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Dealing with acne in your middle age (or older)

We’ve all dealt with skin breakouts in one form or another in our lives.

The bumps, the redness and not feeling like we’re looking our best are things that none of us look forward to experiencing. It’s even more frustrating if we are still getting acne at the age of 40 and above! Shouldn’t we be over dealing with pimples by then?

The type of acne we tend to get in middle age is known as hormonal acne, and is actually more common than we think. As per its name, hormonal acne occurs as a result of fluctuations in the amount of hormones our body produces, e.g. just before and during our period.

Nobody likes any form of acne, of course, but it affects everyone at all stages of life to varying degrees. Fortunately, hormonal acne outbreaks can be minimised and alleviated with a combination of over-the-counter products and changes to your lifestyle.

Care for your skin

Acne forms through a four-step process and can range from mild to severe. — pch.vector/Freepik

Hormones exist in a delicate balance in your body. Even a small increase in one hormone can have a noticeable effect on your health and appearance. Most acne that occurs is hormonal.

Your body produces certain hormones that stimulate the production of sebum, which is a type of oil that lubricates your skin. Normal sebum production keeps your skin smooth and healthy-looking.

But when sebum production goes into overdrive, the extra sebum can clog hair follicles and cause you to develop acne. So, which hormones tend to trigger sebum overproduction?

The main culprit seems to be testosterone, an androgen hormone. Most of the time, this boost in androgen production occurs at the same time as your period.

Yes, despite being commonly known as a male hormone, testosterone is produced in women too. Small amounts of testosterone circulating throughout your body are essential for everything from your energy levels to your strength and fitness.

Hormonal acne is extremely common in puberty as the body produces much greater levels of androgens then. Medical conditions that affect your hormone levels, such as polycystic ovary syndrome (PCOS), can also cause an overproduction of androgens and lead to hormonal acne.

For some women, going through menopause can lead to hormonal acne outbreaks due to the imbalance of androgen and oestrogen hormones. Menopausal hormonal acne can also occur if hormone replacement therapy (HRT) is used to deal with the symptoms of ageing.

This is as HRT uses an artificial hormone, progestin, to replace oestrogen and progesterone, which can cause your skin to go awry.

A four-step process

As each person has a different sensitivity to fluctuations in hormone levels, not everyone will break out with acne. This explains why some of your friends appear blessed with “good skin” most of the time.

For the rest of us, acne breakouts are a four-step process:

Hormone production

Before periods or some other cause of hormonal change, your body starts to increase its androgen production. Higher testosterone levels trigger your body to create more sebum, which can lead to oilier facial skin.

Clogged hair follicle

The increased sebum clogs up hair follicles, creating comedones. Completely blocked comedones form a whitehead pimple, and partially blocked comedones form blackheads.

Bacterial infection

Infections can occur when bacteria get trapped inside a comedone, resulting in a painful or itchy pimple.


Your immune system will respond to an infection, causing the clogged hair follicle to become red, swollen and uncomfortable. Hormonal acne breakouts tend to mostly affect the T-zone of our face, which consists of our forehead, nose and chin.

A mild acne breakout usually includes non-painful whiteheads and blackheads that occur in small batches. Moderate acne usually comes with inflamed lesions, making them red, painful and itchy.

This includes pus-filled, cystic lesions, and acne nodules, which are large, deep-set pimples that sit beneath the skin.

Care for your skin

Luckily, acne can be treated and managed. Treatment options vary depending on the severity of your outbreaks. Mild acne will likely clear up on its own and won’t require medication.

For severe outbreaks, options include tretinoin, isotretinoin or an antibiotic. Taking certain steps to care for your skin can usually help to improve mild to moderate hormonal acne, for example:

Don’t pick at your pimples

An exposed pimple allows bacteria to enter the pore easily, increasing your risk of an infected lesion.

Don’t overwash your face

Avoid washing your face more than twice a day, unless you sweat excessively. Overwashing dries the skin and irritates it, making acne even more severe.

Use gentler face washes

Many over-the-counter facial washes are full of chemicals that irritate your skin. Find ones that are recommended for acne-prone skin.

Limit your use of makeup

Liquid and powder foundation will clog the pores even more and make the acne worse. During an outbreak, it’s best to just completely avoid using makeup that goes onto the areas of your skin with acne.

Avoid excessive sweating

Try not to spend extra time outside if the weather is hot and humid, as excessive sweating can worsen your outbreaks and make inflamed, infected pimples worse. Shower right after you finish your workout to reduce the amount of time your bare skin is exposed to sweat.

Try natural treatments and face masks

Applying green tea onto your acne may help because of its mild anti-inflammatory properties. The results you can expect from green tea and other natural treatments are fairly mild, meaning this probably won’t be useful if you have anything more than a few small pimples.

Meanwhile, face masks that are meant to treat acne contain alpha hydroxy acids – naturally-occurring compounds that can help improve your skin. The small boost in skin health they can provide could help to bring your hormonal acne under control.

Eat more antioxidant-rich foods

Foods rich in natural antioxidants such as strawberries, blueberries, kale, spinach, kiwi, avocado and broccoli, can potentially decrease skin irritation.

Minimising flare-ups

It’s not really possible to stop acne from returning, but you can establish a consistent skincare routine as a method of preventing acne flare-ups:

Consult a dermatologist

They can help with developing a personalised skincare routine that targets your specific skin problems.

Gentle cleansing

To keep acne at bay, use a cleanser that clears dead skin cells and excess daily oil without overdrying the skin.

Use acne products in moderation

Products like benzoyl peroxide or salicylic acid are useful for acne treatment, but too many acne products create a negative effect on your skin. Stick with one skincare routine for a few months before making big changes.


Even oily skin requires hydration. Choose a product that is suited to your skin type and it will prevent acne breakouts by keeping your skin hydrated and not irritated by dryness.

Wear sunscreen

Apply a sunscreen that has about SPF50 protection when going out in order to minimise the effects of harsh sunlight.

In severe cases

There are a number of medications available to treat severe acne. Retinoids can speed up your skin’s growth process and enable your skin to turn over more quickly than normal.

Sebum then doesn’t have as much time to build up inside your pores, resulting in milder acne outbreaks. The most common topical retinoid is tretinoin, which can be applied daily.

Antibiotics can be quite effective in keeping outbreaks under control. Oral antibiotics are usually prescribed for moderate to severe inflammatory acne.

If blockage occurs, antibiotics stop the infection and reduce inflammation. Therefore, your doctor might prescribe you antibiotics, in addition to retinoids.

Some common antibiotics for acne are tetracycline, doxycycline, erythromycin and minocycline. Hormonal medication can be recommended if retinoids and antibiotics don’t work.

Birth control pills are quite common, as they contain ethinyl oestradiol, an oestrogen that can help to balance the effects of androgens. Bioidentical hormones can also be considered and they have the added effect of helping to correct any hormonal imbalances.

Nutritional supplements such as zinc, which is an essential mineral, have antibacterial effects, and can reduce oil production and inflammation, as well as improve skin health. Likewise, vitamin D also has an anti-inflammatory effect and is useful in treating inflamed acne.

As a last resort, there are certain drugs that can be used to treat really bad cases of acne. One of these is spironolactone, which is a drug that blocks androgens from triggering overproduction of sebum.

There is also isotretinoin. Like tretinoin, isotretinoin is a vitamin A derivative, but it is more powerful than tretinoin (a prescription drug) or retinol (available over-the-counter).

However, a serious side effect of these drugs is birth defects, so sexually-active women are usually advised to avoid these medications.

By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 14 Jun 2021

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