Say acne and many people think of bumpy-complexioned teens — but a surprising 26% of women in their 40s and 15% in their 50s report pimple problems, according to a University of Alabama survey. And in fact, even seniors can suffer from acne. Good news: There are new treatments for this often-chronic condition — so if you gave up years ago because nothing helped, it’s time to see your dermatologist.

Who gets adult acne? Just about anyone can, said dermatologist Bethanee J. Schlosser, MD, PhD, director of the Women’s Skin Health Program at Northwestern University Feinberg School of Medicine. “This disease doesn’t discriminate. Acne that develops earlier in life can continue through the adult years or recur after years of clear skin… or it can appear for the first time in mature adulthood,” she said.

Factors that commonly contribute to acne…

A hormonal imbalance often occurs in midlife when estrogen levels drop, leaving a relative overabundance of androgen hormones such as testosterone. Acne is a hormone-sensitive condition (which is why it often first appears during the hormonal upheaval of puberty). Middle-aged women may experience increased activity of or sensitivity to androgens even when blood levels of these hormones are normal, Dr. Schlosser noted.

Bacteria can proliferate on skin and lead to inflammation, particularly when the sebaceous glands’ production of sebum (oil) — a process controlled by hormones — is excessive, resulting in blocked pores.

Abnormal maturation of cells allows dead skin cells to stick together and clog pores.

What helps? For starters, try a high-fiber, low-glycemic-load diet…

You may remember being told as a teen that chocolate and pizza could bring on pimples — but, in fact, studies have not revealed any specific food triggers for acne. However: Recent research has found that acne is more common in people whose diets have a high glycemic load — which basically means that they eat a lot of low-fiber foods that cause blood sugar and insulin levels to spike.

Acne may improve when a high-fiber, low-glycemic-load diet is adopted, Dr. Schlosser said. Glycemic load is a calculation based on a food’s glycemic index. To see which foods have a potentially pimple-fighting low glycemic index, visit the University of Sydney Web page at www.GlycemicIndex.com.

Topical treatments, used alone or in combination, clear up many cases of midlife acne…

Nonprescription three-step systems make it easy to follow a consistent regimen and can be helpful for midlife patients with mild acne and as an initial treatment option, Dr. Schlosser said. These systems can be used alone or along with prescription treatments (see below). Options: MaxClarity Foam includes a cleanser with antibacterial benzoyl peroxide that is micronized into tiny particles to penetrate pores, a leave-on benzoyl peroxide foam and nighttime toner with exfoliating salicylic acid to get rid of dead cells… Proactiv has an antibacterial cleanser, toner with exfoliating glycolic acid and a leave-on benzoyl peroxide lotion.

Prescription topical retinoids are vitamin A derivatives in cream, gel or liquid form that help prevent clogged pores by normalizing cell maturation. Options include tretinoin (Retin-A), adapalene (Differin) and tazarotene (Tazorac). When starting treatment, acne may look worse at first, but most patients notice improvement after four weeks of regular use
— so Dr. Schlosser generally recommends that patients who try retinoids continue for at least 10 to 12 weeks. New option: A gel called Epiduo, which combines adapalene with bacteria-killing benzoyl peroxide, can simplify treatment since you have to apply only one product.

Prescription topical antibiotics, such as clindamycin (Cleocin-T), erythromycin (E-Mycin) and sulfacetamide sodium(Klaron), have antimicrobial and anti-inflammatory effects. Also ask your dermatologist about medications that combine an antibiotic with benzoyl peroxide (such as Benzaclin, Duac and the newest option Acanya), which help reduce the risk for antibiotic resistance.

Oral medications may help if topical approaches alone are not sufficient…

Oral tetracycline antibiotics, such as doxycycline or minocycline, have long been used to treat acne — but there also are newer formulations that minimize side effects and/or maintain a more even level of medication in the bloodstream. Ask your doctor about…

  • Solodyn, extended-release minocycline taken once daily. Your doctor can determine which of its eight strengths provides the lowest effective dose for you.
  • Doryx, doxycycline with an enteric coating that reduces risk for gastrointestinal upset.
  • Oracea, extended-release doxycycline that is subantimicrobial — meaning it works not by killing bacteria but rather by combating inflammation, so it minimizes antibiotic resistance risk.

Birth control pills help correct hormonal imbalances because their estrogen and progestin offset the effects of excess androgens. Three brands are FDA-approved for treating acne — Ortho Tri-Cyclen, Estrostep and Yaz — though even brands that are not specifically approved for that purpose can help clear the complexion, Dr. Schlosser said. Oral contraceptives are not appropriate for women who have high blood pressure, liver problems or a history of blood clots or stroke… or for smokers over age 35.

Antiandrogen medication also helps women whose acne results from a hormonal imbalance. Spironolactone (Aldactone) and similar drugs work by keeping testosterone from binding to receptors on follicles and sebaceous glands. It should not be used by women who have kidney problems or who are pregnant or trying to conceive.

Your dermatologist can help you sort through all these options to find what’s best for you — but the bottom line is, you no longer have to simply suffer with adult acne!