When 'younger' skin is not a blessing
Skin Deep: More adult women are getting pimples than ever before, according to a recent study.
The New York Times
Growing up, Eileen Wolter, now 40 and a blogger about stay-at-home motherhood in Summit, N.J., was one of those rare teenagers without complexion concerns.
"I had really good skin," she said. "And I just used Ivory bar soap."
But in recent years, that skin has gone from picture-perfect to problematic.
"I've got uneven skin that's also oily with constant blackheads and cystic acne bumps on my chin," Wolter said.
And her once-simple regimen now involves a complicated product list: face brush, acne cover-up, face mask, cortisone shots and prescription acne gel, as well as cleansers and lotions to treat both acne and aging.
Wolter isn't the only grown-up who feels as if she's going on 16. More adult women are getting pimples than ever before, according to a study presented in March at the American Academy of Dermatology annual meeting. Today, clinical acne afflicts the complexions of 45 percent of women ages 21 to 30, 26 percent of women ages 31 to 40, and 12 percent of women ages 41 to 50, according to the study, conducted by researchers at Massachusetts General Hospital.
Wolter said she first noticed her breakouts at age 31, "right when I moved cross-country and in with a boyfriend, lost the job and friends I'd had for years, and let my eating habits go awry."
There is no definitive proof that specific foods cause breakouts, but some medical professionals say diet can play a role.
"Whenever hormones surge — around your period, during perimenopause and menopause, when you're pregnant, when you start or stop the pill, and, yes, when you're stressed or eat hormone-enhanced foods, i.e. nonorganic meat and dairy, skin changes can occur," said Dr. Jeanine Downie, a dermatologist in Montclair, N.J.
Whatever the cause, hormonal havoc can overstimulate oil glands to pump out extra sebum, said Dr. Joshua Zeichner, director of cosmetic and clinical research in the dermatology department at Mount Sinai Medical Center in New York. But aging skin is also drier, in part because of the cumulative effects of sun exposure. So when it comes to treatment, "less can be more, especially when it comes to adult acne," Zeichner said.
He suggested tossing out creams, gels or lotions containing 5 or 10 percent benzoyl peroxide, the standard antiseptic for teenage acne (which is on oily, durable skin).
Two and a half percent benzoyl peroxide has been shown to be just as effective as 5 or 10 percent, but is associated with less stinging, itching and overdrying, all of which can act as disincentives to continue a regimen.
"Effective treatment does not necessarily require skin irritation," Zeichner said.
There is no cure for acne, although the drug Accutane (isotretinoin) came pretty close, said Dr. Ranella Hirsch, a dermatologist in Boston.
"It is and was the single most effective treatment available for severe forms of nodular cystic acne. Period. There is no qualifier to that statement," she said.
The documented side effects, though, include birth defects, depression and severe skin dryness.
So it's not surprising that many older women turn to milder remedies, some of which also take into account that their blemishes sit atop dry, sensitive skin.
Zeichner likes Aczone (dapsone), a topical anti-inflammatory medication that has been shown to be gentle. He also mentioned newer, gentler formulations of topical retinoids, a longstanding weapon in the acne arsenal, like Atralin Gel and Retin-A Micro 0.04 percent gel.
SkinCeuticals, a brand favored by some dermatologists, recently introduced Blemish + Age Defense, a serum that combines 2 percent dioic acid with an alpha- and beta-hydroxy acid, and is designed to prevent acne, reduce hyperpigmentation and make fine lines and wrinkles less apparent.
Laser and light therapy is an increasingly popular option in doctors' offices since studies in publications like the Journal of Cosmetic Laser Therapy and the Journal of Dermatological Treatment showed it to be effective on the reduction of inflammatory acne lesions. Diane Lang, 42, a therapist in Morris County, N.J., gets it once a month to shrink cystic bumps. It is also finding its way into less-expensive home devices like the ANSR: Beam, although consumer reviews are mixed.
For those leery of chemicals and gadgets, purifying the diet can seem like an appealing option, although research on this front is not comprehensive. In 2006, Harvard researchers found that girls who drank two or more glasses a day of milk had a higher risk of acne than did girls drinking less than a glass a week. A study published in 2007 in the American Journal of Clinical Nutrition linked a low glycemic diet to clearer skin.
Three years ago, Bridgette Raes, 38, a New York City writer, began to gradually cut sugar and wheat out of her diet.
"The restriction has seemed to balance my hormones and make me break out less before my menstrual cycle," she said.
Raes, whose grocery staples now include boiled eggs, spelt toast, sashimi and natural peanut butter, added that she no longer has to take Aldactone, which is often prescribed by doctors to treat high blood pressure and by dermatologists for hormonal acne.
Along with sorting out what treatment approach to take, women in their 30s and 40s can find the psychological component especially hard, since acne is not expected at their age.
"It drives me crazy because I didn't have acne as a teenager, but when I turned 39 it started and hasn't stopped," Lang said. "I feel very insecure about my looks when I have my acne flare-ups, which is a few times a month."
It helps to realize that those around you are not popularity-seeking teenagers looking to find fault, said Dr. Tracey Marks, an Atlanta psychiatrist and author.
"Your middle-aged peers may notice your skin problem, but they have so many other responsibilities and life issues that they are not likely to waste mental space ruminating about the sight of your face," she said.