By Natalia Spierings - Consultant Dermatologist at Kings College Hospital London in Dubai
‘I feel like a teenager again.’
This is one of the most frequent things I hear from my female patients. It is a cruel fact of life for many women that, after achieving so much in their 30’s (career/children/family/self-confidence), suddenly skin becomes an issue. Again. And most women find the prospect of using the same over-the-counter acne treatments (like those benzoyl peroxide-soaked pads – remember those?) that they used as teenagers simply unacceptable; they didn’t work then so why would they work now? Plus, surely your skin is different now then it was when you were a teen?
Yes and no. What can you do if you are faced with pimples again in your 40s?
The first step is definitely to see a consultant or board-certified dermatologist. This is not the time to attempt a DIY job at your local chemist or even at the hands of a well-meaning beautician. You are older and wiser and it is time to manage your adult acne effectively and efficiently.
The first thing I do with my patients is to take a look at their skincare and then basically tell them to stop using it all of it except the absolute ‘essentials’ – which for most is a basic non-foaming cleanser to remove makeup (I like an oil or balm cleanser), a greasy moisturiser at night (my go-to is Vaseline but anything without ‘water/aqua’ in the ingredients list will do – and no, it will not clog you pores!) and for most a sunscreen in the daytime.
And then we add in the treatments. The gold standard topical treatment for acne is a topical retinoid – and the one you should get your hands on is generally on prescription only and is called tretinoin. Don’t waste your time with cosmetic ‘retinol’ products – they are expensive and ineffective. If you can’t afford to see a dermatologist for a script, there are some great online prescription services that provide tretinoin for around £20 per month. Start with 0.025% and use it nightly. The worst thing that can happen is that you get a bit of redness and dryness initially but just stick with it. It will get better.
Bonus: topical retinoids are also the gold-standard to improve the appearance of fine lines so definitely dab it around your eyes as well as your entire face.
The next step is, for most women, an oral medicine. Anti-androgen tablets like spironolactone work brilliantly for some women and don’t affect hormone levels so won’t interfere with HRT. I still use oral antibiotics for some of my perimenopausal acne patients and this can be combined with spironolactone and a topical treatment to optimise efficacy.
Finally, we have oral isotretinoin (Roaccutane or Accutane). This is an oral vitamin A derivative and is the most effective and efficient way to clear acne and, for many, keep it away permanently. It works mainly by shrinking the oil glands in the skin (so can reduce pore size and get rid of shiny skin for good). The most important side effect is that it causes birth defects so you can’t get pregnant while taking it. Patients are often concerned that oral isotretinoin will dry out their skin and cause them to look older. This does not happen, partially because the dose I use in this patient population is low (I go low and slow – the dryness is dose-dependent) but also because the dryness mainly impacts the mucous membranes (like lips).
Bottom line is this: no one should have acne, especially not a woman in her 40’s who already has enough life stuff to deal with. If you find your skin is taking you back to high school, see a knowledgeable dermatologist who has an arsenal of sophisticated tools in her toolbox to get you back to clear skin faster than you can say ‘I need a date for the pro'.