Acne at 50? NYC New York NY

Frequently I see women aged 20-55 with breakouts continuing well into middle years, starting again after a period of clear skin, or first occurring in the 30’s and 40’s. Often these same women are starting to see signs of aging and say  "Seriously, this is ridiculous--wrinkles and acne?"

Acne in adult women is strongly hormonal, combined with an inherited tendency and additional triggers of stress, heat, sweat and cosmetics which plug pores. It predominantly occurs on the chin and jaw line, areas where oil glands are most hormonally influenced. Stimulation of oil glands by male hormones, called androgens, is a key factor. Symptoms of hormonal imbalance with excess androgens are irregular menstrual cycles, acne, excess hair growth and infertility. Some women have normal androgen levels but oil glands that are more sensitive. 

Certain birth control pills, progestin containing IUD's, and the birth control shot have androgenic activity that aggravate acne. Menopausal women taking estrogen-testosterone for libido, or DHEA supplements may develop acne, facial hair growth and balding. Under stress--emotional, physical, sleep deprivation or a hectic Frequently I see women aged 20-55 with breakouts continuing well into middle years, starting again after a period of clear skin, or first occurring in the 30’s and 40’s. Often these same women are starting to see signs of aging and say  "Seriously, this is ridiculous--wrinkles and acne?"



Acne in adult women is strongly hormonal, combined with an inherited tendency and additional triggers of stress, heat, sweat and cosmetics which plug pores. It predominantly occurs on the chin and jaw line, areas where oil glands are most hormonally influenced. Stimulation of oil glands by male hormones, called androgens, is a key factor. Symptoms of hormonal imbalance with excess androgens are irregular menstrual cycles, acne, excess hair growth and infertility. Some women have normal androgen levels but oil glands that are more sensitive. 



Certain birth control pills, progestin containing IUD's, and the birth control shot have androgenic activity that aggravate acne. Menopausal women taking estrogen-testosterone for libido, or DHEA supplements may develop acne, facial hair growth and balding. Under stress--emotional, physical, sleep deprivation or a hectic life--adrenal glands release stress hormones; worsening acne, and increasing stress even more.



Cosmetics alone don't cause acne, but may worsen it by plugging oil glands. Long-wearing "all day coverage" foundations, oil-based foundations, covering pimples with concealer, or using a brush to apply mineral powder may plug or irritate pores and worsen acne. Look for moisturizers, foundations and powders that are non-comedogenic and non-acnegenic. Mineral powder applied with a sponge or liquid oil-free foundations are best. Hair styling products, heat, sweat, oil and friction (sweaty workout clothes, cell phones and touching your face etc) should be reduced.



To treat, we start with a skin care and surface retinoid program that both targets acne and is the mainstay of an anti-aging program. Antibiotic pads after workouts, light chemical peels, blue light treatment, and in certain patients, medical microdermabrasion are helpful. Oral antibiotics are often needed for larger, deeper cysts.



Getting hormones straightened out is essential, but complicated. For patients needing birth control or with hormonal imbalance, birth control pills such as Ortho Tri-Cyclen, Estrostep, Alesse, Yasmin, Yaz, Mircette, Ortho-Cept, and Desogen  improve acne. Dosages of estrogen-testosterone or DHEA may need to be reduced.



A related problem, perioral dermatitis, occurs as a pimply rash around the mouth. Your dermatologist can determine whether you have adult acne or perioral dermatitislife--adrenal glands release stress hormones; worsening acne, and increasing stress even more.

Cosmetics alone don't cause acne, but may worsen it by plugging oil glands. Long-wearing "all day coverage" foundations, oil-based foundations, covering pimples with concealer, or using a brush to apply mineral powder may plug or irritate pores and worsen acne. Look for moisturizers, foundations and powders that are non-comedogenic and non-acnegenic. Mineral powder applied with a sponge or liquid oil-free foundations are best. Hair styling products, heat, sweat, oil and friction (sweaty workout clothes, cell phones and touching your face etc) should be reduced.

To treat, we start with a skin care and surface retinoid program that both targets acne and is the mainstay of an anti-aging program. Antibiotic pads after workouts, light chemical peels, blue light treatment, and in certain patients, medical microdermabrasion are helpful. Oral antibiotics are often needed for larger, deeper cysts.

Getting hormones straightened out is essential, but complicated. For patients needing birth control or with hormonal imbalance, birth control pills such as Ortho Tri-Cyclen, Estrostep, Alesse, Yasmin, Yaz, Mircette, Ortho-Cept, and Desogen  improve acne. Dosages of estrogen-testosterone or DHEA may need to be reduced.

A related problem, perioral dermatitis, occurs as a pimply rash around the mouth. Your dermatologist can determine whether you have adult acne or perioral dermatitis