Q: I'm a female in my late thirties with an embarrassing problem. I've never suffered from skin problems in my life (with the exception of an occasional PMS flare up), yet I'm all of a sudden experiencing horrible breakouts. I have no idea why this is happening or how to stop it. What can I do to clear up my acne?

A: It sounds as if you are one of the many women who suffers with adult acne. Acne isn't just a problem for teenagers; many people experience acne, often for the first time, in their twenties and thirties. Males are more commonly affected during the teen years. Adult acne, however, is a chronic condition and more commonly affects women. At the age of 25, 12 percent of women and five percent of men report having acne. At the age of 45, five percent of both men and women report having acne--I actually have a handful of female acne patients in who are in their fifties and sixties.

Acne is a disease of the hair follicles, with many different factors contributing to the formation of acne lesions. Our current understanding is that acne starts in the skin with an invisible abnormal plug formation called the microcomedone. As the plug grows, "blackheads" or "whiteheads" may become visible. Excess oil production, the presence of bacteria, and inflammation also contribute to acne formation. Some women notice acne flares before menstruation. This is caused by the effects of an androgen hormonal surge, which contributes to increased oil production. For this reason, some women find that their acne is controlled with use of birth control pills.

Expectation management is a critical part of acne therapy. Adult acne is a chronic disease, and currently, the only potential cures are isotretinoin, and, for some women, menopause. Therefore, it is important to understand that all current treatments are aiming to manage this ongoing problem and may have to be used repeatedly. Choosing a board-certified dermatologist to treat your acne is essential--he or she will be best able to offer you a range of therapies, as well as direct the skin care regime.

On the bright side, when dealing with acne under the care of a dermatologist, a person may develop good skin care habits that prevent the signs of aging. A non-comedogenic moisturizer with sunscreen is an important part of acne therapy.  Not only has dry skin been shown to cause acne to flare, but the use of a moisturizer may be required to tolerate some of the medications, which may be drying. Sunscreen prevents skin cancer and photo aging of the skin. Additionally, some of the active ingredients in acne medicines (such as retinoids, glycolic acid and salicylic acid) and procedures such as chemical peels have the positive side effects of reduced wrinkles, reduced sun damage, and blemish fading. 

Dina D. Strachan, M.D. is a board certfied dermatologist who directs Aglow Dermatology in Manhattan. She has lectured both nationally and internationally on a variety of topics in dermatology. She has appeared on the CBS News in New York and Healthline and has been quoted in a variety of local and national media, including The New York Times, The Washington Post, AM New York, health.com, and Latina and Black Enterprise. Dr. Strachan was named one of America's "Top Dermatologists" by the Consumers Research Council of America. She is a graduate of Yale Medical School and is currently an Assistant Clinical Professor of Dermatology at Columbia University College of Physicians and Surgeons in New York City.