right.
• 11:46
  SPEAKER_02: So in the the study that you're referencing, it's a brinkett study from the 1980s.
• 11:51
  SPEAKER_02: That's how old our data.
• 11:53
  SPEAKER_02: That's how old our data is, Patty.
• 11:55
  SPEAKER_02: It's wild.
• 11:56
  SPEAKER_02: And it's and but I it's a really important data point because it separates hormonal aging and it differentiates it from chronologic aging.
• 12:04
  SPEAKER_02: Because after age, you know, 18 to 20, we see different things.
• 12:07
  SPEAKER_02: We're losing 1% of our collagen per year.
• 12:10
  SPEAKER_02: And then within five years of menopause, it drops by 30%, and then 2% per year thereafter.
• 12:17
  SPEAKER_02: Our aging, chronologic aging didn't speed up.
• 12:20
  SPEAKER_02: What changed was our estrogen.
• 12:23
  SPEAKER_02: So that's very important for laying this groundwork.
• 12:27
  SPEAKER_02: So we think about what is estrogen doing for our skin?
• 12:30
  SPEAKER_02: It's stimulating collagen production, both type 1 and type 3 with our fibroblasts.
• 12:35
  SPEAKER_02: Well, it goes away, our skin thins, our collagen content goes down.
• 12:39
  SPEAKER_02: We see more wrinkles and our skin barriers impaired.
• 12:42
  SPEAKER_02: It supports hyaluronic acid production.
• 12:44
  SPEAKER_02: We do become more dehydrated.
• 12:46
  SPEAKER_02: It helps regulate skin cycle turnover.
• 12:50
  SPEAKER_02: And so we actually, our skin cycle and turnover slows over time.
• 12:53
  SPEAKER_02: We see more pigmentation dysregulation in this stage.
• 13:00
  SPEAKER_02: So by looking at what it's doing for our skin, you can really extrapolate and it makes sense why our skin starts to almost deteriorate at times and its function deteriorates as we age.
• 13:12
  SPEAKER_02: It also points out why this is not just a cosmetic problem.
• 13:16
  SPEAKER_02: This is the skin barrier.
• 13:17
  SPEAKER_02: This is wound healing.
• 13:19
  SPEAKER_02: There's vast literature on the impact of estrogen deficiency in wound healing.
• 13:25
  SPEAKER_02: And when we lose these things, we need to be aware of the repercussions.
• 13:31
  SPEAKER_00: So interesting.
• 13:40
  SPEAKER_00: And so for so long, estrogen was really with help from women.
• 13:45
  SPEAKER_00: And so now it's so great to see us entering a new era where people are have a heightened understanding of the importance of hormone replacement therapy.
• 13:55
  SPEAKER_00: I mean, it used to be they might put you on for a while, but they didn't keep you on very long.
• 13:59
  SPEAKER_00: And it was just to mitigate some of the hot flashes and the unpleasantries of menopause.
• 14:05
  SPEAKER_00: But now we understand bone and all of the ramifications of low estrogen.
• 14:10
  SPEAKER_02: We understand bone.
• 14:12
  SPEAKER_02: We have musculoskeletal syndrome of menopause.
• 14:14
  SPEAKER_02: We understand the genito-urinary impact with GSM, which did you know that used to be called the senile vagina?
• 14:22
  SPEAKER_02: That was its original, original name.
• 14:25
  SPEAKER_02: And then we got vulva vaginal atrophy, and thank God they replaced it with genito-urinary syndrome of menopause.
• 14:31
  SPEAKER_02: And now we need this understanding in dermatology, because to really take care of a woman who's approaching or going through the menopause continuum, the erratic hormone fluctuations of perimenopause, and then the postmenopausal state of estrogen decline, whether she is on hormone therapy or not, in order to take the best care of her skin, keeping those shifts in mind will only support her.
• 15:03
  SPEAKER_02: So I feel I feel very strongly that there's a need for this more broadly in our field.
• 15:09
  SPEAKER_00: Yeah, absolutely.
• 15:11
  SPEAKER_00: Um how do you feel about estrogen cream for skin aging?
• 15:15
  SPEAKER_00: I mean, there's so many different types, and um, you know, it's hotly debated, as you know, and you're right, it's always on social media.
• 15:24
  SPEAKER_00: It seems to be the new it girl in the anti-aging world.
• 15:28
  SPEAKER_00: So, how do you approach patients with topical estrogen?
• 15:32
  SPEAKER_02: Well, the first thing that I want to clarify is the absolute most important topical estrogen for the skin is vaginal estradiol for the bulvo vaginal area.
• 15:42
  SPEAKER_02: And recent studies show reduction in death from UTIs and urosepsis with the use of twice a week vaginal estradiol.
• 15:54
  SPEAKER_02: And as of November 2025, vaginal estradiol no longer carries that horrific black box warning that was so misplaced.
• 16:03
  SPEAKER_02: And, you know, I think as a dermatologist, I've certainly been guilty of being like, well, make sure your GYN is taking care of your vulva vaginal area.
• 16:10
  SPEAKER_02: And that's not long, that's I don't do that anymore.
• 16:12
  SPEAKER_02: I'm very conscientious about that as a shared area of anatomy with skin health because vaginal estradiol, yeah, can restore pH and prevent UTIs, restore blood flow, help with libido.
• 16:27
  SPEAKER_02: It can help with hydration and lubrication of the area.
• 16:30
  SPEAKER_02: It can even help with some structural changes that impact urinary incontinence.
• 16:34
  SPEAKER_02: And I don't know, I don't want to be destined for diapers.
• 16:38
  SPEAKER_02: So I'm all on board.
• 16:39
  SPEAKER_02: But the hot topic, of course.
• 16:42
  SPEAKER_02: So I'm passionate about vaginal estradiol, and I prescribe it like candy to women over the age of 40.
• 16:47
  SPEAKER_02: Um, but I'm also very intrigued about how estradiol could locally and topically do the same thing for the face.
• 16:55
  SPEAKER_02: And up until 2002, a lot of people were interested in this and it was being studied and there was product development underway.
• 17:02
  SPEAKER_02: But then when everyone thought it was going to cause breast cancer, the funding shut it down and the studies shut down, which doesn't mean we don't have any data.
• 17:11
  SPEAKER_02: It just means this data we have is not what we would want, right?
• 17:14
  SPEAKER_02: The clinical studies that show its impact are relatively old and they're relatively small.
• 17:21
  SPEAKER_02: But they do show, like one of the um Schutze from uh 1996 showed improvement in wrinkling and skin thickness and hydration with topical estrogen formulations.
• 17:35
  SPEAKER_02: Um, there's been more recent studies in 2018 that show benefit on photoprotected skin more so than photo-aged skin, which is something else that we need to watch, watch for.
• 17:47
  SPEAKER_02: Interesting, isn't it?
• 17:48
  SPEAKER_00: I've seen those studies.
• 17:49
  SPEAKER_00: Yes, it's fascinating.
• 17:51
  SPEAKER_02: It is.
• 17:52
  SPEAKER_02: And you know what I would say is I think that if estrogen is missing, let's say a woman really does have sign of estrogen decline and there's other symptoms of estrogen deficiency in her skin, then giving estrogen back biologically makes sense.
• 18:10
  SPEAKER_02: It just needs to be done with the important discussion that the studies are small and mostly old, although there are some new ones that are coming out.
• 18:20
  SPEAKER_02: We don't understand enough about some of the potential side effects.
• 18:25
  SPEAKER_02: How much local estrogen therapy is local before it becomes systemic and you need a systemic progestogen to protect the uterine lining, for example.
• 18:34
  SPEAKER_02: We don't understand enough about melasma and how atopical estrogen formulation might provoke a new or recurrent melasma flair.
• 18:44
  SPEAKER_02: Is that different between estradiol, for example, and estriol?
• 18:48
  SPEAKER_02: Because they actually bind with different receptors in the skin.
• 18:51
  SPEAKER_02: Estradiol has been linked with hyperpigmentation being reported, whereas estriol has not, and it may have to do with the type of estrogen receptor that's at play.
• 19:03
  SPEAKER_02: So there are things that we don't know, and women need to be aware of that.
• 19:06
  SPEAKER_02: It is off-label, and it's not going to fix skin that's not estrogen deficient.
• 19:11
  SPEAKER_02: If you have plenty of estrogen, you don't need to put estrogen on your face.
• 19:15
  SPEAKER_00: And that's such a great point.
• 19:16
  SPEAKER_00: I was going to ask you that very question.
• 19:18
  SPEAKER_00: So many women are interested in it, and younger women as well, as again, as if it's sort of the new it girl to make your skin not age.
• 19:28
  SPEAKER_00: So it and it made sense to me when I looked at those studies on photo-aged versus photoprotected, because intrinsic aging is what we're really talking about here.
• 19:38
  SPEAKER_00: It's not extrinsic aging.
• 19:40
  SPEAKER_00: With the you know, extrinsic aging is so much more complicated because of the environmental factors and upregulation about ROS and you know, all of those things.
• 19:50
  SPEAKER_00: So it made sense to me that that would be where its sweet spot would really be, would be in photoprotected, intrinsically aged skin.
• 19:59
  SPEAKER_00: Does it help crepey skin?
• 20:01
  SPEAKER_00: I mean, crepey skin is a huge problem.
• 20:04
  SPEAKER_02: It helps with hydration.
• 20:06
  SPEAKER_02: And part of crepey skin, I mean, crepey skin is dehydrated dermal thinning, right?
• 20:13
  SPEAKER_02: That's that's the crepiness, and it has been shown to help skin thickness, and it has been shown to help hydration.
• 20:21
  SPEAKER_02: So it follows that it it could, it's plausible.
• 20:24
  SPEAKER_02: More studies need to be done.
• 20:26
  SPEAKER_02: I'm hesitant to recommend anyone smear estrogen all over her body, though, since crepey skin is usually a broader surface area without a pretty significant discussion of systemic absorption.
• 20:39
  SPEAKER_02: And I think that's really where that's where the clinical nuance comes in.
• 20:45
  SPEAKER_02: And we certainly don't want anyone developing endometrial hyperplasia in an Because they're trying to treat creep because they're trying to creep creepy skin.
• 20:53
  SPEAKER_02: I mean, you 10% urea has a good track record for treating some peptides.
• 20:58
  SPEAKER_02: Put some retinol in your skin and some urea and some keratalytics, and possibly estriol at lower formulations.
• 21:07
  SPEAKER_02: But it's a great and exciting opportunity for research.
• 21:09
  SPEAKER_02: And to your point, this is not a substitute for the things we know help with extrinsic aging.
• 21:16
  SPEAKER_02: It is not a substitute for sunscreen and topical antioxidants and retinoids every day.
• 21:22
  SPEAKER_02: Those are critical for our extrinsic aging drivers.
• 21:26
  SPEAKER_02: They play very well when appropriate with incorporating an estrogen approach.
• 21:35
  SPEAKER_00: That makes total sense.
• 21:36
  SPEAKER_00: You mentioned hair loss sort of in passing, but let's dig into that for a second because boy oh boy, these perimenopausal and menopausal females, those that are prone to AGA, that is that is the unmasking.
• 21:50
  SPEAKER_00: That is the time of life when they really start to see it.
• 21:53
  SPEAKER_00: So tell us about how you're approaching those patients.
• 21:56
  SPEAKER_00: And you're right.
• 21:56
  SPEAKER_00: Why is that always sort of a oh, by the way, you've got 8,000 things wrong with me, but my hair started falling out recently.
• 22:05
  SPEAKER_02: I'll share with you something that has made my hair loss treatment journey a much bigger success.
• 22:11
  SPEAKER_02: And that is when I start my skin exams, I start at the scalp and I just ask the question because I feel like a lot of women are just sitting there sweating, wondering if it's okay to ask.
• 22:22
  SPEAKER_02: And I just invite it into the room.
• 22:25
  SPEAKER_02: Now I love taking care of hair loss because it's very much in my wheelhouse, but it removes the anxiety around it and we can get to the point.
• 22:34
  SPEAKER_02: And it takes that doorknob dash out of the picture with hair loss.
• 22:40
  SPEAKER_00: So you just ask them straight up.
• 22:41
  SPEAKER_00: I'm just asking it.
• 22:43
  SPEAKER_02: I'm looking at your scalp.
• 22:44
  SPEAKER_02: Tell me about your hair, your scalp health.
• 22:46
  SPEAKER_02: Are you noticing any changes?
• 22:48
  SPEAKER_02: I'm not, I don't lead them.
• 22:50
  SPEAKER_02: I just want to know, are they noticing any changes?
• 22:53
  SPEAKER_02: Because if they are and they're holding it in, it's going to come out before I leave.
• 22:57
  SPEAKER_02: And I'd rather know at the beginning.
• 22:58
  SPEAKER_02: It shapes, it shapes the visit.
• 23:01
  SPEAKER_02: Um, and it really then helps to put into context the rest of it, how dry their skin is, if they are having any um hormonal acne breakouts.
• 23:08
  SPEAKER_02: But hair loss is really key with women.
• 23:10
  SPEAKER_02: And I always call it female pattern hair loss because I find that it is unlike men, it is not just androgen driven, right?
• 23:18
  SPEAKER_02: It's the some telogen effluvium often unmasked by hormonal shifts, maybe going on or off a hormonal agent.
• 23:27
  SPEAKER_02: It's that iron insufficiency or deficiency shedding related to erratic periods and perimenopause and our inability to compensate after menopause.
• 23:37
  SPEAKER_02: There's often a lot of stress at play.
• 23:40
  SPEAKER_02: So this interlaying of telogen effluvium and an androgen-driven process often coincides in many, many ways.
• 23:49
  SPEAKER_02: And then there's often, you know, I think this is when thyroid disease really picks up, and we need to be on the lookout for that.
• 23:56
  SPEAKER_02: So the hair is really a great window into a woman's overall health and hormonal status.
• 24:04
  SPEAKER_02: Um, that is an opportunity where sometimes lab work can be really helpful.
• 24:08
  SPEAKER_02: I talk a lot about strategic supplementation, not just throwing everybody on a proprietary supplement blend, but like if you need iron, let's talk about how much you need and how to take it and how we're gonna monitor.
• 24:20
  SPEAKER_02: Do you need vitamin D?
• 24:21
  SPEAKER_02: Do you need zinc?
• 24:23
  SPEAKER_02: Um so in that really gets her on a better path.
• 24:26
  SPEAKER_02: And I find feel women feel a lot more confident when they leave the appointment.
• 24:31
  SPEAKER_02: If you have really had that long conversation about the hair loss, it's as distressing for women as a severe chronic disease when we lose our hair.
• 24:41
  SPEAKER_02: And it affects up to 50% of women by age 70.
• 24:45
  SPEAKER_02: So, but it's considered cosmetic, and women dismiss it in themselves as a vanity concern.
• 24:51
  SPEAKER_02: And I think that just bringing it out there into the open, acknowledging it and validating it has a lot of power.
• 24:57
  SPEAKER_00: I love that.
• 24:58
  SPEAKER_00: I love that you just asked the question up front because that really does bring down the barriers.
• 25:03
  SPEAKER_00: I think women are also sometimes embarrassed to talk about hair loss.
• 25:07
  SPEAKER_00: Men come right in and they're like, I'm losing my hair, I'm freaking out.
• 25:11
  SPEAKER_00: But women don't do that very often.
• 25:14
  SPEAKER_00: They seem to be somewhat more guarded about it because it is so personal.
• 25:19
  SPEAKER_02: It's personal, and we've been delivered this message that our skin and hair health is cosmetic and that we should care about other things, that we shouldn't be so, so vain or so frivolous.
• 25:31
  SPEAKER_02: And the fact is, exactly when you look at it with this hormonal framework, it's not cosmetic at all.
• 25:37
  SPEAKER_02: What if your hair loss and bringing that up to your dermatologist is what gets you in for a cardiovascular health assessment?
• 25:44
  SPEAKER_02: Because she talks to you about how that risk could go up as you enter menopause.
• 25:48
  SPEAKER_02: What if you get a DEXA scan before you have osteoporosis?
• 25:52
  SPEAKER_02: What if you get on hormone therapy and you can sleep through the night and have energy to maintain your career?
• 25:59
  SPEAKER_02: You know, what if you don't have to sleep through the night?
• 26:02
  SPEAKER_02: Yeah, it is possible.
• 26:03
  SPEAKER_02: It is possible.
• 26:05
  SPEAKER_02: It's possible.
• 26:06
  SPEAKER_02: So I just think that you can start.
• 26:08
  SPEAKER_02: We see it.
• 26:09
  SPEAKER_02: We perimenopause and menopause are so often diagnosed in the mirror, Patty.
• 26:13
  SPEAKER_02: It's not a lab test, it's not a specific set of diagnostic criteria.
• 26:20
  SPEAKER_02: It's it's a period of life that will ultimately be hopefully 40% of a woman's lifetime.
• 26:26
  SPEAKER_02: And how privileged are we as dermatologists to be the ones who could really set her up for better success by understanding the link between things we see multiple times every day and getting her on path to a healthier hormonal transition.
• 26:41
  SPEAKER_00: Yeah, that's perfectly sad.
• 26:43
  SPEAKER_00: So, sort of wrapping it up, how do you make this more approachable for a dermatologist?
• 26:49
  SPEAKER_00: It's it's something that I think a lot of derms would be very intimidated by, by sort of tackling this.
• 26:56
  SPEAKER_02: Yeah.
• 26:57
  SPEAKER_02: So I thought about this framework that I had created for myself to break it down and manage it in the room in a limited time frame with estrogen decline and relative androgen excess.
• 27:08
  SPEAKER_02: And I started thinking about the woman who comes in with such a similar list of concerns.
• 27:15
  SPEAKER_02: And I decided that there is power in giving this a name, just as we've done with GSM, the genito-urinary syndrome of menopause back in 2014, in 2024, the musculoskeletal syndrome of menopause.
• 27:30
  SPEAKER_02: What we have in dermatology that I propose is the pilocutaneous syndrome of menopause.
• 27:37
  SPEAKER_02: Pilo for hair, cutaneous for skin, rooted in Latin and rooted in the hormone transitions that women face across this continuum.
• 27:48
  SPEAKER_02: And not only does that framework gives you a place to stand and make sense of the multiple different concerns that a woman has, it gives you a framework to treat.
• 27:59
  SPEAKER_02: So naming it PSM, pilocutaneous syndrome of menopause, allows us as dermatologists to name it, to recognize it better, and to treat it in ways that are grounded in the pathophysiology that's driving it.
• 28:16
  SPEAKER_02: Whether that's hormone related or more conventional medical management.
• 28:21
  SPEAKER_02: It also allows us to name it for the patient.
• 28:24
  SPEAKER_02: And there's power in that.
• 28:28
  SPEAKER_00: That's fantastic.
• 28:30
  SPEAKER_00: I love that.
• 28:30
  SPEAKER_00: That's such a great direct approach.
• 28:33
  SPEAKER_00: And the patient certainly can understand you know, the I agree with you.
• 28:39
  SPEAKER_00: There's so much power in having a name for it.
• 28:42
  SPEAKER_02: Yeah.
• 28:42
  SPEAKER_02: It it just feels more unified and more directional.
• 28:46
  SPEAKER_02: And it's more teachable because a huge area of need in this group are clinicians who understand and who are educated about these changes.
• 28:57
  SPEAKER_02: I believe it's going to make it more approachable for dermatologists to have menopause conversations in their clinics.
• 29:04
  SPEAKER_02: So I've I've written it.
• 29:06
  SPEAKER_02: I've actually just said, where's the paper?
• 29:09
  SPEAKER_02: Yeah, it's it's currently published as a preprint.
• 29:12
  SPEAKER_02: I'm getting ready to submit it to the menopause journal because I really believe in the cross-collaboration between dermatology and gynecology and building those bridges and connecting our specialties.
• 29:26
  SPEAKER_02: So it is available on a preprint, and I'll include the DOI for you to put in the show notes so that people can read it if they're interested.
• 29:34
  SPEAKER_00: And also tell our listeners before we um finish, where do they find you on social media?
• 29:40
  SPEAKER_00: Aren't you the menopause dermatologist?
• 29:42
  SPEAKER_02: I'm the menopause derm on social media.
• 29:45
  SPEAKER_02: Um, the menopause derm.
• 29:47
  SPEAKER_02: I write a substack called the Skin Pause that's free.
• 29:51
  SPEAKER_02: Um and yeah, that's where that's where they can find me.
• 29:56
  SPEAKER_00: Fantastic.
• 29:57
  SPEAKER_00: Well, this has been, as I knew it would be so informative.
• 30:00
  SPEAKER_00: I know our listeners will love this episode.
• 30:04
  SPEAKER_00: And I can't thank you enough for sharing your expertise with us.
• 30:08
  SPEAKER_00: And I I love everything that you're doing.
• 30:11
  SPEAKER_00: So congratulations on an incredible career, contributing significantly to the literature and to what we know as dermatologists about menopause and how to take care of patients with cutaneous pylor.
• 30:25
  SPEAKER_02: Pylocutaneous.
• 30:26
  SPEAKER_02: I know it rolls off.
• 30:28
  SPEAKER_00: It rolls off the tongue, right?
• 30:30
  SPEAKER_00: Pilocutaneous.
• 30:33
  unknown: Okay.
• 30:33
  SPEAKER_00: PSM.
• 30:35
  SPEAKER_00: PSM.
• 30:36
  SPEAKER_00: I got it.
• 30:37
  SPEAKER_00: All right, thank you so much.
• 30:38
  SPEAKER_00: I hope everybody's enjoyed this episode as much as I have.
• 30:41
  SPEAKER_00: Thanks again for joining us, Corinne, and everybody.
• 30:44
  SPEAKER_00: Have a great day.