Face acne with resolve - no matter your age

It often strikes in the dead of night. You hit the sack, your skin all clean and clear. You wake up, and there's been an overnight visitor - an unwelcome one at that.

Call it a bump, a blemish or a zit. If you're 35, even 45, you're just as frustrated by your rebellious complexion as you were at 15.

Adult acne. It affects about 25 percent of men and more than 50 percent of women, according to Acne-resource.org, an Internet guide compiled by a maker of acne-care products. Among boomers, fluctuations in hormones seem to be the main culprit, regardless of gender. Poor diet, lack of exercise and, of course, stress can exacerbate the problem. Certainly, no one is immune to acne - no matter his or her age. Even celebrities like Jessica Simpson, who became the spokeswoman for the Proactiv Solution acne line, still give this sensitive subject a "face" - with blemishes - that consumers can relate to.

Besides hormonal changes, what can lead to adult acne? Can you effectively deal with it on your own? When should you see a doctor? How can it affect you emotionally? We talked to experts to get their insights.

The good news is, if you have acne, you can (no pun intended) face it and achieve positive results. "There is always a hormonal component to acne," regardless of gender, says Paula Begoun, the noted "Cosmetics Cop" and author of several skin-care and cosmetic guides. Her company, Paula's Choice, is based in Renton, Wash. "Women who experience breakouts later in life but were acne-free as teens or young adults may have early symptoms of menopause," she says via e-mail.

OK, so with hormones in mind, here's the medical "birth" of a blemish. This from Dr. Emil Tanghetti, head of the Center for Dermatology and Laser Surgery in Sacramento, Calif.: Hormones affect the sebaceous glands under the skin, which are connected to hair follicles. Hormones prompt the glands to produce oil - sometimes too much. If there's excess oil trying to get through a narrow pore in the skin, bacteria and other "gunk" is trapped, which leads to inflammation, i.e., a breakout.

Experts are adamant that adult acne has more of a hormonal connection than a lifestyle link, even for men. People suffering from acne tend to have oily skin. And with time, changes in hormones, especially a drop in estrogen, can cause imbalances that impact the skin's glands.

Adults typically lead just as busy lives as teens. While stress doesn't cause acne, it can worsen it if you have a poor diet and a lack of exercise or sleep. Says Begoun: "Think of it this way: Most adults endure some level of stress every day, but not every adult has acne. If stress caused acne, we'd see a lot more adults looking frazzled and blemished."

Begoun says the biggest lifestyle factor that contributes to acne is not treating it with the right products, such as gentle cleansers and topical antibacterial agents. Tanghetti also supports the hormone theory, acknowledging that, after age 30, women are two times more likely to have acne than men. Women typically suffer breakouts around the chin, mouth and cheeks. Spot treatments are commonly used just on the blemish, which can help, but Tanghetti says all areas should get attention. "You want to keep all the pores unplugged, even in places where you're not breaking out," he says, "and that means treating the entire face."

Whereas Stridex and Clearasil were pretty much the treatments of choice back in the 1970s, visit any drugstore today and you might spend a good hour trying to figure out what to buy. Begoun and Tanghetti agree that an over-the-counter benzoyl peroxide product (2.5 percent to 5 percent in strength), combined with a gentle cleanser, such as Cetaphil or Dove, can keep excess oil in check, kill bacteria and help clear blemishes.

One of the most heavily marketed acne systems is Proactiv Solution, which was launched in 1994 by dermatologists Dr. Kathy Fields and Dr. Katie Rodan. Fields, who operates her private practice from San Francisco, says that, when Proactiv hit the infomercial circuit, about 97 percent of adult women didn't identify with adult acne, even though they had breakouts. "They were burning up a blemish by putting something strong on it, instead of a low-strength medicine every day," Fields said by phone. With the Proactiv system, you're pretty much putting other products aside and following a three-step skin-care regimen, which includes benzoyl peroxide in two of its three application stages. "However, it still feels to me like there's more adult acne than ever," Fields says, "maybe because there's a new awareness that it goes beyond two or three blemishes a month."

When is it time to seek a doctor's help? According to Tanghetti, if you've tried over-the-counter products for a couple of months and aren't seeing results, or if you develop large cysts or lesions, it's time to make an appointment with a physician.

"Mostly because you are dealing with hormones that might require a dual plan of both oral and topical medications," Tanghetti says.

For example, topical agents such as Tazorac, Retin-A and other vitamin A derivatives, which are lauded for treating signs of hyperpigmentation (brown spots), also can help with acne by normalizing the cells in the pores. As companion therapy, certain prescription birth-control pills have been shown to help curb the hormones that overproduce oil.

Remember the commercials for Ortho Tri-Cyclen? They went from talking about its efficacy as a form of birth control to how the drug could clear up your skin.

Yasmin is another birth-control pill that Tanghetti says "has shown benefits for dealing with adult acne." Vicki Rowden, 53, is a product specialist in The Skin Corner, which is affiliated with Tanghetti's medical practice. She helps customers with their daily skin-care routine, depending on their needs and the doctor's recommendations. On a personal front, she says, she has had acne since she was a teen-ager.

"Back then, I was using the typical products - Sea Breeze, Stridex - but I don't remember it being really horrible." Her bad zones? Chin and cheeks, but not all over. "It's definitely hormonally driven," she says. "I use Tazorac (topically), tried the birth-control thing but hated it because I gained weight. Fortunately, I haven't had a breakout in a while."

Rowden, who lives in Sacramento, says anyone can get on a vicious cycle trying to tackle acne. She says most patients start off too aggressively, using cleansers with abrasive scrubs (tiny particles to exfoliate) and alcohol-based toners. "The key is to be gentle and pay attention to when you're prone to a breakout," she says. Yes, picking is a natural inclination, but a bad one because it can lead to scarring. "Always ask for help, especially with acne, because there's so much that can be done," Rowden says.