It's a cruel irony that more than half of adult women are battling breakouts at the same time they're coping with crow's-feet. The culprit is hormones, which ebb and flow throughout a woman's life rather than stabilize as they do in men. "As estrogen levels fluctuate — or, in the case of menopause, decrease — androgens, the hormones that stimulate oil glands, can lead to breakouts," says Jonette E. Keri, M.D., Ph.D., an assistant professor of dermatology at the University of Miami School of Medicine. Also to blame: stress, which raises hormone levels. One thing you needn't stress about is controlling the condition. New remedies make it easier to get the clear skin you've always wanted — and erase signs of aging in the bargain.
Beat blemishes at home
This skin care routine fights the main cause of acne: pores clogged by oil and cellular debris and inflammation from P. acnes bacteria. But unlike topical teenage treatments — formulated for oilier complexions — these OTC solutions are less likely to dry mature skin and make wrinkles more pronounced. The routine relies on products that address the dual concerns of acne and aging (see products at right) by employing agents such as:
- Salicylic acid, which unclogs pores and smooths skin by sloughing off dead cells.
- Retinoids like retinol, a vitamin-A derivative that improves acne, fine lines and sun spots by normalizing cellular turnover.
- Humectants that attract moisture and anti-inflammatories, like green tea and allantoin, to quell inflammation.
Follow these steps to eradicate existing pimples and prevent new ones:
In the morning:
- Cleanse gently. Use a facial wash with salicylic acid. "It gets into the pores and dislodges debris," says Diane Berson, M.D., an assistant professor of dermatology at the Weill Medical College of Cornell University and board member of the American Acne and Rosacea Society. Avoid gel cleansers (they can contain alcohol) and granulated scrubs, which strip the skin of oil, making it overcompensate and produce more, says Keri.
- Treat affected areas. If you have a blemish, dab on a spot corrector with salicylic acid or benzoyl peroxide, which kills surface bacteria and dries oil. If you're prone to breakouts in a particular area (say, your chin), apply it to the entire zone daily to help prevent them.
- If skin is dry, apply a moisturizer with SPF 15 or higher. Choose one that contains an alpha-hydroxy acid like glycolic acid for a double benefit: The AHA exfoliates pores as it sloughs off dead cells and moisturizes skin. If your complexion is oily, use an oil-free sunscreen. UV rays thicken the outer layer of skin, which can block pores and lead to breakouts.
At night:
- Remove makeup with a gentle, nonmedicated cleanser. The skin can't exfoliate properly if it's not clean.
- Apply a retinol cream. The prescription retinoid Retin-A was approved for treating acne long before it became the gold standard for fighting wrinkles. "Retinoids help clear up and prevent all kinds of acne, from tiny bumps and blackheads to inflammatory acne and red nodules around the jawline," says Keri. OTC retinoids like retinol don't pack the same punch as Rx versions, but they can be less irritating and a good way to acclimate skin.
- Moisturize as needed. Apply face lotion frequently to prevent dryness.
What your doc can do
If your skin doesn't respond to at-home treatments within a few weeks or you have many pimples (especially cystlike nodules, which are large, painful, and can cause scarring), see a dermatologist. She'll prescribe a more potent retinoid and topical antimicrobial like benzoyl peroxide to kill bacteria and quell inflammation. Bonus: New Rx meds are more appropriate for aging and dry skin. "If there's not enough improvement after a few months, other drugs can be added," says Berson. Also available in a derm's anti-acne arsenal:
Oral antibiotics: A two- to six-month course speeds healing by targeting deeper blemishes. These drugs travel through the bloodstream, so they also fight hard-to-reach back and chest acne.
Hormone therapy: To steady hormones and quiet premenstrual flares, patients are often put on a low-dose birth control pill. One caveat: Women who are over 40 can be at increased risk of developing the same side effects associated with hormone therapy to reduce menopausal symptoms, including blood clots. Also prescribed in conjunction with oral contraceptives or by itself: spironolactone, an anti-androgen that decreases oil production.
Light therapy: These treatments are used in conjunction with other Rx remedies to boost their benefits. Blue light therapy temporarily kills P. acnes in a painless, 15-minute procedure. The bacteria can return, however, so ongoing therapy — at up to $500 a pop — is necessary. The new Isolaz Pore-Cleansing Acne Treatment suctions pores to eliminate excess sebum, while a laser targets bacteria. Four to six sessions at $300 to $500 each are needed, followed by monthly maintenance.