"We don’t totally understand why, but new onset acne is a growing problem in adult women," explains New York City-based dermatologist Joshua Zeichner, MD. "It is thought to be due to a combination of hormonal fluctuations, environmental stress, and diet."
Virginia-based derm Lily Talakoub, MD highlights the "hormonal fluctuations" part of the problem, noting that women tend to start menopause at some point during their 40s. "When we are young our estrogen is high and protects our skin against acne, but the older we get, especially around menopausal years, the progesterone is higher than the estrogen, and that causes painful cystic adult acne," she explains. "It’s awful, and hard to get rid of. Most topical medications don’t help."
There's no "one size fits" all answer as to what acne looks like, and that extends into acne at 40. But what sorts of symptoms can you look out for? "It can appear mostly along the jawline, as large red or pink inflammatory bumps on the cheeks, small fine whitish bumps on forehead and cheeks and around nose and mouth, or as very oily skin causing breakouts," says Nava Greenfield, MD at Schweiger Dermatology Group in NYC. But each of these different types of pimples may be caused by a different culprit.
Even so, there are ways to deal with acne at 40—some of which are totally different than the ones you relied on in high school. Here, derms explain what might be causing acne at 40, and what you can do to treat it.
Causes of acne at 40
1. It all comes back to hormones: Like I said, acne—especially hormonal acne—isn't just a puberty problem, which is why you may see bumps on the "hormone belt" at some point. "Most commonly, as we age, our estrogen goes down and progesterone increases. This causes deep cystic bumps along the chin and jaw," explains Dr. Talakoub. So what can you do to treat it? "Usually oral medication is needed," she explains. "But cutting down soy and dairy in the diet will help. Increasing a supplement called saw palmetto also helps regulate the hormones like progesterone that increase oil production and cause acne."
2. Consider your makeup and hair products: No matter how old you are, the products you're putting on your skin will ultimately effect your skin (well, duh). But these type of pimples, says Dr. Lily, will look totally different than the hormonal ones. "Acne due to clogging hair serums or makeup will form as small white bumps under the skin," she explains, which is why it's important to pay attention to any changes on your skin whenever you're changing up your routine. "Avoiding hair serums and primers with silicone will help," she says, but notes that if it doesn't improve when you swap your products, a dermatologist may need to give you an oral medication.
3. Pay attention to bacteria: Bacteria and breakouts go together like peanut butter and jelly (though admittedly far less appealing). As most of us know, if you don't wash your face of dirt and grime, you'll probably end up with a pimple or two, regardless of how old you are. Be sure to remove your makeup with something like a micellar water, cleansing oil, or good old-fashioned makeup remover, and cleanse, exfoliate, and moisturize regularly.
How to treat acne at 40
Regardless of the cause behind acne at 40, there are certain derm-approved topical ingredients that can help treat the symptoms, most of which you've seen in your products since back in the days when your first ever pimples popped up. "There are many treatment options for acne," says Dr. Greenfield. "Spironolactone is great for hormonal acne. Retinoids work well for many types of acne. Antibiotics treat inflammatory acne well. Isotretinoin can help in severe cases." Plus, she says, a good face wash and moisturizer can go a long way in treating acne as well. A few others that derms swear by follow.
1. Bring on the benzoyl peroxide: An acne-zapping favorite at any age, Benzoyl peroxide kills acne-causing bacteria on the skin, which subsequently reduces inflammation. Dr. Zeichner recommends the Neutrogena Rapid Clear Stubborn Acne Daily Leave-On Mask ($12) for an effective, acne-clearing dose of BP.
2. Slather on salicylic acid: Another acne-clearing, oldie-but-goodie, salicylic acid is a chemical exfoliant that helps remove excess oil and exfoliate the dead cells from the surface of the skin. "Salicylic acid is a common ingredient used in acne control cleansers: Think of a cleanser really have a short contact therapy," says Dr. Zeichner, who's a fan of the Aveeno Clear Complexion Foaming Cleanser ($6). "It should be applied to the skin and allowed to sit while you sing the alphabet to ensure enough contact time before rinsing off." Salicylic acid is also one of the best ingredients you can look for in moisturizer for acneic skin, because, yes, you should be using moisturizer if you've got acne.
3. Try topical retinoids: Retinol is basically the holy grail of aiding with skin concerns, and acne at 40 is no exception. "Topical retinoids are vitamin A medications that help reduce inflammation in the skin and prevent cells from sticking together within the pores," says Dr. Zeichner. "They also have the advantage of stimulating collagen, making them an attractive option for adult women." While there are a number of different options for topical retinoids on the market (both prescription and OTC-strength), the FDA just approved a new prescription-strength tretinoin (a form of retinoid) lotion called Alterno, which delivers the same effectiveness as regular tretinoin, but in a formulation that can be handled by sensitive skin. It has been specifically studied and shown to be effective in adult women with acne, says Dr. Zeichner.
4. Tweak your diet: Sugar and dairy have been known to spike cortisol, which can ultimately show itself on your skin. Try as best you can to cut these nutrients from your diet in order to help stave off zits that are being caused by hormones (AKA those cystic suckers on your chin and jawline)
5. Wash your towels: Random fact, but dirty towels happen to be packed with bacteria, and that's not exactly great for your skin (because, ya know, bacteria causes acne). If you're using the same towel over and over (and over and over) again to dry your face after you wash it, that could be why your breakouts aren't going away. Make sure you're swapping your towels after every few uses, or take a cue from K-Beauty and let your skin air-dry instead of wiping it with a towel.
6. Talk to your derm: If figuring things out on your own doesn't seem to be working, it may be time to seek professional help. Head to the dermatologist, who will be able to help you find the root behind your breakouts.
And one thing to keep in mind, when looking into treatments: “Everyone’s genetic makeup is a little bit different, which helps explain why people develop different types of acne, and people are susceptible to break out from different aggravating factors,” says Dr. Zeichner. “Genetics may also explain why certain treatments are more effective on one person than another.”
Acne can be a bummer, but it really, really doesn't have to be. Here's how one editor learned to accept her acne as a part of life. And if you can't figure out where the heck your zits are coming from, here's how to use "face mapping" as a way to tell.
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