July 2, 2025 • 44 mins
Acne doesn't discriminate by age. From teenagers to menopausal women, breakouts can strike at any life stage—often when we least expect them. Speaking of Women's Health Podcast Host Dr. Holly Thacker dives deep into why some of us battle persistent acne while simultaneously fighting wrinkles and dry skin, revealing the surprising hormonal connections that dermatologists and patients often miss.
This comprehensive guide to skin health explores how our body's largest organ responds to everything from stress hormones to dietary choices. Dr. Thacker explains how the surge in adrenal hormones during perimenopause can trigger what feels like "reverse puberty" on your skin, and why some women see dramatic improvements with certain hormonal treatments while others don't. You'll discover why that midlife pimple appeared on your chin despite your careful skincare routine.
Whether you're dealing with teenage acne, adult hormonal breakouts, or trying to prevent future skin problems, this episode offers actionable advice for achieving healthier skin at any age. Plus, discover the decade-by-decade skincare essentials that address your changing skin needs as you move through life. Your skin deserves better than trial and error—tune in for evidence-based strategies that target the root causes of troublesome skin.
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Episode Transcript
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Speaker 1 (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI'm back in the Sunflower House
for a new podcast for the summerpodcast.
(00:31):
For the summer, I'm going totalk all about the skinny on
acne and skin care for all ages,as we're wearing somewhat
lighter, skimpier clothes forthe long-awaited summer.
And while we're in the middleof summer, unfortunately acne
can worsen because it can be sohot and humid.
Your body perspires more andbeing exposed to the sun
(00:55):
certainly has a drying effect, apotential aging effect,
depending on how you'reprotecting yourself and what
skin is being exposed.
And when sweat mixes with oiland dead skin cells it can clog
the pores and the sun'skeratolytic effects, which is
(01:17):
kind of breaking down thekeratin in the skin.
It can lead to clogged poresand, paradoxically with aging,
the skin turnover sometimes isslower and it's not as efficient
at shedding.
And so a lot of people noticeas they get older they get
(01:38):
little milia, little bumps underthe skin of keratin skin
material.
And even though acne is thoughtto be quintessential time of
being a teenager, in fact,artemis, my oldest granddaughter
(02:00):
of the three I have threegranddaughters now with baby
Vivian Vira Vive, as in longlive.
She was just born in 2023.
Anyway, all threegranddaughters have beautiful
complexions, and when Artemisheard that acne is common in
(02:24):
teenage years, she told me Mimi,I am not going to be a teenager
, I'm going to skip that age.
And so there could be a lot ofthings that people might want to
skip about some of theawkwardness of you know, trying
to grow into your body and findyour own way and transition from
childhood to adulthood cancertainly be a challenging time,
(02:44):
and having you know big redbumps and altered skin certainly
can make it more challenging.
But unfortunately acne is notjust for teenagers.
Almost every week I have somewoman talk to me and say why am
I getting acne now, while I'mgetting wrinkles and dry skin?
(03:05):
And so actually at midlife,when there is a surge in the
stress hormones because of thelack of estrogen and the adrenal
glands which put out, theadrenal stress hormones can
actually increase acne becausethey're what we call more
androgenic, and some people arejust predisposed to acne their
(03:29):
whole life.
And it is frustrating to me atmy stage in life when I wake up
with a pimple on my face.
It does happen, and some peopledon't get any acne at all, and
so maybe you're one of those andthinking I can tune out for
(03:51):
this one, but chances arethere's someone in your circle
of loved ones that may have todeal with this.
And we will also talk about justgood skincare.
In fact, speaking of greatskincare, I met our skincare
estheticians at the ClevelandClinic back when my three sons
(04:12):
were in high school and havingacne.
And in males there's not asmuch many treatment options,
because one of the big treatmentoptions we offer for females is
hormonal contraceptives,because they'll suppress the
ovarian and the adrenalandrogens and can many times
(04:32):
beautifully clear up the skin.
And we've got an upcomingpodcast in the fall with Dana
Leslie, our wonderful I call herthe role model of all role
models of women's health andnurse practitioners, and we're
going to talk about how shecounsels and selects different
(04:56):
types of contraceptive agents inyounger women in terms of
looking at other medicalconditions.
So if you're geneticallypredisposed to acne or you've
ever had acne, you couldcertainly have acne again and
certain hormones can trigger it.
(05:16):
Certain bacteria can play arole, certain underlying skin
abnormalities, there'sdefinitely a genetic component
to it, and stress stress levelsincrease the stress hormones,
which can be bad on the skin andcertainly, like with everything
(05:38):
, your lifestyle, your nutrition, your vitamin status can play a
role, and there's definitelysome people who believe that
certain foods tend to triggeracne.
Most people don't say that, butthere are some people Now.
Acne can occur on differentparts of the body and I remember
(06:02):
when I was, and I remember whenI was getting towards the end
of my medical school career andwe got our test score results
and we were thinking about whattypes of specialties to go into,
and when I got my board scores,which were pretty high, I had a
(06:22):
lot of my friends andco-medical students like grab my
hand and say, wow, that's sogreat, you can apply to
dermatology.
And back then I thought, oh, Idon't want to take care of acne
and eczema and warts, and so Ithought no, no, no, dermatology
is not for me, because I kind ofdismissed it as maybe not those
(06:47):
conditions as not as seriousconditions as a lot of internal
medicine diseases, and I wasvery, of course, interested in
the differences between the twosexes and the manifestations of
disease and that really had notbeen very well explored even
after my medical school trainingand residency, and so it was
nice to be able to have a careerwhere I was a trailblazer in
(07:11):
this field.
And when I think about how kindof dismissive I was of skin
problems, it kind of showed alittle bit of a lack of maturity
, because the skin is thelargest organ in the body and
it's something that you know,you see at least most parts, at
(07:32):
least, of people's faces andhands and arms, and in the
summer sometimes a lot more skinand it's a very important organ
and there's a lot of differentthings that can happen to it.
And acne is not just a cosmeticproblem.
In fact, one of the firstpatients that I took care of
when I was a resident at theCleveland Clinic and at that
(07:54):
time I joined the clinic I wasplanning to specialize in
cardiology and I didn't want tomove my husband, you know, to
two different cities for bothresidency and fellowship.
So I thought I'll pick theplace I want to do the
fellowship and, with the clinicbeing number one in heart, I
thought that'll be good.
I'll do my both sets oftraining there and one of the
(08:17):
first cases I took care of was agentleman who had endocarditis,
which is infection of the heartvalve.
Gentleman who had endocarditis,which is infection of the heart
valve, and it was from acnepropionic bacteria, which is a
type of bacteria that isinvolved in the pathogenesis of
(08:39):
acne, and his acne was sosignificant and he was in his
forties, so he was not ateenager that the infection from
his skin seeded his heart valveand he, despite our best
efforts, actually succumbed anddied from the disease.
So that's obviously a prettydramatic example of what can
(09:02):
happen with acne example of whatcan happen with acne.
But that really did stick in mymind for my whole career about
how the skin is a very importantbarrier and anything that can
irritate it or cause aninfection can be
life-threatening, and infectionsthat occur specifically in this
area of the body that drainsdirectly into the brain can lead
(09:26):
to serious brain infections.
So when there's something wrongwith your skin, even if you
just think it's acne or eczemaor a wart that you're picking,
at many times it is important toget medical attention and to
understand that, even though wedon't routinely see people die
(09:47):
of bacterial infections like wedid in the pre-antibiotic era,
it still does happen.
So the parts of your body thatare more likely to get acne are
where you have more sebaceousoil glands and they're tiny
little oil-producing glands thatare definitely affected by
(10:08):
hormones.
So in children before pubertywe don't see acne and you have
the most sebaceous cyst on yourface, your upper back, the chest
, the neck and the upper arms.
So there's threeclassifications of acne mild,
(10:29):
moderate and severe.
And we discussed the causesbeing related to your genetics.
So if your parents have acne,you're more likely to have acne.
Hormonal fluctuations, anycondition that can increase oil
production from these sebaceousglands, any inflammatory state
(10:50):
and certainly if you eat ahighly inflammatory diet, you're
going to have a lot more skinproblems, that is for sure.
Sometimes the hair follicles arehyperkeratinized and that can
clog up the pores and thencertain bacterial colonization
(11:12):
on the skin can play a role inthe pathogenesis of acne.
If you have abnormal sheddingof the skin, of the sebaceous
glands and the upper section ofthe little hair follicles near
the opening of the pores, andthese skin cells can clog the
pore and form what's calledmedically a microcomodone, so
(11:37):
like a little miniaturewhitehead or blackhead.
Propionide bacterium acnes, orwhat's called P acnes, is a
bacterium that is normally foundon the skin, but in people with
acne it can grow abnormally topretty good levels and this
leads to inflammation and skinchanges and follicular
(12:00):
hyperkeratinization andalteration of the sebum, the oil
in the skin, and alteration ofthe sebum, the oil in the skin.
So, as we said, hormones doplay an important role and
that's why a lot of times acneis referred to as hormonal acne
(12:21):
and generally when you gothrough puberty and you go
through adrenarche, where youradrenal glands produce higher
levels of sex hormones, and thenmenarche, when the ovaries
start to kick in and ovulate.
But in both sexes the sexhormone levels increase and
regardless of gender you can getacne.
Now women can get later.
(12:43):
Acne related to hormonalfluctuations from pregnancy can
get later.
Acne related to hormonalfluctuations from pregnancy,
perimenopause and some forms ofhormonal contraceptives are what
we call more androgenic andworse on the skin, where others
are much less androgenic andvery favorable to the skin,
(13:05):
especially if they lowerandrogen levels.
It's not uncommon for me to getconsults from my dermatology
colleagues because they'resending me women who have
hormonal causes of skin and hairproblems from hormonal
imbalance.
So we talked about inflammationfrom the diet playing a role.
Some people have classicallyargued that the diet is less
(13:28):
significant, but I think overtime our diet has gotten more
inflammatory and I think we havemore bad things in our food
supply.
Last fall, if you didn't hearmy podcast on banned foods in
other countries that areavailable in America, that's
really one to listen to.
(13:49):
Now.
Some medications can increaseacne and some occupational
chemical exposures, but thesetypes of acne are different than
the common acne vulgaris.
Vulgar means common and ofcourse, a lot of us who have
(14:09):
acne think it's rude that wehave it.
It's rude of our body to allowus to have acne.
So, moving on to treatment,adult acne can be treated with
medication, lifestyle changesand, of course, changes in your
diet.
(14:29):
So let's start with what's thebest diet for acne.
What are some good foods to eat?
Maybe foods you should avoid,and are there any supplements
that you might want to consider?
So, in general, when talkingabout skin health, when we talk
about foods to avoid, in generalfoods that have a high glycemic
(14:51):
index, and that's a measure ofhow fast or how slow you break
down food, how fast it spikesyour blood sugar.
So foods that have a very highglycemic index can cause
dramatic ups and downs in bloodsugar and that can make acne
worse.
(15:11):
Some people can feel shaky andhave reactive hypoglycemia, and
so some of these foods are liketeenage favorites, like soda and
candy and sugary cereals andice cream and candy cereals and
(15:31):
ice cream and candy.
So a little bit of ice cream orcandy, you know, for a certain
holiday may be fine, but ingeneral, people of all ages
should avoid excessive sugar andsweets.
As I've said, there's no suchthing as an essential
carbohydrate.
We have essential amino acidproteins and two essential fats.
So other things to avoid wouldbe highly processed foods Again
(15:56):
chips, fast food, microwavablemeals Again, those can be
popular amongst young peopleamongst young people, and
limiting these sweets and sugarsand candies and cakes and
sports drinks and energy drinksand cookies are certainly a good
idea.
(16:17):
Some people find that dairy andor whey protein irritates their
skin and joints, so dairyproducts like milk and cheese
and yogurt do promote insulinsecretion and the production of
some hormones, and then somepeople can contribute to acne.
Being an osteoporosis doctor,I'm very fond of the dairy foods
(16:40):
because they're great for yourbones, and if you haven't caught
my column and podcast oneverything about cheese and why
cheese can be good for you, thatis certainly one to go back and
listen to, and a lot of youngpeople use whey protein
supplements as mealsubstitutions or in part of
(17:02):
their pre-workout, because wheyprotein is great for tendons and
muscles.
It's good for tendon repair.
So I think doing a dietarysurvey in patients is a good
thing to do and sometimes thatcan lead to some things that we
can do differently.
You have been listening to theSpeaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, back in the Sunflower House
(17:26):
this summer for a podcast oneverything acne and skin health.
So what are some good foods toeat?
Well, obviously your vegetablesbroccoli, spinach, kale,
peppers, carrots Both peppersand carrots are rich in vitamin
A.
Vitamin A kind of gives a nicelittle glow to the skin and
(17:50):
vitamin A actually can be veryhelpful if a child has measles.
There's been studies looking atgiving vitamin A.
So that directly helps the skin, just like vitamin C helps and
a lot of skin conditions.
There's excessive skin turnoverand there may be higher
requirements for vitamin C helpsand a lot of skin conditions.
There's excessive skin turnoverand there may be higher
(18:10):
requirements for vitamin C.
So vitamin C foods like berriesand oranges and apples and
bananas, cherries and grapefruitgood old cherries we talked
about in the gout podcast it'sone of the fruits that do really
help lower uric acid levels.
And whole grains, sweet potato,also rich in vitamin a, brown
(18:35):
rice, quinoa, butternut squash.
And then you want heart healthyfats.
They're also good for the skin,like whole eggs and olive oil
and avocado, coconut oil, andvarious healthy nuts and seeds,
omega-3s, which so many peopledon't get enough of.
(18:58):
They're in fish and certainnuts and seeds, like chia seeds
and walnuts, and almonds andflax flax oil.
The omega-3s are very important.
Whenever I have a womancomplaining of dry skin, dry
eyes, worsening eczema, skinthat just doesn't glow as much
(19:19):
as it did before joint aches,mood changes, brain fog I
frequently will find that theomega-6 to omega-3 ratios are
off, and if you haven't read mycolumn on omega-3 or listened to
the podcast on that, it's agood one to go back to Now.
(19:41):
Some plant-based dairyalternatives can include almond
milk and coconut milk, soy milk,cashew milk.
And high quality protein isalways important for the skin,
the bones, the muscle, themetabolism, the brain.
(20:01):
So high quality proteins likesalmon, eggs, shellfish, chicken
, turkey eggs, tofu they're allexcellent sources of protein.
Some have more purine contentthan others, some have more
omega-3 content than others, butin general they pack a good
(20:25):
punch for the calories to thenutritional ratios Legumes like
black beans and chickpeas andlentils, and there's a lot of
herbs that are anti-inflammatory, like cinnamon, black pepper,
turmeric very anti-inflammatorygarlic, ginger, parsley.
(20:48):
So eating a nutrient-dense,anti-inflammatory diet can
certainly help treat and preventmany conditions or at least
help moderate them, things likeacne.
It's important to drinkunsweetened drinks like uh, like
(21:08):
lots of water, green tea,hibiscus tea, um, lemon water
and hibiscus tea and lemon wateruh are good at also helping to
lower uric acid, which isinflammatory.
Supplements for acne vitamin D.
(21:28):
Research has shown that lowvitamin D levels can worsen acne
and over half of people withacne have low vitamin D.
So if you live in a Northernclimate, like we live here in
Cleveland, ohio, especially inpeople over 40, because the skin
doesn't make it as well, plus,a lot of people that are adults
(21:48):
are inside working.
They're not running aroundoutside playing sports and
swimming and getting to enjoyall the outdoor activities
during the sunlight.
Interestingly, green teaextract there was a study of
women with moderate to severeacne and those that boosted
their green tea intake or took agreen tea extract.
For four was a study of womenwith moderate to severe acne and
those that boosted their greentea intake or took a green tea
(22:10):
extract for four weeks did havean improvement in their skin.
I try to drink green teaseveral times a week.
Fish oil or omega-rich fishessuch as fish rather, such as
mackerel, salmon, sardines,anchovy, caviar, herring, trout,
(22:37):
to name a few of my favorites.
If you're not a fish fan,sometimes your physician may
recommend certain types of fishoil supplements.
The results are somewhat mixed.
Some people can actually haveworsening symptoms.
So you really want to do thisunder the guise with your
(22:59):
healthcare team.
B vitamins Supplementing with Bvitamins may benefit people
with acne, but interestingly,high dose injections of B12 may
induce acne in some people,interestingly.
And there's people who don'thave B12 deficiency who just go
to these health spas or go totheir physician to say give me a
(23:20):
B12 shot, kind of like aplacebo, basically.
So again, if you don't need it,it's not good just to take it
to take it.
Zinc Oral zinc supplements canimprove some acne severity and
zinc does play a crucial role inhelping the immune system, the
mood and fighting off virusesand maintaining skin health, and
(23:44):
increasingly I've been doingmore zinc levels and finding a
lot of women that I thoughtpreviously were unhealthy diets
have some low levels.
Vitex Vitex agnus castus is alsoknown as chaseberry, and
sometimes herbalists and otherintegrative doctors may
recommend chaseberry to reduceacne before menstruation because
(24:08):
it might lower some of the sexhormones.
But I really think moreresearch is needed.
If something's not a food orit's not a drug, it isn't
regulated, so it is.
Buyer, beware Barberry Berberisvulgaris.
Barberry has anti-inflammatoryand antibacterial properties,
(24:29):
and so some people recommendsupplementing with barberry
extract based on some studies.
But again, I think you shoulddo this under the recommendation
of either integrative medicineor functional medicine physician
or an herbalist, or at leasttalk with your dermatologist or
family medicine physician aboutthis.
Probiotics and prebiotics thereis some research that shows
(24:55):
that the bacteria in your gutmay reduce skin inflammation and
therefore reduce acne.
So many things are linked toour gut microbiome and really
the research in this area israpidly exploding.
In addition to eating a healthydiet and seeing your health care
(25:15):
team bringing in anysupplements that you may take,
just because they're notprescription doesn't mean you
don't need to bring them in.
Certainly, quit smoking if yousmoke.
Smoking ages the skin.
It's full of toxins, itincreases wrinkling around your
mouth Lots of places.
It's socially unacceptable,it's expensive.
(25:36):
It's highly addictive and ifyou do smoke and you want to
stop smoking, we have some greatsmoking cessation resources on
our website, as well as apodcast on smoking cessation.
It's also a good idea to limityour alcohol intake and get
plenty of sleep.
If you're sleep deprived, likeso many Americans, your stress
(25:59):
hormones are up, and if you'rehaving trouble sleeping, go back
and listen to some of our greatpodcasts on sleep wonderful
sleep tips and I promise you thepodcast won't put you to sleep,
but we'll help you sleep later.
Obviously, learning how tomanage stress and understanding
what proper skincare is and eventhough I'm a woman, I'm a
(26:21):
physician.
I really learned a lot when Iwas interviewing Lori Skarsgård,
our head skincare esthetician,as well as Amanda, who is not
currently an esthetician at theCleveland Clinic, but she was a
wonderful interview on skincareand if you didn't listen to that
(26:43):
or you just need a refresher, Ialways learn something when I
listen to them.
It's a good one to go back to.
So, moving on to your facialskincare, for acne prone skin,
it's very important to have acleanser specifically formulated
for acne.
They usually contain salicylicacid, which helps get rid of the
(27:04):
extra keratin in the skin, orbenzoyl peroxide, which can
inhibit the bacteria on the skin.
You want to clean your facegently, because if you are
traumatizing your skin trying toexfoliate too roughly, that can
(27:25):
actually worsen acne outbreaksand cause scarring, and that's
one of the reasons why, even ifsomeone's not bothered by
cosmesis, they're not botheredby their acne.
It's important to treat itbecause scarring can be
permanent and skin infectionscan take root that occasionally
can lead to serious consequenceslike sepsis.
I've seen people get boneinfections from skin infections
(27:47):
where they have to get home IVantibiotics for six weeks or
longer or a new heart valve.
So it is important to care foryour skin because it's a barrier
between our internal organs andthe parts of our body that
aren't supposed to have anybacteria in them.
You want to somewhat minimizeyour use of facial moisturizers
(28:12):
and if you do need a facialmoisturizer which, of course, a
lot of us women need as we'regetting older you want a light,
non-comedogenic moisturizerwhich doesn't aggravate acne,
(28:33):
and it's best, if you're goingto use a foundation, to use an
oil-free one and avoid heavymakeups or cosmetic products
that can block the pores.
Now, beta-hydroxy acid orsalicylic acid does help improve
acne and even if you don't haveacne.
It can be very nice for kind ofclarifying the skin and the
color and the texture.
It does penetrate oil-ladenhair follicles and as such helps
(28:54):
reduce acne formation.
There's a lot of differentproducts over the counter and
some do require a physician'sprescription.
Now hormonal therapy for acne Intheory, most any
estrogen-containing hormonalcontraceptive should help if
it's used for three to sixmonths.
(29:15):
But there's only some that areFDA approved.
Orthotricycline was the firstone.
It has athenolestrogile withdiffering doses of norgestimate,
yaz, yasmin Biaz, safral.
They have athenol, estradioland drosperinone, which is like
(29:37):
spironolactone.
Those have specific FDAapproval for acne.
Now, when I first started onhormonal contraceptives in
medical school, I was on alevonorgestrel brand and I still
had the same amount of acne.
And then, finally, when I gotto my endocrine rotation and I
learned more about the differenttypes of progestins, which are
(30:03):
actually C21, more androgens,but they function to protect the
uterus, I realized I was on thewrong hormonal contraceptive
and so I got on a non-androgenicone and, oh my, did my skin
significantly clear up and Ireally had wished I would have
done that sooner.
(30:24):
Now, body acne, back, knee.
That is a really tough problemand it's not as cosmetically
affecting, except it is in thesummer, of course.
But when it happens on the back, arms, shoulders and neck it
can be particularly difficult totreat.
It doesn't seem to be asamenable to Accutane, which is a
(30:47):
very potent treatment.
One of my sons and my nephewand niece had severe enough acne
that they needed to go onAccutane and there can be really
dramatic effects.
But it has to be very closelymonitored.
There can be some significantside effects, so it's not
something to just jump intoloosely and whoever you see has
(31:13):
to be able to prescribe it andmonitor it.
Whoever you see has to be ableto prescribe it and monitor it.
So you want to avoid tight,constrictive clothing or rubbing
up against the skin with apurse or a backpack.
You always want to stayhydrated.
You don't want to pick at orpop pimples.
I know a lot of these YouTubevideos with Dr Pimple Popper are
(31:34):
very popular, but do not dothis.
You could really get a seriousinfection or scarring.
Some of the treatments for acneon the back some have suggested
tea tree oil, which has someantifungal effects.
Warm compresses apple cidervinegar can be applied.
(31:55):
Diluted three parts water toone part apple cider vinegar.
Oatmeal baths can calm the skin.
Topical benzoyl peroxide,salicylic acid and topical
adapalene different, and that0.1% and 0.3% are now
over-the-counter oroff-the-shelf without a
prescription are now over thecounter or off the shelf without
(32:15):
a prescription.
Many times a dermatologist mayneed to prescribe stronger
topical creams, topicalretinoids, prescription strength
benzoyl peroxide or evenanti-inflammatory antibiotics
like doxycycline.
If you're pregnant orbreastfeeding, though, you
(32:42):
cannot take doxycycline.
It's a tetracycline.
It can permanently stay in theteeth of the forming baby or
child.
So since we're in the middle ofa lot of sunshine, I do want to
also talk about skin care themust-haves for the decade, and
they're also good tips foranyone who has acne of any age
or anyone who just wants to havegood skin.
(33:03):
So we tend to be a little bitmore in tune with the changes in
our body as we age.
But just like the rest of ourbody changes with age, so does
the skin and sometimes theskincare routine needs to be
changed.
So in the teen years, acne andfluctuating hormones can be a
(33:24):
big issue, and if you're afemale and you're a candidate
for hormonal contraceptives evenif you don't need contraception
but you just want to have apotent treatment for acne, it
would be good to see yourphysician.
In fact, females generally whoare going on Accutane, since it
(33:47):
can cause such teratogeniceffects in a forming baby, are
required to be on hormonalcontraceptives even if they're
not sexually active, justbecause of that risk.
Salicylic acid can be veryhelpful in teens.
It's over the counter in lotsof cleansers, lotions or some
(34:13):
facial washes.
Benzoyl peroxide works on sebumproduction and actually can
kill that P acnes bacteria, andagain it's in lots of
over-the-counter products.
But there are higher strengthsavailable by prescription.
Isotretinoin, known as Accutane, is kind of one of our last
resorts.
It can be very effective.
It may permanently dry yourskin, though for the rest of
(34:34):
your life.
My one son says that his skinis just drier and a lot more
sensitive.
But if you might becomepregnant or you're planning to
become pregnant, it's a big fatno-no and there's a maximum dose
that you can take over yourlifetime.
So you need to know how muchyou've taken, because if you
(34:55):
ever go for a second course oftreatment down the road, which
sometimes is needed, it has tobe limited and you have to know
the amount that you've taken.
And we need to teach our teenshow not to pick at their face
and to get them early treatmentso they don't feel compelled to
(35:16):
do that.
As you move into your 20s, hityour stride.
You still may have acne, but ifyou've graduated from that, you
still need to prevent it andyou might want to use a good SPF
.
If you're in sunny Florida andyou want to use a daily
(35:40):
moisturizer, if you're planninga Caribbean spring break, use
your SPF during the day andbring a wide brim hat, because
really protecting yourself fromthe direct sunlight,
particularly when it's at itsstrongest, is the best.
But if you're avoiding sunexposure, then your vitamin D
(36:01):
levels may not be good.
So season one, podcast three,was everything about vitamin D,
and I can't emphasize the numberof conditions that can be
improved, reduced or preventedfrom adequate vitamin D.
Now in your 20s, you may want toreach for a retinoid agent.
Some are in over-the-countercreams or cleansers.
(36:23):
In low doses they do stimulatecollagen production or
anti-aging, and it's not justfor the face.
You can apply it to the neck aswell, because the neck tends to
get thinner first and a lot ofwomen take really good care of
their skin and they kind ofignore their neck and their
(36:44):
décollet area, which is thisarea.
Here, once you hit your 30s,hopefully, you've got your life
together and you already knowhow to take care of your skin,
but now you're busy with workand a family, maybe, and
planning for your future.
So sometimes we see somesignificant changes in the 30s
(37:10):
and the skin turnover tends toslow down, and this might be
when people start noticing someof their first signs of aging.
So this might be the time youneed to go from a lower potency
retinoid to something just alittle bit stronger, if you can
tolerate it, and you might needthis as a prescription from your
physician or your APP.
But it can be irritating to theskin, so you might want to
(37:33):
start every other day or mixingit with a moisturizer.
If your skin starts to flake orbecome more sensitive, then
back down and you might want toadd an acid-based serum to your
routine.
Vitamin C, of course, is mostimportant to get it in your diet
, but topical vitamin C can helpeven out skin tone, brighten
(37:55):
the skin and target signs ofaging.
I received a gift of someskincare products that had
vitamin C and also had topicalferric acid, which is iron,
which apparently can sometimeshelp brighten the skin.
Glycolic acid is similar to theretinoids and it boosts
collagen formation and helpfight, you know, those fine
(38:19):
lines and wrinkles.
Lactic acid is similar toglycolic acid, but less harsh
and it's a little bit moregentle to the skin.
I have used topical lachydrin,which is a pretty potent
concentration of it, on my armsand legs, as a moisturizer.
(38:42):
It's a little bit stinging, soit doesn't feel particularly
pleasant, but it is very goodfor the skin.
Chemical peels it's a procedurethat aims to accelerate the skin
(39:09):
exfoliation by using chemicalsubstances that result in
renewed, healthier looking skinand a more uniform complexion.
With one of our skincareestheticians, I finally got up
the courage to get that perfectpeel, and I did that over
Halloween.
I thought, well, if my skin'speeling and I look weird, I can,
it'll just fit with the season.
And I was really hesitant to doit because I had done one um
(39:31):
several years earlier and myskin was uncomfortable and I
just felt so irritable and eventhough it tightens up the pores
and kind of helped cleaned upsome of my acne, I just didn't
want to undergo it.
But that perfect peel was notdifficult and when you get that
fresh new layer of skin, it wasreally very nice Skin caring
(39:53):
your 40s Well, by then you wouldthink everything would be in
check.
But that's when perimenopausecan hit, and fluctuating
hormones it's like reversepuberty.
And then you have aging.
Maybe you havehyperpigmentation from too much
sun exposure, thinner skin,maybe loss of elasticity, dry
skin so you may have to use moremoisturizer.
(40:17):
Dry skin, so you may have touse more moisturizer.
Melasma, which we've talkedabout in other podcasts, the
mask of pregnancy I developedthat with my first son.
I had a doctor look at myforehead, saying wipe that dirt
off your forehead.
Like I went in the mirror andit's like I didn't see any dirt.
It was melasma.
But luckily hydroquinone, whichis a skin bleaching treatment,
(40:40):
can be used along with topicalretinoids and sometimes it's
mixed with a little potentsteroid that can only be used
for a short period of time,called Triluma.
There is hydroquinone over thecounter, but higher potency ones
need a prescription.
And if you're having a lot ofacne, even if you don't need
(41:03):
contraception some women havehad tubals or they don't need
contraception, for whateverreason.
Sometimes, if they're in goodhealth, with good blood
pressures and no history of DVT,we will prescribe hormonal
contraceptives just to clear uptheir skin.
Now skincare in your 50s andbeyond.
(41:24):
Usually by the 50s women haveentered menopause.
It's very unusual to go to thelate 50s or even up to 60.
That's very rare.
So most people have hitmenopause and certainly
postmenopausal hormone therapydoes help the skin.
It's not one of the officialreasons.
(41:44):
Medically we prescribe itbecause we women would do
anything for skin and hair.
But many times when I see olderwomen and I just look at their
skin.
I can tell who's been onhormone therapy and who has it.
I can tell who's been onhormone therapy and who hasn't.
There's a lot of these onlineplaces that prescribe hormones
(42:04):
without really any directsupervision.
Topical estriol on the skin.
I don't recommend that.
I recommend if you needestrogen, because you're low in
estrogen and you understand thebenefits and the risk that you
take it systemically.
Wrinkles and fine lines becomemore evident.
The skin can sag a little more.
There's firming creams andserums, and topical retinoids
(42:28):
still play significant roles andI think it's important.
I mean, a lot of women arereally happy that they have
their laugh lines and that theyare maturing with grace.
So when you're in your 50s andbeyond, you don't need to look
like you're 20.
That's for sure.
But this is the time you mightwant to start getting regular
(42:49):
skin checks for cancer, becauseskin cancer and other skin
conditions can increase.
So thank you so much forlistening to this episode.
Don't miss a future episode.
Hit, follow or subscribe onApple Podcasts or Spotify.
(43:09):
Tune in.
We're also on YouTube andRumble.
If you've enjoyed this episodeand you want to help or support,
please share it with others,donate to our non-profit or
leave a nice review.
Thanks again and I'll see younext time in the sunflower house
(43:31):
.
Remember, be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI'm back in the Sunflower House
for a new podcast for the summerpodcast.
(00:31):
For the summer, I'm going totalk all about the skinny on
acne and skin care for all ages,as we're wearing somewhat
lighter, skimpier clothes forthe long-awaited summer.
And while we're in the middleof summer, unfortunately acne
can worsen because it can be sohot and humid.
Your body perspires more andbeing exposed to the sun
(00:55):
certainly has a drying effect, apotential aging effect,
depending on how you'reprotecting yourself and what
skin is being exposed.
And when sweat mixes with oiland dead skin cells it can clog
the pores and the sun'skeratolytic effects, which is
(01:17):
kind of breaking down thekeratin in the skin.
It can lead to clogged poresand, paradoxically with aging,
the skin turnover sometimes isslower and it's not as efficient
at shedding.
And so a lot of people noticeas they get older they get
(01:38):
little milia, little bumps underthe skin of keratin skin
material.
And even though acne is thoughtto be quintessential time of
being a teenager, in fact,artemis, my oldest granddaughter
(02:00):
of the three I have threegranddaughters now with baby
Vivian Vira Vive, as in longlive.
She was just born in 2023.
Anyway, all threegranddaughters have beautiful
complexions, and when Artemisheard that acne is common in
(02:24):
teenage years, she told me Mimi,I am not going to be a teenager
, I'm going to skip that age.
And so there could be a lot ofthings that people might want to
skip about some of theawkwardness of you know, trying
to grow into your body and findyour own way and transition from
childhood to adulthood cancertainly be a challenging time,
(02:44):
and having you know big redbumps and altered skin certainly
can make it more challenging.
But unfortunately acne is notjust for teenagers.
Almost every week I have somewoman talk to me and say why am
I getting acne now, while I'mgetting wrinkles and dry skin?
(03:05):
And so actually at midlife,when there is a surge in the
stress hormones because of thelack of estrogen and the adrenal
glands which put out, theadrenal stress hormones can
actually increase acne becausethey're what we call more
androgenic, and some people arejust predisposed to acne their
(03:29):
whole life.
And it is frustrating to me atmy stage in life when I wake up
with a pimple on my face.
It does happen, and some peopledon't get any acne at all, and
so maybe you're one of those andthinking I can tune out for
(03:51):
this one, but chances arethere's someone in your circle
of loved ones that may have todeal with this.
And we will also talk about justgood skincare.
In fact, speaking of greatskincare, I met our skincare
estheticians at the ClevelandClinic back when my three sons
(04:12):
were in high school and havingacne.
And in males there's not asmuch many treatment options,
because one of the big treatmentoptions we offer for females is
hormonal contraceptives,because they'll suppress the
ovarian and the adrenalandrogens and can many times
(04:32):
beautifully clear up the skin.
And we've got an upcomingpodcast in the fall with Dana
Leslie, our wonderful I call herthe role model of all role
models of women's health andnurse practitioners, and we're
going to talk about how shecounsels and selects different
(04:56):
types of contraceptive agents inyounger women in terms of
looking at other medicalconditions.
So if you're geneticallypredisposed to acne or you've
ever had acne, you couldcertainly have acne again and
certain hormones can trigger it.
(05:16):
Certain bacteria can play arole, certain underlying skin
abnormalities, there'sdefinitely a genetic component
to it, and stress stress levelsincrease the stress hormones,
which can be bad on the skin andcertainly, like with everything
(05:38):
, your lifestyle, your nutrition, your vitamin status can play a
role, and there's definitelysome people who believe that
certain foods tend to triggeracne.
Most people don't say that, butthere are some people Now.
Acne can occur on differentparts of the body and I remember
(06:02):
when I was, and I remember whenI was getting towards the end
of my medical school career andwe got our test score results
and we were thinking about whattypes of specialties to go into,
and when I got my board scores,which were pretty high, I had a
(06:22):
lot of my friends andco-medical students like grab my
hand and say, wow, that's sogreat, you can apply to
dermatology.
And back then I thought, oh, Idon't want to take care of acne
and eczema and warts, and so Ithought no, no, no, dermatology
is not for me, because I kind ofdismissed it as maybe not those
(06:47):
conditions as not as seriousconditions as a lot of internal
medicine diseases, and I wasvery, of course, interested in
the differences between the twosexes and the manifestations of
disease and that really had notbeen very well explored even
after my medical school trainingand residency, and so it was
nice to be able to have a careerwhere I was a trailblazer in
(07:11):
this field.
And when I think about how kindof dismissive I was of skin
problems, it kind of showed alittle bit of a lack of maturity
, because the skin is thelargest organ in the body and
it's something that you know,you see at least most parts, at
(07:32):
least, of people's faces andhands and arms, and in the
summer sometimes a lot more skinand it's a very important organ
and there's a lot of differentthings that can happen to it.
And acne is not just a cosmeticproblem.
In fact, one of the firstpatients that I took care of
when I was a resident at theCleveland Clinic and at that
(07:54):
time I joined the clinic I wasplanning to specialize in
cardiology and I didn't want tomove my husband, you know, to
two different cities for bothresidency and fellowship.
So I thought I'll pick theplace I want to do the
fellowship and, with the clinicbeing number one in heart, I
thought that'll be good.
I'll do my both sets oftraining there and one of the
(08:17):
first cases I took care of was agentleman who had endocarditis,
which is infection of the heartvalve.
Gentleman who had endocarditis,which is infection of the heart
valve, and it was from acnepropionic bacteria, which is a
type of bacteria that isinvolved in the pathogenesis of
(08:39):
acne, and his acne was sosignificant and he was in his
forties, so he was not ateenager that the infection from
his skin seeded his heart valveand he, despite our best
efforts, actually succumbed anddied from the disease.
So that's obviously a prettydramatic example of what can
(09:02):
happen with acne example of whatcan happen with acne.
But that really did stick in mymind for my whole career about
how the skin is a very importantbarrier and anything that can
irritate it or cause aninfection can be
life-threatening, and infectionsthat occur specifically in this
area of the body that drainsdirectly into the brain can lead
(09:26):
to serious brain infections.
So when there's something wrongwith your skin, even if you
just think it's acne or eczemaor a wart that you're picking,
at many times it is important toget medical attention and to
understand that, even though wedon't routinely see people die
(09:47):
of bacterial infections like wedid in the pre-antibiotic era,
it still does happen.
So the parts of your body thatare more likely to get acne are
where you have more sebaceousoil glands and they're tiny
little oil-producing glands thatare definitely affected by
(10:08):
hormones.
So in children before pubertywe don't see acne and you have
the most sebaceous cyst on yourface, your upper back, the chest
, the neck and the upper arms.
So there's threeclassifications of acne mild,
(10:29):
moderate and severe.
And we discussed the causesbeing related to your genetics.
So if your parents have acne,you're more likely to have acne.
Hormonal fluctuations, anycondition that can increase oil
production from these sebaceousglands, any inflammatory state
(10:50):
and certainly if you eat ahighly inflammatory diet, you're
going to have a lot more skinproblems, that is for sure.
Sometimes the hair follicles arehyperkeratinized and that can
clog up the pores and thencertain bacterial colonization
(11:12):
on the skin can play a role inthe pathogenesis of acne.
If you have abnormal sheddingof the skin, of the sebaceous
glands and the upper section ofthe little hair follicles near
the opening of the pores, andthese skin cells can clog the
pore and form what's calledmedically a microcomodone, so
(11:37):
like a little miniaturewhitehead or blackhead.
Propionide bacterium acnes, orwhat's called P acnes, is a
bacterium that is normally foundon the skin, but in people with
acne it can grow abnormally topretty good levels and this
leads to inflammation and skinchanges and follicular
(12:00):
hyperkeratinization andalteration of the sebum, the oil
in the skin, and alteration ofthe sebum, the oil in the skin.
So, as we said, hormones doplay an important role and
that's why a lot of times acneis referred to as hormonal acne
(12:21):
and generally when you gothrough puberty and you go
through adrenarche, where youradrenal glands produce higher
levels of sex hormones, and thenmenarche, when the ovaries
start to kick in and ovulate.
But in both sexes the sexhormone levels increase and
regardless of gender you can getacne.
Now women can get later.
(12:43):
Acne related to hormonalfluctuations from pregnancy can
get later.
Acne related to hormonalfluctuations from pregnancy,
perimenopause and some forms ofhormonal contraceptives are what
we call more androgenic andworse on the skin, where others
are much less androgenic andvery favorable to the skin,
(13:05):
especially if they lowerandrogen levels.
It's not uncommon for me to getconsults from my dermatology
colleagues because they'resending me women who have
hormonal causes of skin and hairproblems from hormonal
imbalance.
So we talked about inflammationfrom the diet playing a role.
Some people have classicallyargued that the diet is less
(13:28):
significant, but I think overtime our diet has gotten more
inflammatory and I think we havemore bad things in our food
supply.
Last fall, if you didn't hearmy podcast on banned foods in
other countries that areavailable in America, that's
really one to listen to.
(13:49):
Now.
Some medications can increaseacne and some occupational
chemical exposures, but thesetypes of acne are different than
the common acne vulgaris.
Vulgar means common and ofcourse, a lot of us who have
(14:09):
acne think it's rude that wehave it.
It's rude of our body to allowus to have acne.
So, moving on to treatment,adult acne can be treated with
medication, lifestyle changesand, of course, changes in your
diet.
(14:29):
So let's start with what's thebest diet for acne.
What are some good foods to eat?
Maybe foods you should avoid,and are there any supplements
that you might want to consider?
So, in general, when talkingabout skin health, when we talk
about foods to avoid, in generalfoods that have a high glycemic
(14:51):
index, and that's a measure ofhow fast or how slow you break
down food, how fast it spikesyour blood sugar.
So foods that have a very highglycemic index can cause
dramatic ups and downs in bloodsugar and that can make acne
worse.
(15:11):
Some people can feel shaky andhave reactive hypoglycemia, and
so some of these foods are liketeenage favorites, like soda and
candy and sugary cereals andice cream and candy cereals and
(15:31):
ice cream and candy.
So a little bit of ice cream orcandy, you know, for a certain
holiday may be fine, but ingeneral, people of all ages
should avoid excessive sugar andsweets.
As I've said, there's no suchthing as an essential
carbohydrate.
We have essential amino acidproteins and two essential fats.
So other things to avoid wouldbe highly processed foods Again
(15:56):
chips, fast food, microwavablemeals Again, those can be
popular amongst young peopleamongst young people, and
limiting these sweets and sugarsand candies and cakes and
sports drinks and energy drinksand cookies are certainly a good
idea.
(16:17):
Some people find that dairy andor whey protein irritates their
skin and joints, so dairyproducts like milk and cheese
and yogurt do promote insulinsecretion and the production of
some hormones, and then somepeople can contribute to acne.
Being an osteoporosis doctor,I'm very fond of the dairy foods
(16:40):
because they're great for yourbones, and if you haven't caught
my column and podcast oneverything about cheese and why
cheese can be good for you, thatis certainly one to go back and
listen to, and a lot of youngpeople use whey protein
supplements as mealsubstitutions or in part of
(17:02):
their pre-workout, because wheyprotein is great for tendons and
muscles.
It's good for tendon repair.
So I think doing a dietarysurvey in patients is a good
thing to do and sometimes thatcan lead to some things that we
can do differently.
You have been listening to theSpeaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, back in the Sunflower House
(17:26):
this summer for a podcast oneverything acne and skin health.
So what are some good foods toeat?
Well, obviously your vegetablesbroccoli, spinach, kale,
peppers, carrots Both peppersand carrots are rich in vitamin
A.
Vitamin A kind of gives a nicelittle glow to the skin and
(17:50):
vitamin A actually can be veryhelpful if a child has measles.
There's been studies looking atgiving vitamin A.
So that directly helps the skin, just like vitamin C helps and
a lot of skin conditions.
There's excessive skin turnoverand there may be higher
requirements for vitamin C helpsand a lot of skin conditions.
There's excessive skin turnoverand there may be higher
(18:10):
requirements for vitamin C.
So vitamin C foods like berriesand oranges and apples and
bananas, cherries and grapefruitgood old cherries we talked
about in the gout podcast it'sone of the fruits that do really
help lower uric acid levels.
And whole grains, sweet potato,also rich in vitamin a, brown
(18:35):
rice, quinoa, butternut squash.
And then you want heart healthyfats.
They're also good for the skin,like whole eggs and olive oil
and avocado, coconut oil, andvarious healthy nuts and seeds,
omega-3s, which so many peopledon't get enough of.
(18:58):
They're in fish and certainnuts and seeds, like chia seeds
and walnuts, and almonds andflax flax oil.
The omega-3s are very important.
Whenever I have a womancomplaining of dry skin, dry
eyes, worsening eczema, skinthat just doesn't glow as much
(19:19):
as it did before joint aches,mood changes, brain fog I
frequently will find that theomega-6 to omega-3 ratios are
off, and if you haven't read mycolumn on omega-3 or listened to
the podcast on that, it's agood one to go back to Now.
(19:41):
Some plant-based dairyalternatives can include almond
milk and coconut milk, soy milk,cashew milk.
And high quality protein isalways important for the skin,
the bones, the muscle, themetabolism, the brain.
(20:01):
So high quality proteins likesalmon, eggs, shellfish, chicken
, turkey eggs, tofu they're allexcellent sources of protein.
Some have more purine contentthan others, some have more
omega-3 content than others, butin general they pack a good
(20:25):
punch for the calories to thenutritional ratios Legumes like
black beans and chickpeas andlentils, and there's a lot of
herbs that are anti-inflammatory, like cinnamon, black pepper,
turmeric very anti-inflammatorygarlic, ginger, parsley.
(20:48):
So eating a nutrient-dense,anti-inflammatory diet can
certainly help treat and preventmany conditions or at least
help moderate them, things likeacne.
It's important to drinkunsweetened drinks like uh, like
(21:08):
lots of water, green tea,hibiscus tea, um, lemon water
and hibiscus tea and lemon wateruh are good at also helping to
lower uric acid, which isinflammatory.
Supplements for acne vitamin D.
(21:28):
Research has shown that lowvitamin D levels can worsen acne
and over half of people withacne have low vitamin D.
So if you live in a Northernclimate, like we live here in
Cleveland, ohio, especially inpeople over 40, because the skin
doesn't make it as well, plus,a lot of people that are adults
(21:48):
are inside working.
They're not running aroundoutside playing sports and
swimming and getting to enjoyall the outdoor activities
during the sunlight.
Interestingly, green teaextract there was a study of
women with moderate to severeacne and those that boosted
their green tea intake or took agreen tea extract.
For four was a study of womenwith moderate to severe acne and
those that boosted their greentea intake or took a green tea
(22:10):
extract for four weeks did havean improvement in their skin.
I try to drink green teaseveral times a week.
Fish oil or omega-rich fishessuch as fish rather, such as
mackerel, salmon, sardines,anchovy, caviar, herring, trout,
(22:37):
to name a few of my favorites.
If you're not a fish fan,sometimes your physician may
recommend certain types of fishoil supplements.
The results are somewhat mixed.
Some people can actually haveworsening symptoms.
So you really want to do thisunder the guise with your
(22:59):
healthcare team.
B vitamins Supplementing with Bvitamins may benefit people
with acne, but interestingly,high dose injections of B12 may
induce acne in some people,interestingly.
And there's people who don'thave B12 deficiency who just go
to these health spas or go totheir physician to say give me a
(23:20):
B12 shot, kind of like aplacebo, basically.
So again, if you don't need it,it's not good just to take it
to take it.
Zinc Oral zinc supplements canimprove some acne severity and
zinc does play a crucial role inhelping the immune system, the
mood and fighting off virusesand maintaining skin health, and
(23:44):
increasingly I've been doingmore zinc levels and finding a
lot of women that I thoughtpreviously were unhealthy diets
have some low levels.
Vitex Vitex agnus castus is alsoknown as chaseberry, and
sometimes herbalists and otherintegrative doctors may
recommend chaseberry to reduceacne before menstruation because
(24:08):
it might lower some of the sexhormones.
But I really think moreresearch is needed.
If something's not a food orit's not a drug, it isn't
regulated, so it is.
Buyer, beware Barberry Berberisvulgaris.
Barberry has anti-inflammatoryand antibacterial properties,
(24:29):
and so some people recommendsupplementing with barberry
extract based on some studies.
But again, I think you shoulddo this under the recommendation
of either integrative medicineor functional medicine physician
or an herbalist, or at leasttalk with your dermatologist or
family medicine physician aboutthis.
Probiotics and prebiotics thereis some research that shows
(24:55):
that the bacteria in your gutmay reduce skin inflammation and
therefore reduce acne.
So many things are linked toour gut microbiome and really
the research in this area israpidly exploding.
In addition to eating a healthydiet and seeing your health care
(25:15):
team bringing in anysupplements that you may take,
just because they're notprescription doesn't mean you
don't need to bring them in.
Certainly, quit smoking if yousmoke.
Smoking ages the skin.
It's full of toxins, itincreases wrinkling around your
mouth Lots of places.
It's socially unacceptable,it's expensive.
(25:36):
It's highly addictive and ifyou do smoke and you want to
stop smoking, we have some greatsmoking cessation resources on
our website, as well as apodcast on smoking cessation.
It's also a good idea to limityour alcohol intake and get
plenty of sleep.
If you're sleep deprived, likeso many Americans, your stress
(25:59):
hormones are up, and if you'rehaving trouble sleeping, go back
and listen to some of our greatpodcasts on sleep wonderful
sleep tips and I promise you thepodcast won't put you to sleep,
but we'll help you sleep later.
Obviously, learning how tomanage stress and understanding
what proper skincare is and eventhough I'm a woman, I'm a
(26:21):
physician.
I really learned a lot when Iwas interviewing Lori Skarsgård,
our head skincare esthetician,as well as Amanda, who is not
currently an esthetician at theCleveland Clinic, but she was a
wonderful interview on skincareand if you didn't listen to that
(26:43):
or you just need a refresher, Ialways learn something when I
listen to them.
It's a good one to go back to.
So, moving on to your facialskincare, for acne prone skin,
it's very important to have acleanser specifically formulated
for acne.
They usually contain salicylicacid, which helps get rid of the
(27:04):
extra keratin in the skin, orbenzoyl peroxide, which can
inhibit the bacteria on the skin.
You want to clean your facegently, because if you are
traumatizing your skin trying toexfoliate too roughly, that can
(27:25):
actually worsen acne outbreaksand cause scarring, and that's
one of the reasons why, even ifsomeone's not bothered by
cosmesis, they're not botheredby their acne.
It's important to treat itbecause scarring can be
permanent and skin infectionscan take root that occasionally
can lead to serious consequenceslike sepsis.
I've seen people get boneinfections from skin infections
(27:47):
where they have to get home IVantibiotics for six weeks or
longer or a new heart valve.
So it is important to care foryour skin because it's a barrier
between our internal organs andthe parts of our body that
aren't supposed to have anybacteria in them.
You want to somewhat minimizeyour use of facial moisturizers
(28:12):
and if you do need a facialmoisturizer which, of course, a
lot of us women need as we'regetting older you want a light,
non-comedogenic moisturizerwhich doesn't aggravate acne,
(28:33):
and it's best, if you're goingto use a foundation, to use an
oil-free one and avoid heavymakeups or cosmetic products
that can block the pores.
Now, beta-hydroxy acid orsalicylic acid does help improve
acne and even if you don't haveacne.
It can be very nice for kind ofclarifying the skin and the
color and the texture.
It does penetrate oil-ladenhair follicles and as such helps
(28:54):
reduce acne formation.
There's a lot of differentproducts over the counter and
some do require a physician'sprescription.
Now hormonal therapy for acne Intheory, most any
estrogen-containing hormonalcontraceptive should help if
it's used for three to sixmonths.
(29:15):
But there's only some that areFDA approved.
Orthotricycline was the firstone.
It has athenolestrogile withdiffering doses of norgestimate,
yaz, yasmin Biaz, safral.
They have athenol, estradioland drosperinone, which is like
(29:37):
spironolactone.
Those have specific FDAapproval for acne.
Now, when I first started onhormonal contraceptives in
medical school, I was on alevonorgestrel brand and I still
had the same amount of acne.
And then, finally, when I gotto my endocrine rotation and I
learned more about the differenttypes of progestins, which are
(30:03):
actually C21, more androgens,but they function to protect the
uterus, I realized I was on thewrong hormonal contraceptive
and so I got on a non-androgenicone and, oh my, did my skin
significantly clear up and Ireally had wished I would have
done that sooner.
(30:24):
Now, body acne, back, knee.
That is a really tough problemand it's not as cosmetically
affecting, except it is in thesummer, of course.
But when it happens on the back, arms, shoulders and neck it
can be particularly difficult totreat.
It doesn't seem to be asamenable to Accutane, which is a
(30:47):
very potent treatment.
One of my sons and my nephewand niece had severe enough acne
that they needed to go onAccutane and there can be really
dramatic effects.
But it has to be very closelymonitored.
There can be some significantside effects, so it's not
something to just jump intoloosely and whoever you see has
(31:13):
to be able to prescribe it andmonitor it.
Whoever you see has to be ableto prescribe it and monitor it.
So you want to avoid tight,constrictive clothing or rubbing
up against the skin with apurse or a backpack.
You always want to stayhydrated.
You don't want to pick at orpop pimples.
I know a lot of these YouTubevideos with Dr Pimple Popper are
(31:34):
very popular, but do not dothis.
You could really get a seriousinfection or scarring.
Some of the treatments for acneon the back some have suggested
tea tree oil, which has someantifungal effects.
Warm compresses apple cidervinegar can be applied.
(31:55):
Diluted three parts water toone part apple cider vinegar.
Oatmeal baths can calm the skin.
Topical benzoyl peroxide,salicylic acid and topical
adapalene different, and that0.1% and 0.3% are now
over-the-counter oroff-the-shelf without a
prescription are now over thecounter or off the shelf without
(32:15):
a prescription.
Many times a dermatologist mayneed to prescribe stronger
topical creams, topicalretinoids, prescription strength
benzoyl peroxide or evenanti-inflammatory antibiotics
like doxycycline.
If you're pregnant orbreastfeeding, though, you
(32:42):
cannot take doxycycline.
It's a tetracycline.
It can permanently stay in theteeth of the forming baby or
child.
So since we're in the middle ofa lot of sunshine, I do want to
also talk about skin care themust-haves for the decade, and
they're also good tips foranyone who has acne of any age
or anyone who just wants to havegood skin.
(33:03):
So we tend to be a little bitmore in tune with the changes in
our body as we age.
But just like the rest of ourbody changes with age, so does
the skin and sometimes theskincare routine needs to be
changed.
So in the teen years, acne andfluctuating hormones can be a
(33:24):
big issue, and if you're afemale and you're a candidate
for hormonal contraceptives evenif you don't need contraception
but you just want to have apotent treatment for acne, it
would be good to see yourphysician.
In fact, females generally whoare going on Accutane, since it
(33:47):
can cause such teratogeniceffects in a forming baby, are
required to be on hormonalcontraceptives even if they're
not sexually active, justbecause of that risk.
Salicylic acid can be veryhelpful in teens.
It's over the counter in lotsof cleansers, lotions or some
(34:13):
facial washes.
Benzoyl peroxide works on sebumproduction and actually can
kill that P acnes bacteria, andagain it's in lots of
over-the-counter products.
But there are higher strengthsavailable by prescription.
Isotretinoin, known as Accutane, is kind of one of our last
resorts.
It can be very effective.
It may permanently dry yourskin, though for the rest of
(34:34):
your life.
My one son says that his skinis just drier and a lot more
sensitive.
But if you might becomepregnant or you're planning to
become pregnant, it's a big fatno-no and there's a maximum dose
that you can take over yourlifetime.
So you need to know how muchyou've taken, because if you
(34:55):
ever go for a second course oftreatment down the road, which
sometimes is needed, it has tobe limited and you have to know
the amount that you've taken.
And we need to teach our teenshow not to pick at their face
and to get them early treatmentso they don't feel compelled to
(35:16):
do that.
As you move into your 20s, hityour stride.
You still may have acne, but ifyou've graduated from that, you
still need to prevent it andyou might want to use a good SPF
.
If you're in sunny Florida andyou want to use a daily
(35:40):
moisturizer, if you're planninga Caribbean spring break, use
your SPF during the day andbring a wide brim hat, because
really protecting yourself fromthe direct sunlight,
particularly when it's at itsstrongest, is the best.
But if you're avoiding sunexposure, then your vitamin D
(36:01):
levels may not be good.
So season one, podcast three,was everything about vitamin D,
and I can't emphasize the numberof conditions that can be
improved, reduced or preventedfrom adequate vitamin D.
Now in your 20s, you may want toreach for a retinoid agent.
Some are in over-the-countercreams or cleansers.
(36:23):
In low doses they do stimulatecollagen production or
anti-aging, and it's not justfor the face.
You can apply it to the neck aswell, because the neck tends to
get thinner first and a lot ofwomen take really good care of
their skin and they kind ofignore their neck and their
(36:44):
décollet area, which is thisarea.
Here, once you hit your 30s,hopefully, you've got your life
together and you already knowhow to take care of your skin,
but now you're busy with workand a family, maybe, and
planning for your future.
So sometimes we see somesignificant changes in the 30s
(37:10):
and the skin turnover tends toslow down, and this might be
when people start noticing someof their first signs of aging.
So this might be the time youneed to go from a lower potency
retinoid to something just alittle bit stronger, if you can
tolerate it, and you might needthis as a prescription from your
physician or your APP.
But it can be irritating to theskin, so you might want to
(37:33):
start every other day or mixingit with a moisturizer.
If your skin starts to flake orbecome more sensitive, then
back down and you might want toadd an acid-based serum to your
routine.
Vitamin C, of course, is mostimportant to get it in your diet
, but topical vitamin C can helpeven out skin tone, brighten
(37:55):
the skin and target signs ofaging.
I received a gift of someskincare products that had
vitamin C and also had topicalferric acid, which is iron,
which apparently can sometimeshelp brighten the skin.
Glycolic acid is similar to theretinoids and it boosts
collagen formation and helpfight, you know, those fine
(38:19):
lines and wrinkles.
Lactic acid is similar toglycolic acid, but less harsh
and it's a little bit moregentle to the skin.
I have used topical lachydrin,which is a pretty potent
concentration of it, on my armsand legs, as a moisturizer.
(38:42):
It's a little bit stinging, soit doesn't feel particularly
pleasant, but it is very goodfor the skin.
Chemical peels it's a procedurethat aims to accelerate the skin
(39:09):
exfoliation by using chemicalsubstances that result in
renewed, healthier looking skinand a more uniform complexion.
With one of our skincareestheticians, I finally got up
the courage to get that perfectpeel, and I did that over
Halloween.
I thought, well, if my skin'speeling and I look weird, I can,
it'll just fit with the season.
And I was really hesitant to doit because I had done one um
(39:31):
several years earlier and myskin was uncomfortable and I
just felt so irritable and eventhough it tightens up the pores
and kind of helped cleaned upsome of my acne, I just didn't
want to undergo it.
But that perfect peel was notdifficult and when you get that
fresh new layer of skin, it wasreally very nice Skin caring
(39:53):
your 40s Well, by then you wouldthink everything would be in
check.
But that's when perimenopausecan hit, and fluctuating
hormones it's like reversepuberty.
And then you have aging.
Maybe you havehyperpigmentation from too much
sun exposure, thinner skin,maybe loss of elasticity, dry
skin so you may have to use moremoisturizer.
(40:17):
Dry skin, so you may have touse more moisturizer.
Melasma, which we've talkedabout in other podcasts, the
mask of pregnancy I developedthat with my first son.
I had a doctor look at myforehead, saying wipe that dirt
off your forehead.
Like I went in the mirror andit's like I didn't see any dirt.
It was melasma.
But luckily hydroquinone, whichis a skin bleaching treatment,
(40:40):
can be used along with topicalretinoids and sometimes it's
mixed with a little potentsteroid that can only be used
for a short period of time,called Triluma.
There is hydroquinone over thecounter, but higher potency ones
need a prescription.
And if you're having a lot ofacne, even if you don't need
(41:03):
contraception some women havehad tubals or they don't need
contraception, for whateverreason.
Sometimes, if they're in goodhealth, with good blood
pressures and no history of DVT,we will prescribe hormonal
contraceptives just to clear uptheir skin.
Now skincare in your 50s andbeyond.
(41:24):
Usually by the 50s women haveentered menopause.
It's very unusual to go to thelate 50s or even up to 60.
That's very rare.
So most people have hitmenopause and certainly
postmenopausal hormone therapydoes help the skin.
It's not one of the officialreasons.
(41:44):
Medically we prescribe itbecause we women would do
anything for skin and hair.
But many times when I see olderwomen and I just look at their
skin.
I can tell who's been onhormone therapy and who has it.
I can tell who's been onhormone therapy and who hasn't.
There's a lot of these onlineplaces that prescribe hormones
(42:04):
without really any directsupervision.
Topical estriol on the skin.
I don't recommend that.
I recommend if you needestrogen, because you're low in
estrogen and you understand thebenefits and the risk that you
take it systemically.
Wrinkles and fine lines becomemore evident.
The skin can sag a little more.
There's firming creams andserums, and topical retinoids
(42:28):
still play significant roles andI think it's important.
I mean, a lot of women arereally happy that they have
their laugh lines and that theyare maturing with grace.
So when you're in your 50s andbeyond, you don't need to look
like you're 20.
That's for sure.
But this is the time you mightwant to start getting regular
(42:49):
skin checks for cancer, becauseskin cancer and other skin
conditions can increase.
So thank you so much forlistening to this episode.
Don't miss a future episode.
Hit, follow or subscribe onApple Podcasts or Spotify.
(43:09):
Tune in.
We're also on YouTube andRumble.
If you've enjoyed this episodeand you want to help or support,
please share it with others,donate to our non-profit or
leave a nice review.
Thanks again and I'll see younext time in the sunflower house
(43:31):
.
Remember, be strong, be healthyand be in charge.
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