There are some things we may miss about our teenage years—say, the ability to stay up till all hours and then sleep till noon. One thing that's not on our nostalgia lists? A sprinkling of pimples on our faces. But it turns out that many of us are noticing blemishes at the same time we're encountering wrinkles.
A 2012 study published in the Journal of Women's Health found that acne affects nearly half of all women ages 21 to 30, a quarter of women ages 31 to 40, and 12% of women ages 41 to 50. No matter how old we are, pimples usually form in the same time-honored way: Pores—which contain oil glands—become blocked, letting dirt, bacteria, and cells build up and form a plug.
Why it happens
For most women, hormonal changes, either around the monthly cycle or during a menopausal shift, are the culprit. But dietary imbalances and stress also cause flare-ups. "Acne in adults is like a whistle blow. Often it's a sign that something else not quite right is going on," says Michael Murray, ND, a naturopath and coauthor of The Encyclopedia of Natural Medicine.
For most women, hormonal changes, either around the monthly cycle or during a menopausal shift, are the culprit. But dietary imbalances and stress also cause flare-ups. "Acne in adults is like a whistle blow. Often it's a sign that something else not quite right is going on," says Michael Murray, ND, a naturopath and coauthor of The Encyclopedia of Natural Medicine.
Here, a range of solutions for sufferers.
"Eating chocolate or a lot of junk food doesn't by itself seem to cause acne, but not having a balanced diet and eating too many refined carbs can cause problems," says Albert Lefkovits, MD, director of the Park Avenue Center for Advanced Medical and Cosmetic Dermatology in New York City. In a 2007 study, Australian researchers found that people who followed a low-glycemic index (GI) diet (which is low in refined carbohydrates like those found in white bread) had a 22% decrease in acne lesions, compared with a control group that ate more high-GI foods. Scientists suspect that raised insulin levels from the carbs may trigger a release of hormones that inflame follicles and increase oil production.
A 2006 Harvard study found that girls who drank two or more glasses of milk daily had about a 20% higher risk of acne than those who had less than a glass a week. Studies published last year and in 2008 suggested that fat-free milk in particular, which is higher in sugar than whole milk, might be a culprit. (Another hypothesis is that hormones in dairy products play a role.) If you regularly drink fat-free, consider switching to 1% milk or nondairy nut milks (look for those that have fewer than 10 g of sugar per serving).
These powerful rays penetrate follicles to kill off acne-causing bacteria. For severe cases, photodynamic therapy adds a topical solution called Levulan to blue light therapy. Note that these treatments can cause temporary redness and may not be covered by insurance. Dermatologists' fees start at about $250 per session for blue light therapy and $800 for photodynamic therapy.
Long used to treat high blood pressure, prescription Aldactone (spironolactone) is now getting a second life as a treatment for hormonal acne. The drug (a tablet taken orally) blocks receptors of the hormone androgen, helping to limit the testosterone surges that can prompt pimples.
Less irritating than its chemical cousin benzoyl peroxide, tea tree oil has a long history of fighting mild to moderate acne outbreaks. The oil, which comes from the leaves of a tree native to Australia, has antiseptic properties that help reduce acne-causing bacteria on the skin and quell inflammation in skin cells. "We've seen it work against a wide range of organisms, including 27 of the 32 strains of acne-causing bacteria," says Murray. (Tea tree oil has even been shown to help fight yeast infections.) Multiple studies, including a review last year in theInternational Journal of Dermatology, back the plant's power. You can find tea tree oil in a wide variety of soaps, skin washes, and topical solutions. Look for a minimum concentration of 5% of the oil (up to 15% for more severe acne).
Some doctors suspect that sodium has consequences for skin, because the iodine frequently found in table salt and some seafood may worsen acne breakouts. Stick to low-sodium versions of packaged foods, and try to keep your overall salt consumption below 1,500 mg a day.
"Stress doesn't create skin disease on its own, but it can make any existing issues worse," says Beth McLellan, MD, a dermatologist at NYU Langone's Joan H. Tisch Center for Women's Health in New York City. Researchers haven't established just why stomach-churning anxiety creates skin blemishes, but they point the finger at stress hormones such as cortisol for increasing inflammation levels in the body and stimulating oil glands. In any case, managing stress through exercise, meditation, or whatever method helps calm your nerves may also calm your skin.
For mild to moderate acne, dermatologists often suggest a cleanser with bacteria-killing benzoyl peroxide (to minimize irritation, try 10% strength), along with a prescription topical antimicrobial such as clindamycin or erythromycin. Stronger cases may call for prescription retinoids (such as Retin-A or Tazorac), which "are really the standard of care for most acne therapy," says Joshua Zeichner, MD, a dermatologist at Mount Sinai Medical Center in New York City. Newer drugs, such as Epiduo and Ziana, combine retinoids with antibacterials and may be more effective than separate products. Because retinoids also have antiwrinkle properties (they help stimulate collagen production), they can be especially beneficial for adult acne sufferers.
Oral contraceptives can help normalize hormonal surges and regulate monthly cycles so that oil glands don't go into overdrive, says Zeichner. Doctors may prescribe one of four brands of birth control pills—Yaz, Beyaz, Estrostep, and Ortho Tri-Cyclen—that are FDA approved for treating acne. As always, patients taking oral contraceptives should be aware of potential risks, including blood clots.
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