Dear Paula,

I am 41 years old and have had acne since I was 13. It was severe in my teens and I was on oral and topical medications which helped a lot.  I always thought acne was a teenage problem and when I turned 20 I wouldn't have to deal with it anymore. Perhaps not surprising to you, I wasn’t cured of my acne in my 20's...or my 30's...and now I'm in my 40's still battling acne! I have the cystic type plus blackheads and whiteheads. I use every acne wash on the shelves (one at a time, alternating between them) and am not currently on any medication or using any other anti-acne skin-care products.

To add insult to injury, now I'm finding my skin starting to show its age in the form of wrinkles, dullness, and sagging. I can’t imagine using a moisturizer on my skin or any of the brilliant anti-aging lotions out there, for fear of more acne! But I desperately want nice skin. The worst spot on my face for noticeable aging is the deep lines between my nose and mouth (nasolabial folds). Seeing those, I almost cry when I look in the mirror. I don't even know how to search for the appropriate products on your Beautypedia web site, because the options are EITHER acne, OR wrinkle products - not both. How does one fight acne and aging at the same time?

Donna, via email

Dear Donna,

I can empathize with your plight! At age 56, I still struggle with acne and have since before I entered my teen years. Thanks to a skin-care routine using products I formulated, my acne is consistently under control save for the occasional small breakout. Please know that you’re not alone in your plight; many women in their 40s and beyond are still battling acne and, with each passing year, wrinkles and other signs of aging (most of which is actually signs of cumulative sun damage). The good news is that women dealing with acne and wrinkles CAN treat both concerns at the same time. It’s simply a matter of choosing the right products and avoiding those you know to be a problem (such as thick moisturizers or balm-like creams).

I am concerned that the only thing you’re doing to manage your acne is using numerous anti-acne cleansers. Those can help, but only to a certain extent. For example, no cleanser is going to wash away blackheads or reduce the appearance of whiteheads. You didn’t mention this, but I’m curious as to why you’re not using topical anti-acne products such as a lotion with benzoyl peroxide or a toner with salicylic acid. Both of these active ingredients are exceptionally helpful for most cases of acne (and salicylic acid can work wonders on blackheads). Perhaps you’ve used products with these active ingredients in the past but they weren’t well formulated or they contained irritants that make acne worse. It’s shocking how common this is; no wonder many women give up on trying to manage their acne!

You mentioned your acne is cystic, which is the most difficult to treat. I encourage you to explore a skin-care routine consisting of gentle cleanser, an exfoliant with 2% salicylic acid (BHA), and a topical disinfectant with 5% benzoyl peroxide. The salicylic acid has multiple benefits for skin, including reducing inflammation that leads to signs of aging and stimulating collagen production for smoother, younger-looking skin. Even if the salicylic acid doesn’t do much for your cystic acne, it will offer anti-aging benefits.

If well formulated over-the-counter anti-acne products fail to work, you need to see a dermatologist to discuss further options, up to and including oral isotretinoin (formally known as Accutane). Isotretinoin has its risks and the side effects should be discussed at length with your dermatologist, but it is often the only workable option when cystic acne is the issue (and you’ve been dealing with this long enough to know it’s not a flash in the pan).

As for fighting wrinkles and acne, in addition to the routine I mentioned above, you can add a lightweight serum loaded with antioxidants, cell-communicating ingredients (niacinamide, retinol), and skin-identical ingredients to your routine. There are several serums whose textures are imperceptibly light and extremely unlikely to clog pores or exacerbate acne. Three to consider are Olay Regenerist Daily Regenerating Serum Fragrance-Free,   Estee Lauder Perfectionist [CP+] Wrinkle Lifting Serum, and Paula’s Choice Skin Balancing Super Antioxidant Mattifying Concentrate Serum. You also want to make sure that your anti-wrinkle skin-care routine includes an antioxidant-rich sunscreen rated SPF 15 or greater. Again, there are lightweight options available such as Good Skin’s Clean Skin Oil-Free Lotion SPF 15 or Murad Oil-Control Mattifier SPF 15.

Of course, in addition to a brilliant skin-care routine that helps control acne and improve/prevent the signs of aging, you need to, as I’ve said in the past, “fall in love with a good cosmetic dermatologist”. The cosmetic corrective procedures a dermatologist can perform dovetail beautifully with a smart skin-care routine. Dermal fillers (there are many types, many use hyaluronic acid) work to fill-in nasolabial folds, Botox can be used to erase expression lines like that furrow between the brow, and laser or intense-pulsed light treatments can significantly improve signs of sun damage, wrinkles—and acne, too. In short, fighting acne and wrinkles requires properly formulated skin-care products coupled with the in-office cosmetic corrective procedures by a competent, skilled dermatologist.  And as mentioned, you may need to rely on a dermatologist for potent prescription options (isotretinoin among them) to finally make your cystic acne a distant memory.