So you thought your teenage years of waking up before homeroom with a huge zit were over? That’s not the case for thousands of women suffering from adult female acne, which can affect woman ages 20 to 60.
According to experts, women over 40 have different needs in acne treatment because other medical conditions may influence the treatment regimen. For example, women with a history of breast cancer may not be a candidate for anti-hormonal medications. Additionally, women over 40 may not be candidates for taking oral hormonal contraception, which tends to work well for acne.
This article takes a look at the best acne treatments for women over 40. We’ve gathered input from Board Certified Dermatologists, as well as a Board Certified Plastic surgeon, who provide their expertise for women suffering from adult acne. Our experts cover a range of sub-topics, including the causes of acne in women over 40 and the best treatments – as well as how acne in this age group can affect their self-esteem.
Keep in mind that this article is not intended as medical advice. Before you try any of the methods mentioned in this article, talk to your medical provider, or a Board Certified Dermatologist, first.
Typically, acne in women over 40 is hormonal in nature.
As we age, our hormones fluctuate, and particularly in women, the changes in estrogen and progesterone levels can lead to acne, and the ratio of estrogen to progesterone can also cause fluctuations in testosterone which women also have that may cause acne, explained Dr. Matthew J. Elias, a Board Certified Dermatologist at Elias Dermatology, which has locations in Fort Lauderdale and Pembroke Pines in Florida.
Dr. Elias added that typically, hormonal acne can be found around the chin and jaw, “but it can also occur in other areas of the face and neck, too.”
Dermatologists call this adult-onset acne, said Dr. Paul Yamauchi, Ph.D., a dermatologist in private practice at the Dermatology Institute and Skin Care Center in Santa Monica, California.
“It is more common in women than men, and especially in women who are starting or in menopause,” said Dr. Yamauchi, noting that fluctuating hormone levels will cause an imbalance that can lead to breakouts.
Women often experience fluctuating hormones around their periods, during pregnancy, perimenopause, and menopause, or after discontinuing or sometimes starting birth control pills, Dr. Yamauchi further explained.
“Checking hormone levels can identify whether the acne is hormonal or not,” said Dr. Yamauchi, adding that persistent acne around the jaw-line and chin can be indicative of hormonal imbalances.
Thousands of women suffer from adult female acne, which affects adult woman ages 20 to 60, said Dr. Lauren L. Levy, an acne specialist and Board Certified Dermatologist at Loucas Dermatology in New York City.
“Most adult female acne is hormonally mediated with large cystic lesions on the chin and jaw-line and is caused by increased androgen levels,” said Dr. Levy, further noting that there may be a monthly or cyclical pattern to the acne, with acne worse around the time of menstruation. “Acne may affect women who never had any blemish or pimples when they were younger, which is often very frustrating for the patients.”
Stress is a common trigger for acne, according to Dr. Yamauchi, who noted that researchers have found a relationship between stress and acne flare-ups.
“In response to stress, our bodies produce more of a type of hormone called androgens,” Dr. Yamauchi explained. “These hormones stimulate the oil glands and hair follicles in the skin which clogs the pores and lead to acne. This explains why acne can be an ongoing problem when we find ourselves under constant stress.”
Additional Contributing Factors to Adult Acne
Research studies have suggested that some people may have a genetic predisposition for acne, Dr. Yamauchi noted. For instance, “a close blood relative, such as a parent, brother, or sister who have adult-onset may indicate a predisposition for an adult woman to get acne.”
Skin and Hair Care Products
Skin and hair care products may contain ingredients that cause a woman to break out.
Therefore, “make sure that you see one of the following terms on every container that says non-comedogenic, non-acnegenic, oil-free, won’t clog pores,” Dr. Yamauchi advised. “You want to make sure your moisturizer, cleanser, sunscreen, and all other products contain one of these terms. These products are least likely to cause acne.”
In some cases, acne is a side effect of certain medications.
“If you suspect that a medication is triggering your acne or making it worse, ask the doctor who prescribed it if acne is a side effect,” Dr. Yamauchi said. “If so, inquire if you can take a different medicine. If this is not possible, see a dermatologist who can help you control the acne.”
Underlying Medical Condition
Sometimes, acne is a sign of an underlying medical condition, Dr. Yamauchi added. “Once the medical condition is diagnosed and treated, the acne often clears.”
Affect of Adult Acne on Self-Esteem
Acne at any age can affect self-esteem leading to mood changes, stress, depression, difficulty with partners – and shamefulness with going to work with acne when not a teenager, Dr. Elias said.
Many women are very embarrassed about having acne as an adult, especially if they have careers that put them in the spotlight often, said Dr. Levy, who added that the acne lesions can also be painful.
“Adult females with acne often feel frustrated because they feel that they shouldn't have acne at their age and that it was only a problem of teenagers,” Dr. Levy said.
Acne is often thought of an “adolescent” issue, noted Dr. Geoffrey Trenkle, an otolaryngologist and Board Certified Facial Plastic Surgeon at the Los Angeles Center for Cosmetic Surgery.
“Acne is often looked over as a cosmetic, trivial issue, but it can cause deep emotional and social stressors on any individual – especially someone who feels like what they are suffering from is abnormal or something they should be ashamed of,” Dr. Trenkle said. “Acne can make women feel depressed, angry, anxious, lower their self-esteem and cause them to become socially withdrawn.”
According to Dr. Yamauchi, adult women with acne have said that their skin makes them feel unattractive, embarrassed, or self-conscious.
“They complain they didn’t have acne when they were a teenager – why now when I’m over 40?” Dr. Yamauchi said. “Depression, anxiety, low self-esteem, poor self-image, decreased quality of life, and a feeling of being all alone are some of the common feelings women report when they get acne. This can impact their social life, work, and their relationship with their significant other. When the acne improves, their self-esteem improves.”
Best Acne Treatments for Women Over 40
The severity of the acne determines the treatment. For instance, milder cases usually respond to topical therapy; while moderate to severe acne frequently are treated with pills, Dr. Yamauchi said.
“Often times, combination therapy is done, such as topical plus oral therapy, as well as procedures done to the skin,” he said. “Your doctor will provide you with best advice on what you can do and not do.”
Topical therapy is the most common treatment for acne, according to Dr. Yamauchi, who noted that these include retinoids (Retin-A), benzoyl peroxide and clindamycin.
“Topical agents unclog the pores, exfoliate the skin, reduce sebum production, and kill the bacteria that cause acne,” Dr. Yamauchi explained.
He further noted that topical agents can cause dryness of skin, especially if your skin is sensitive. “If that’s the case, then using them less often can minimize dryness,” advised Dr. Yamauchi, adding that it’s okay to put moisturizer on your skin after applying a topical agent.
Women who use retinoids should know that they can make your skin more sensitive to the sun; therefore, “wearing sunscreen is important if your doctor prescribes you something like Retin-A,” he said.
In Dr. Levy’s experience, topical retinoids are “the mainstay” of acne treatment, because they reduce the development of new lesions and prevent the development of comedones. In other benefits, retinoids help with cellular turn over, reduce pigmentary changes (dark spots left by acne), and build collagen over time.
“There are numerous different topical retinoids of varying strengths and formulations, so discussion with your physician is important,” Dr. Levy advised. “A major benefit of retinoids for acne in older women is the fact that they also have the added benefit of preventing fine lines and wrinkles and building collagen, so they should be part of every woman's routine.”
With consistent daily use, there is a noticeable difference in outbreaks at 8 to12 weeks.
Women with eczema or sensitive skin “may need to slowly use the retinoid to allow time for your skin to get used to the medication,” Dr. Levy added. “I recommend starting with a lower strength retinoid and working up to a higher strength. Retinoids also should not be used in those who are pregnant or trying to conceive.”
In Dr. Yamauchi’s experience, oral therapy is commonly recommended if topical therapy alone is not sufficient. These include oral antibiotics such as doxycycline or minocycline.
He noted that doxycycline can make you more sensitive to the sun, “and some people get nauseous from it;” while minocycline has an uncommon side effect of dizziness, “and a bad headache.” Also, “antibiotics can cause yeast infections in the vaginal area.”
Dr. Levy added that oral antibiotics can be used for a short period of time to calm down acne, “but is not recommended as a long term treatment option.”
There also is an androgen hormone blocker called spironolactone that is commonly recommended by dermatologists. “This is commonly used for adult acne to counteract the androgens that cause a woman to break out,” Dr. Yamauchi said.
Spironolactone (Aldactone) is an oral medication used to treat high blood pressure (hypertension), but also blocks the androgen receptor and inhibits an important enzyme in the testosterone pathway, Dr. Levy explained.
“This medication works very well for adult females with acne on the chin and jaw-line (i.e. hormonal acne) that is not improving with other methods and acne that is worse around the menstrual cycle,” said Dr. Levy, adding that “it has been a major game changer for all of my adult female patients.”
Most patients usually notice an effect in 8 to 12 weeks, she said, but dosage titration may need to occur (i.e. increasing the dose slowly) to get to the beneficial dosage. “There is a noticeable reduction in outbreaks with the medication.”
Given the fact it is a blood pressure medication, headaches, dizziness, or fatigue may occur, as well as increased potassium levels, Dr. Levy warned. Additionally, irregular periods and breast tenderness are also reported side-effects.
“Adults on this medication may be asked to check their potassium level and kidney function and need to avoid overeating high potassium foods – such as bananas, oranges, avocado, coconut water, and sweet potato,” Dr. Levy advised.
Certain medications (diuretics) may also interact with this medication; therefore “those trying to conceive should also avoid this medication,” she said. “The medication can decrease breast milk supply so those who are breastfeeding should also not use the medication.”
For more advanced cases of acne that leads to scarring, isotretinoin controls cystic acne.
“However, this pill causes birth defects,” Dr. Yamauchi warned, “and routine monthly monitoring is required.”
Isotretinoin “is very effective,” Dr. Yamauchi added, “but requires blood testing monthly for pregnancy as well as checking your liver and cholesterol level since it can increase.”
Procedures performed by a Board Certified Dermatologist are commonly done to treat acne.
“One trick is to come to the dermatologist’s office to have an inflamed pimple such as a cyst injected with a drop of cortisone,” said Dr. Yamauchi, who explained that frequently a cyst can form a knot or result in scarring.
“Injecting cortisone will knock down the inflammation quickly get rid of the pimple,” he noted. “Occasionally small divot can occur at the site of injection, but goes away.”
Additionally, many women get facial treatments from an esthetician at the dermatologist’s office. “These treatments will also unclog the pores and make your acne better,” he said.
Sulfa Washes and Chemical Peels
Many adult female patients are concerned to take oral medications because of side effects and prefer to go the topical route, such as sulfa washes and chemical peels.
“In addition to a topical retinoid, the use of topical anti-inflammatory like topical dapsone (aczone) and topical sulfur washes can really be beneficial,” Dr. Levy advised.
Chemical peels can also help with acne, fine lines, and dyspigmentation, and therefore women with acne may benefit their overall skin tone and texture from chemical peels. These usually work within days to weeks after the peel, but repeat treatments are often necessary.
As far as potential side effects are concerned, she warned that these treatments may cause dryness and irritation. Additionally, with chemical peels, “the skin may be red and scaly for a few days after the peel and the sun should be avoided.”
Dr. Levy added that people who have a history of cold sores (herpes virus) should alert their provider before getting a peel.
Additional Tips for Women Over 40 with Acne
If an underlying cause is making a woman breakout – such as a skin care product or a certain medication – once this cause is identified and eliminated, the acne should improve with or without treatment, Dr. Yamauchi said.
“Also, minimizing stress can lead to an improvement of acne – yoga, meditation, exercising, or seeing a counselor may help,” he advised.
Some all-natural treatments may be helpful, Dr. Levy noted, such as taking vitamins and minerals like zinc and niacinamide, which will have an anti-inflammatory effect. Additionally, “a low glycemic-index diet also has shown evidence to help with acne.”
In other advice, Dr. Yamauchi warned against picking on your acne.
“It is human temptation to pick things off the skin…doing so will lead to scarring and worsening of the acne,” he said. “Changing your diet such as cutting out sweets can help your acne. However, everyone is different, so if you notice a certain food that makes your acne worse, then avoid or minimize eating it.”
In Dr. Levy’s experience as an acne specialist, “most of my patients are so embarrassed and feel as if they are the only ones suffering from this problem. But I want you to know and be aware that it is quite a common condition and is treatable, so speak to your Board Certified Dermatologist.”
At a time when women over 40 are learning to accept the aging process, “it almost seems backward to consider that they need to deal with issues that they had to deal with when they were in their teenage years,” Dr. Trenkle said.
“Women do not feel like they can discuss the issues of breakouts with their friends because those friends are figuring out how to navigate through the world of sagging skin, age spots and crow’s feet,” Dr. Trenkle noted.
His advice to women is this:
“Treat your body right, treat your skin right, get rest, drink plenty of water,” Dr. Trenkle recommended. “If your acne seems like it is out of control, seek help and do not be ashamed. Plenty of women are suffering from the same. The options are available to you, and trying to pick, hide and stress yourself out over acne will only make it worse.”
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