Hello Dr. Bailey,
I’m impressed by your blog. I’m just finishing my last year of emergency medicine residency training and recently moved from Chicago to Charleston SC.
I’ve always had acne-prone skin with mild acne as a teenager and then bouts of breakouts as an adult. I just turned 40, Charleston is hot and humid…and my skin is going crazy. Mostly the problem is on my chin, and a little around the nose/t-zone. I have excellent hygiene practices, rarely use foundation, use a zinc/titanium sunblock (as I have had issues with chemical sunblocks) but nothing about my skin care, other than my move, has changed.
I’m guessing that the acne might be a combination of several years of bad eating, the heat and the humidity and hormonal changes involved in turning 40 but I really don’t know. Here’s what I’ve been doing to try to clear up my acne flare: I’ve recently purchased a Clarisonic and have used it for 2 weeks. I believe it is helping a little and I love it either way. I’ve started slowly re-introducing Retin-a to my skin care routine to treat the acne, but I’ve noticed it makes my skin peel. I don’t mind that too much except that my make-up/concealer looks horrible over peeling skin. I try to exfoliate but by the end of the day my blemishes look cracked and peeled. It is embarrassing but I feel like I need to cover them.
My questions: First: do you recommend the Acne Treatment Kit or the Anti-Aging Skin Care Kit? Second: what make-up do you recommend for acne-prone skin that peels a bit from my regimen?
Your story is similar to that of so many women who continue to struggle with acne beyond the teen years. The challenge is that your skin’s needs change with each decade. Most traditional acne products are designed to fit teen skin needs and the most common form of acne called acne vulgaris. Traditional acne treatment products don’t always accommodate your skin after adolescence, which is why the skin care routine I use is often different than the routine for teen acne.
What’s my usual approach to treating an adult woman with acne?
It’s a 5-step process that ranges from confirmation of the diagnosis to treatment and then observation. Here is my approach broken into steps:
Step 1: I always start by trying to determine if the pimples are due to the most common form of acne called acne vulgaris.
There are other reasons to have pimples and the treatments are different.
Here is a post I wrote that summarizes the most common reasons for acne other than acne vulgaris: Reasons Why Your Acne Treatment Might Not Be Working
Another important skin problem to consider based on the acne being on your chin and around your nose is perioral dermatitis (it’s not always limited to the perioral skin around the mouth, its name is a misnomer). Click here to read a post that describes perioral dermatitis.
Step 2: I almost always treat the pityrosporum yeast because it often plays some role.
Here is a 2-part series I wrote explaining pityrosporum folliculitis, the type of acne caused by this yeast. The bottom line is that I add Calming Zinc soap once a day to the skin care routine. I have patients use it without the Clarisonic at first since the medicine in the soap can be drying for some people.
Step 3: I create a comprehensive skin care routine to treat the causes and consequences of adult acne.
Usually I employ Retin A (tretinoin). It’s my favorite adult acne treatment because it:
- helps lighten and get rid of acne scars.
- helps keep pores clean.
- is a great acne treatment medicine.
- is the best anti aging cream to treat wrinkles.
I also use only tretinoin cream since it has more anti-aging benefits than the other tretinoin and retinoid products. I double check to be certain that my patient is using the product correctly too, as there are some tricks to minimizing irritation. Click here to see my tips and instructions for tretinoin.
If there is still skin peeling from tretinoin usage, then treatment options include:
- Prescribing a lower strength
- Backing down on how often the cream is applied; meaning: instead of nightly we back down to to once or twice a week. Once the skin is tolerating that application schedule, we slowly move up as the skin tolerates.
- Taking away other products that can be potential irritants like cleansers and acne medicines. Often this means washing with Toleriane and Calming zinc only.
If, for some reason, a patient can’t use tretinoin then I use my Glycolic Acid Skin Care Kit For Oily Skin, which also helps to keep pores clean to fight acne. It also lightens marks from acne and is great anti-aging skin care.
My skin care regimen usually also includes Green Tea Antioxidant Skin Therapy twice a day right after washing to hydrate skin without oils. It also helps to ease the redness and inflammation of acne and allow skin to better tolerate tretinoin usage.
Step 4: I often also try to add one more acne fighting medicine for p. acnes bacteria. Options include either a benzoyl peroxide (which can be a spot treatment) or Cleocin Lotion twice a day. The Cleocin is a safer bet when there is a history of peeling and skin irritation.
I make sure all the other products used in the skin care routine are non-irritating and oil free. Some of my favorites are:
Daily Moisturizing Face Cream for Normal to Oily Skin to help balance skin moisture on those areas of the face that are drier.
EltaMD Clear SPF Sunscreen or one of the other oil-free sunscreens that I use in my practice (click here for my comparison chart to find the oil free sunscreen that fits your product preferences and budget). Sun protection is important because of the tretinoin use, which increases sun sensitivity, and to help prevent red and brown scars following acne breakouts. It’s also a key anti-aging skin care step in any complete anti-aging skin care routine.
My Mineral Makeup Pressed Minerals Powder is the perfect makeup for adult acne because it’s oil free and covers beautifully.
A complete skin care routine might look like this:
- Cleanse with the appropriate facial cleanser, possibly using the Clarisonic Brush.
- Apply Green Tea Antioxidant Skin Therapy.
- Apply additional acne treatment such as Glytone exfoliation lotion, benzoyl peroxide lotion, or Cleocin lotion.
- Apply daily face cream where there is skin dryness.
- Apply sunscreen.
- Apply makeup if desired.
- Wash with Calming Zinc and Clarisonic, if tolerated.
- Apply Green Tea Antioxidant Skin Therapy.
- Apply Cleocin, if using.
- Wait 15 minutes or more, and then apply tretinoin cream as tolerated.
Step 5: I give it time to work before changing things around.
We give it about 2 months before deciding if we are on the right track. Acne improves slowly so we need to give the skin care routine time. If I’m not entirely satisfied with the skin clearing then I may consider other additional diagnosis that can cause facial pimples such as the presence of:
- Demodex mite overgrowth
- Staph aureus super-infection of the pimples
- a gram negative infection
Thanks for sending in a great question about a tough complexion problem. I hope that my answer helps give you some additional new ideas on how I approach an adult patient with pimples in my dermatology practice.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.