Help! I’m Too Old for Acne

QandA3Question:  I’ve had acne since I was a teenager, but now  I’m  37  and its still a problem.  I wanted my doctor to give me Retin A, but she insisted that Differin would work better.  Its not covered by my heath plan and I can buy  Retin A online for a lot less.  Any advice?

Answer: Its sad but true  that acne can remain a problem long past high school.   Differin ( adapalene)  is actually the newest form of Retin A  ( aka  tretinoin).   This new kid on the block  has several advantages than its older cousins.  It is less irritating than traditional  Retin A, yet can be more effective  preventing   blocked-pores.  It also acts both to reduce inflammation and helps the skin shed old dead skin cells.  But what makes adapalene   an anti-acne rock star is its ability to get along well with  other acne fighters.  Both benzoyl peroxide which kills acne causing bacteria and clindamycin  which reduces  inflammation,   reduce effectiveness of  Retin A.  By contrast,  Differin ( adapalene)  works beautifully with other acne medications.  You can layer all three at night and  then use the benzoyl peroxide and clindamycin during the day.  To round out dynamic acne care, wash your face with an oil free cleanser like Neutrogena  Oil-Free Acne Wash   and  be sure to use an oil-free  physical sunscreen  such as  SkinCeuticals Physical Fusion UV Defense  SPF50 during the day.  Keep in mind that  Differin like the original Retin A  increases skin sensitivity.

This triple threat program is the current  gold standard for acne care and you should see  big improvements in 2-3 months. If  things  don’t get better, you probably have some form of hormonal acne  and will need hormonal therapy.   I agree that its outrageous that most  healthcare plans refuse to cover any form  of tretinoin  much past adolesence.  Retin A is now available in less expensive generic form while newer Differin is  still under patant. Despite the increase in costs,  I think your doctor  made a good call.

Question and Answer– Do I Need Another Doctor?

Question: My doctor says I have rosacea but when I checked online medical   photos,  my skin did not  look at all like those  pictures.  Should I get another doctor?

Answer:  There are  actually two parts to this question:

1) How accurate are online medical photos?

2) When should I get a second opinion?

Online medical photos can be pretty lurid.  When I was looking to illustrate my series on sensitive skin, I had to be careful to avoid scaring  small children.  Medical illustrations usually feature full blown  disease states.   Early stages or mild cases  often look very differrent.  It may be that you are comparing your  newly diagnosed rosacra with long term, wide spread rosacea– are fortunately your complexion issues are not as severe or advanced.

Try the suggested treatment for two weeks.  If there is no  improvement you have two options– go back  to the same MD and ask for a different approach or make an appointment  with a different dermatologist.

The decision to try another doctor is often rooted  more in  personality than performance.  We all need ( and deserve) medical professionals  who are accessible, and willing to explain to you what is  happening to your body and  how the treatments are designed to work.  You should feel comfortable asking questions– lots of them.  Once  you leave   the office, if you have questions or  new issues, your MD should get back to  you within a day.  

One final thought.  Many of us need to go to physicians on our health care plans and this may limit  choices.  While it does decrease options, there are still plenty of   professionals available.  I’ve always found that nurses are the best judge of a physicians’ skill levels.  Ask  nurses in your plan, not who they recommend, but who THEY actually go to for  skin care  issues.  I learned the approach when my oldest  daughter was born and I needed a new pediatrician.  Now she has two children of her own and its still   a great way to  find good doctors.

Universal Beauty Questions: Adult Acne

I have been getting   quite a few questions about  acne past the teeneage years.  Its not really surprising  since  up to 50% of women over  25  have acne  problems.   And  while its not an anti-aging issue, the whole point of  getting rid of  age spots   and wrinkles is to look better– and getting rid of  breakouts certainly falls  under that category.

Question 1: I am 45.  Can I use my daughter’s acne soaps and gels to control  my breakouts?

Probably not.  During the teenage years bacteria in the pores  are a  major driver of breakouts.   In moms, not so much.   Benzoyl peroxide, an ingredient found in many acne  cleansers and treatments products, works by attacking these bacteria, and is a go-to ingredient in  many  acne products aimed at teenagers. When you’re  in the fabulous forties, bacteria play a  much smaller role and Benzoyl Peroxide  is much less effective.   For mom acne, a better choice would be products with salicylic  acid.  This is a beta  hydroxy acid  that acts by helping  empty clogged pores.  No clogged pores= no pimples.  Neutrogena  makes a full line of acne products with salicylic acid.  Make sure the  treatment  product  you use  has at least 2% salicylic acid  to get  a real benefit.

Question 2: What is hormonal acne?

In truth  hormone levels  can  promote acne at any age, but in some women,  higher levels of  androgen, a male hormone,  can be  causing hard to treat acne.  If you have tried all the usual remedies of benzoyl peroxide, salicylic acid peels, LED light, diet and even Retin A and acne  still is  a problem, you  may well  have hormonal acne.  Best treatment is with  a series of birth control pills that contain both estrogen and progestin.  This combo works by  cutting down the androgen levels.  Two  well known brands  are Ortho Tri-Cyclen and Yaz.  I had this type of acne and had tried everything.  Finally my Dad who was a science writer  found a doctor  who specialized in this problem.  The hormone combo he prescribed  changed my life — and  I think that  using medical research  to deal with acne sparked   my interest in the science behind beauty care .

#1 Cause of Adult Acne

Many derms believe that   adult acne breakouts is powered by, wait for  it, three factors in  your diet.  While teenagers can blame hormones, bacteria in the pores and  increased oil production, nutritional  issues seem to be the  big trigger  over age 30.

1.  Dairy Products

There are few foods that seem as natural and  nutritious as milk.  Full of calcium  and protein, we are urged  from childhood to  have  2-3 servings of dairy  products a day.  However, along with all that protein and calcium, milk is also a source of androgen-like hormones.  Some are  naturally in a cow, but  most are the result of feeding the livestock  genetically altered hormones  in order to increse milk production. And androgen hormones are notorious acne triggers.  That’s the bad news.  The good news?  Organic dairy farmers do not feed their cows  hormones and their organic milk, cheese and butter are better choices fora beautiful skin.

2.  Iodine

Iodine  has long linked to acne problems.  In Japan,  seaweed is a major souce of iodine in the diet, but in the US  its in   our salt.   A bit of back story.  At the turn of the century, iodine  deficiency was two  causing serious health problems– goiters and  mental retardation,  in many  parts of the US.  As a  public health measure,  the governement began enhancing salt with iodine.  From a  health point of view, this move was a great success, but what those  doctors could not  have anticipated   was  our surge in salt consumption.  Most of this salt in in  processed foods, especially canned soups, processed meats and chips.   In fact one of the reasons that  foods like pizza and fries are linked to acne is the heavy salt content rather than the extra oil.  Best solution?  Take the salt shaker out of the shopping cart and  off the table.

3. High Glycemic Diet

Foods that stimulate a sharp increase in blood sugar levels also cause a steep rise in insulin levels– which in turn trigger a rise in acne -producing hormones.   Cookies, cake, candy, potatoes and white bread are well-known culprits.  Not as obvious are foods with  corn syrup including  condiments like ketchup, barbecue sauce  and A-1 steak sauce.  According to Park Avenue dermatologist  Dr Albert Lefkovits, eliminating these three hidden sources  of sugars can lead to a huge improvement in acne problems.

And no discussion of diet and acne can be complete without  mentioning chocolate.  For decades women report that eating chocolate can provoke acne  breakouts– yet controlled studies have consistently failed  to prove a real association.  But now experts like Dr Lefkovits are  suggesting  that is the hormones in the milk used in chocolate candy production that is the culprit and  not the chocolate itself.  Even better, dark chocolate or chocolate made with organic milk  can be enjoyed without acne problems.

Have  you found  that certain foods  can provoke breakouts?   What changes have  you made in your food choices that  made a difference?

Since breakouts over 30 are tiggered by different factors than in the teenage years, its not surprising that different treatments are needed to  control it.  Next week, I’ll post  what works, what doesn’t and how to  tell the difference.

#2 Cause of Adult Acne

Many derms believe that  make-up and skin care products are  key triggers for adult breakouts. Dubbed Acne Cosmetica, it is usually seen  around the mouth, chin and jaw line. There are three ways  that  an anti-aging product   can  cause teenage  problems:

1.   Too Rich in Oil–

It’s  probably not news  that heavy, oily beauty aids can block pores and  provoke problems. Some oils cause more problems than others.  Lanolin is at the top of the list, closely followed by cocoa butter, mineral oil,  coconut oil, and jojoba oil.  If you’ve  had frequent breakouts, best  bet would be to go oil-free.

2. Fragrance–

The perfume additives that are used to scent a product have a  long history of driving acne  eruptions.  They create inflammation and it’s this irritation  which leads to a series of events in the pores  that ends  with red bumps and whiteheads.  Easy solution?  Use  only fragrance-free beauty aids.

3. Inflammatory Ingredients–

Certain ingredients used  in the  formulation of a beauty product have been linked to breakouts.  These include isopropyl myristate( a thickener), ocityl palmitate ( another thickener) and propylene glycol( helps ingredients penetrate the skin)  More recently  certain  new  turbo-powered  sunscreens such  Helioplex  have been linked to acne.

Before you go blind trying to read  the label ingredients for every product, look for those beauty aids which state that they are ” noncomedegenic”.  This usually means that they have been tested for breakout potential and are formulated without the usual culprits.  In my case, I had switched from   a super gentle oil free moisturizer with a 30SPF to an uber 70SPF with Helioplex.  It was a good idea to go up in SPF, but in  my case not the right idea.

Have you seen your skin react to a skin care product?  Have you found using  oil-free, noncomedogenic or fragrance- free helpful.  What products or ingredients do you avoid?  And most of all I’d love  to hear recommendations of products that don’t cause  acne.

Coming Up– #1 cause of adult acne:

Adult Acne- How Unfair is That?

Its true I love to watch Glee  and relive my high school memories with better music– but  I’m way too old to deal with teenage style  breakouts.  Or am I?  I was trying out  a new  oil free cleanser and  sunscreen   that promised to reduce signs of aging.  Well,  the new combo  gave me pimples and I don’t  count  that as a youthful look.

I had  taken this photo to show a baseline  photo before a laser treatment.  When I saw  teenage- style pimples next to my wrinkles, I buried the photo  in the  “never use” pile, too embaressed to use it. How could I  put up a photo with  zits when I’m doing  a beauty blog that shows what works and what doesn’t.  But I get so many questions about  acne over 40, I realized that this is a topic that deserves a closer look.

According to  Dr Lefkovits, while acne begins in adolesence, it often persists  for decades.  In fact, about 50% of women over 25   have to deal with  breakouts.  Over age 40, about 25% of  us  have to deal with grey  hair AND  acne.  How unfair is that!  But  while the zits might look the same, the triggers  for breakouts  change over the  years–  and  the tried and true remedies for teenage acne  are not effective for adults.  So not only do  we need to  make different lifestyle changes to prevent acne,  we need different remedies to make our skin  smooth and clear.   It makes sense.  I don’t  have to study for SAT’s  and worry about the mean girls at lunch–   why shouldn’t my skin  care be different.


Can Milk Trigger Breakouts?

There are  undeniable benefits  being 50 plus. I don’t have to study for SAT’s,  I don’t have to endure “keggers” and I don’t have to pack school lunches–  so  why should  my aging face  have random breakouts?  I mean, if  I don’t  have the hormones to keep my skin  soft and firm why should the mirror  show inconvenient blemishes.

According to  my acne guru, Dr Albert Lefkovits, diet can play a big role in adult acne. And the big shocker   was the role  of milk and dairy products.  In a landmark study of 47,000 nurses, those that had more than three servings of milk a day had as much as 44% more acne than those that had less than one serving.

Researchers believe that its  not the milk per se that  is the problem but the hormones   that are given to the cattle to make them produce larger quantities of milk.  Those extra hormones can be enough  to trigger can eruptions, especially when you are over age 30.   But milk is the best source of calcium  which is essential for strong teeth and bones– and eliminating dairy products  is a bad  idea.  A better one?  According to Dr Lefkovits (, switch to organic milk and butter for hormone free dairy.

When looking at diet and acne, dairy is not the only bad actor.  Next week   we’ll look at the eye  opening connection between  sugar, acne and wrinkles.     There are alot of expensive  anti-aging options out there, but  changing you diet  can save  money as it improves  skin quality.  Have you found that certain foods  help or  hurt your complexion?