Why is my skin so itchy in perimenopause?

Scratchy rashes, patches, and redness, oh my!

If you find this topic helpful, would you consider tapping the ❤️❤️❤️ or restacking? Substacks I loved this week: Can These Two Exercises Prevent Menopause Bone Loss as Effectively as Hormone Therapy?, Walks to Remember in Pictures, The Kryptonite Curse Crippling Midlife Confidence, and Sharing my letter from Love.

Not my legs … because while we’re committed to tackling even the icky topics authentically here at Phosis, I’m not sure you need to see my eczema.

It seemed to happen overnight — the intense itchiness. There I was, attempting to explain the importance of slow, controlled movements to a private Pilates client while scratching at my legs like a mad woman hoping she wouldn’t notice. Underneath my leggings was a new eczema flare – dry, flaky, scaly, red, bumpy, uncomfortable skin that stuck with me no matter how much I lotioned.

And then there was my face: an angry, itchy rash around my mouth and nose that I’d later learn was perioral dermatitis. It also refused to budge, leaving my skin bumpy, irritated, and annoyingly tender and tingly.

Sure it’s winter, and we’ve all experienced the parched skin that comes with dry air, a drop in temperature, and toasty indoor heating. But the convergence of issues on my face and body alongside other perimenopause symptoms made me suspect hormones also played a role in my discomfort. I set off to find some solutions so you, dear reader, don’t have to suffer needlessly.

Why are we all so infuriatingly itchy?

A few reasons:

1. Estrogen levels and collagen loss: Estrogen does more than just keep skin hydrated—it plays a key role in maintaining collagen, the protein that gives skin its structure, strength, and ability to retain moisture. As estrogen levels decline, collagen production slows, and the skin starts to thin. With less collagen, the skin’s natural barrier becomes weaker, making it harder to hold onto hydration and protect against irritants.

2. Less oil production: The sebaceous glands produce less oil, leaving the skin feeling parched and prone to fine lines. I’ve had days where my skin was so dry that I’d find what I can only describe as ‘skin dust’ collecting along the hemline of my pants—tiny, flaky reminders of how much moisture my skin was missing.

3. Stress and overwhelm: When you're stressed, your cortisol levels go up, which further weakens your skin's protective barrier. This can trigger inflammation, making existing skin issues worse and increasing histamine release, which leads to more itching. Plus, stress can cause you to scratch without realizing it, which traumatizes your skin. On top of all that, stress can alter your skin's microbiome, making it more vulnerable to bacteria or fungi.

4. The wrong routine: Soaps with drying ingredients like sodium lauryl sulfate (SLS) and sodium chloride strip your skin of its natural oils, leaving it vulnerable and dry. Over-exfoliating can also do a number on your skin by breaking down its protective barrier, leading to more irritation and flare-ups. Using ingredients like retinol or strong acids too frequently can cause your skin to become overly sensitized and irritated, especially since the skin's ability to repair itself slows down with hormonal changes. And, believe it or not, even your moisturizer might not be cutting it—if it's too light it won't do enough to lock in moisture.

5. Irritants like fragrances or essential oils:
   You might not realize that fragrances are lurking in your laundry detergent or even in some of your skincare products, but they can be a huge trigger for irritation. Essential oils, while they seem "clean and natural," are another common culprit. During perimenopause, your skin’s tolerance to these ingredients can drop significantly. Essential oils may make your skin feel soothing at first, but they often contain compounds that can exacerbate irritation and itching, especially when your skin is already sensitized. This is because their strong chemical properties can disrupt the skin’s barrier, causing even more discomfort.

6. Changes in sweat gland function: Hormones in flux sometimes can make you sweat more. If sweat sits on your skin too long, it can cause clogged pores or inflammation, which in turn can lead to itching, especially in areas where the skin is more sensitive.

7. Overwearing athleisure: Moisture-wicking fabrics can exacerbate itchy skin. These clothes are designed to pull sweat away from the skin, but when worn for long periods, they can trap heat and moisture close to your body, creating a breeding ground for bacteria. This can irritate the skin, especially if the fabric contains synthetic fibers that don't breathe well or if they cause friction.

Ask your doctor about these common conditions

• Eczema (Atopic Dermatitis): Red, inflamed patches of skin that are intensely itchy and dry, often with a rough texture that may crack or weep.

• Perioral Dermatitis: A red, bumpy rash around the mouth, nose, and sometimes the eyes, which may be sore or burning and can appear like acne but without the typical white or blackheads.

• Prurigo nodularis: Hard, raised bumps that are extremely itchy, often appearing in clusters and resulting from persistent scratching.

• Hives (Urticaria): Raised, pink, or red welts that can vary in size, often appearing suddenly and causing a burning or stinging sensation.

• Contact Dermatitis: Red, irritated skin with a rash that may be dry, swollen, and sometimes blistered, typically appearing after contact with certain products.

• Seborrheic Dermatitis: Flaky, greasy patches of skin with a yellowish or reddish tint, often found on the scalp, face, and chest, and accompanied by itching or burning.

• Genitourinary Syndrome of Menopause (GSM): Itching and dryness in the vaginal and vulvar areas, often accompanied by a feeling of tightness or discomfort.

What can I do about my itchy skin?

Disclaimer: I’m an expert in cosmetic formulation, skincare, perimenopause, and menopause but I’m not a doctor. However, it can take a long time to get an appointment with a dermatologist – especially in certain parts of the country. This is one of those instances that you really do need to try, though. These conditions can appear similar but often require a very specific prescription and combination of products, depending on your symptoms. In the meantime, here are some things doctors commonly recommend and a few anti-itch strategies that worked for me.

Oil-based cleansers are an absolute necessity for keeping your skin’s precious protective barrier intact in perimenopause.

Skincare Solutions

• Moisturize, moisturize, moisturize: The importance of keeping skin hydrated cannot be overstated. You’re looking for creams described as thick and rich — emollient moisturizers that contain ceramides, hyaluronic acid, and fatty acids, which help to strengthen the skin’s barrier and lock in moisture. For me, the combination of Phosis Calm Deep Hydration Restorative Cream and Luminous Ultrafine Revitalizing Oil works beautifully. I avoid the areas with perioral dermatitis when it’s flaring and use my prescription product there. For body, my dermatologist recommended CeraVe Moisturizing Cream. (Heads up, if you are diagnosed with any of the conditions on the above list, your doctor will likely recommend that you also swap your regular routine with one she or he prescribes.)

• Avoid drying soaps: Steer clear of cleansers with harsh ingredients like SLS or alcohol. Opt for gentle, fragrance-free body washes or cleansers that maintain the skin’s moisture while still effectively cleansing. Switching to this body wash, which contains a blend of pumpkin seed oil and argan oil, was helpful in finally kicking the eczema flare-up on my legs.

• Gentle and less frequent exfoliation: I get it — having textured skin on my face, legs, and arms makes me want to exfoliate morning noon, and night. However, you should avoid daily exfoliation in perimenopause as a rule, especially if you’re experiencing dryness, irritation, redness, or discomfort. Your doctor may recommend you skip exfoliating itchy areas altogether for the time being (as mine did with my perioral dermatitis).

• Use a humidifier: Adding a humidifier to your room can help maintain moisture in the air. (Annoying caveat: Don’t forget to clean the tank every few days otherwise bacteria and mold can build up.)

• Opt for fragrance-free: Fragrances are a big trigger as are essential oils. Be sure to use skincare products that are free from these, and also consider fragrance-free laundry detergents.

• Red light therapy: There’s some evidence that red light therapy can help calm mild to moderate inflammation. Anecdotally I can say that I do see a difference in redness when I use this mask nightly for 10 minutes. (A friend recommended it and I’m grateful!)

• Rx(s) from your dermatologist: As I mentioned, your doctor will need to evaluate your skin in person to determine the right course of treatment. I had never heard of the treatment he prescribed for my face, so I’ll share it here in case it’s helpful. He sent an Rx to a compounding pharmacy to custom-make a lotion that contains 0.1% Tacrolimus (a calcineurin inhibitor) and 4% niacinamide (a moisturizing and anti-inflammatory form of Vitamin B3). A “calcineurin inhibitor” is a drug that suppresses an overactive immune system in the skin to reduce inflammation. My doctor warned that this condition is notoriously hard to treat, and while my face is no longer itching, I’m still not happy about the texture and redness around my lips and chin that has yet to vanish completely.

I shared this photo a couple weeks ago, but I’ll share here again in case you’re in the market for an at-home red light mask.

Lifestyle Solutions

1. Stay hydrated: Drinking plenty of water is essential for keeping your skin hydrated. Try to aim for at least 8 cups a day, and remember that herbal teas or water-rich fruits (like cucumbers and watermelon) can count toward your hydration goals.

2. Manage stress: Easier said than done, I know. A morning movement routine and nightly journaling worked for me during an intense period of work and family stress, but finding your own way to manage overwhelm is critical. If your stress is chronic or you think you may be experiencing anxiety or depression, menopause.org has a list of practitioners who specialize in peri/menopause and mental health.

3. Wear breathable clothing: If you’re itchy, choose fabrics like cotton, linen, and moisture-wicking blends that are soft and breathable. Avoid wearing synthetic fabrics, especially those that trap sweat and heat close to the skin for long periods of time, as they can irritate.

4. Avoid hot showers: If you’re experiencing regular hot flashes, hot showers may be the last thing on your mind. I don’t have this particular perimenopause symptom (yet?), so I LOVE my scalding hot showers. Turning down the temp when you’re dry or itchy is important, though, since it can make both problems worse.

5. Avoid scratching: It’s easy to scratch when your skin itches, but this can worsen irritation and even cause damage. Consider keeping a pair of cotton gloves nearby for particularly stubborn itches to prevent yourself from scratching.

This Week’s Movement Snack

I got some excellent news recently that I can’t wait to share soon. I can’t seem to wipe the smile off my face, so this week’s routine is designed to make you smile, too. Join me as we explore adding movement to traditionally static poses — for a fun balance practice, I’ve added ‘“tiger tail” which is an amusing take on Warrior III.

Cheers to looking and feeling your best,

Susan

Susan Campbell, Founder and CEO, Phosis