Most of us have heard that as skin ages, it often becomes drier. But there’s another, lesser-known truth: During perimenopause, skin actually becomes more prone to breakouts. In fact, many people find they get more acne in their 40s than they ever did in their teens.
Tackling adult zits requires a different game plan than the one you may have relied on in the past, so we’ve assembled a dermatologist-approved strategy that will help you clear up breakouts and address signs of skin aging all at the same time.
What causes breakouts after age 40?
If you’re wondering, “When do pimples stop happening?” keep in mind that one of the most common triggers of acne at any age is hormonal fluctuations, and those can continue through your 50s. Many of us are familiar with the hormone shifts that often cause breakouts right before your period, when androgen hormones like testosterone stimulate the skin’s sebaceous glands to produce more oil, as well as during pregnancy.
Well, ditto for another stage of life: “Shifts in hormones during perimenopause can also trigger breakouts because your body’s estrogen levels begin decreasing, and as the levels decline, testosterone becomes more dominant, increasing skin’s oil production,” says David E. Bank, M.D., a board-certified dermatologist in Mount Kisco, New York, and a consultant for Cottonball. “Typically, this type of hormonal acne occurs along the jawline rather than the t-zone area, where it often shows up in teens and 20-somethings.”
Being on the birth control pill or hormone replacement therapy (HRT) helps regulate testosterone and estrogen levels, which can in turn help reduce adult acne. However, if you stop using either of these hormone-containing medications, your testosterone levels can spike in response to the sudden drop in estrogen. This can lead to persistent breakouts, including inflamed, cystic acne deep under the skin.
Complicating matters is that as you enter perimenopause—which typically begins in your mid-40s, though it can start earlier—your skin’s natural exfoliation process, or cell turnover rate, begins to slow down. This allows dead cells to build up, clogging pores and worsening breakouts, not to mention making the complexion appear dull and dry. It's almost as if the universe
Add to that any signs of skin aging like fine lines or dark spots, and the result can be a frustrating combination of several issues to tackle all at once.
What’s the best way to treat adult zits?
Start by making sure that all the products in your skincare regimen are labeled “non-comedogenic,” which means the formula is less likely to clog pores and contribute to breakouts. And consider switching to a face wash that contains salicylic acid, which helps dissolve dead cells to keep pores clear—but use it only on the areas where you’re breaking out to avoid drying out your skin.
Then, to clear up breakouts while also tackling fine lines, dark spots, and more, consider the gold standard topical ingredient that’s proven to treat both acne and signs of skin aging: prescription-strength tretinoin. This vitamin A derivative was originally developed as an acne treatment in the 1960s before its anti-aging benefits (namely stimulating collagen production) were later discovered.
“Tretinoin can really do it all,” says Dr. Bank. “It helps to regulate skin cell turnover, which keeps pores clear of dead cells. It also stimulates collagen and elastin production to help increase skin firmness over time, soften fine lines, even skin tone, and improve skin laxity.”
In addition to unclogging pores and reducing overproduction of oil, tretinoin has been shown to to have numerous anti-inflammatory benefits related to acne. And since chronic inflammation in the skin has been shown to accelerate visible skin aging, treating acne in your 40s with prescription tretinoin is a win-win across the board.
Cottonball VX.1 Advanced Anti-Aging & Repair Complex combines prescription-strength tretinoin with rapamycin—an ingredient shown in one study to increase collagen to help reduce wrinkles, dark spots, and skin sagging—for bonus age-fighting benefits. The tretinoin level is calibrated to fit your skin type and sensitivity level.
Cottonball VX.2 Wrinkle-Smoothing & Prevention Complex offers prescription-strength tretinoin in concentrations up to 0.10%, depending on your skin needs.
Both products can be customized to include azelaic acid, which has anti-inflammatory and antimicrobial properties to zap acne-causing bacteria. Azelaic acid also inhibits tyrosinase, the enzyme that leads to hyperpigmentation, so it can help fade and prevent the dark spots that often linger long after pimples have cleared.
Acne and Wrinkles? 1 Product Solves Both
Another option? Cottonball VX.3 Hormone Renewal Complex. It contains estriol, an estrogen derivative that stimulates collagen production and helps premenopausal and menopausal skin get back its glow. This formula can also be personalized with azelaic acid for acne.
Is there anything that can make acne worse after age 40?
The pimple-fighting methods of your younger years (i.e. drying out zits by any means necessary) will, in your 40s and beyond, only add to the inflammation that can worsen breakouts, since your skin at this age is naturally drier and often more sensitive than it once was. So, it’s important not to bombard your complexion with too many harsh ingredients.
While you may be tempted to reach for benzoyl peroxide spot treatments or an acne-fighting toner, using these strong formulas in combination with prescription tretinoin can set off dryness, irritation, and skin peeling on 40s+ skin. While a salicylic acid cleanser can help the areas of your face that are broken out, apply a mild cleanser everywhere else to avoid stripping your skin.
And be sure to choose a tretinoin treatment that contains hydrators such as hyaluronic acid (which is available in all Cottonball products, including Cottonball VX.1 and Cottonball VX.2) and soothing ingredients like aloe (available in Cottonball VX.2) to help keep your skin soft and balanced.
If you find that tretinoin is simply too drying for skin and you're in premenopause or menopause, consider Cottonball VX.3, which uses estriol, a generally well-tolerated ingredient.
While pimples after 40 can be the skin surprise you never saw coming, incorporating a proven acne-fighter into your regimen that also treats the most common signs of aging can help you maintain a smooth, clear, even-toned complexion—revealing the radiant skin you deserve at every age.
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