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Natamar

Female, Sudden Acne After 40 - Advice Will Be Appreciated!

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Hello All,

(I am a new subscriber, so I would appreciate if you tell me how I should specify the tags, where I should better place this topic, etc.)

I am a 43-year-old female from Russia. Sounds a bit exotic, but I am a semi-professional translator, so I hope there will be no language barrier.

My problem is rather weird, because I haven't seen any analogs of my situation in Russian or American message boards. But maybe you can give me some advice.

Generally, acne hasn't been a problem most of my life, even in adolescence. A couple of zits before each period, that's all. There were, however, two more or less recent unpleasant episodes: one in the first trimester of my last (third) pregnancy, when I was 37, and one several months after the end of my last breastfeeding, when I was 39. Each time I had some breakouts on my forehead for several months, which then went away without any treatment. They could be either hormonal or due to the fact that I was physically very exhausted at the time.

And then last year. It was difficult for me in many respects. First, it was VERY stressful, and I felt tired even after having a seemingly good rest in summer. Second, I lost weight, just several pounds - but I generally look skinny, so that wasn't good at all. Third, during one of the stresses, I developed an ovarian cyst. And after all of that, in the middle of October - painful zits. Not too glad to see you.

My main problem zone was the forehead (there were also several milia in the nasolabial folds, but this was a minor problem). The strange thing was that my skin wasn't greasy at all. Actually, it remained moderately dry - and, alas, dehydrated. But the sebum suddenly became thick rather than fluid - and got trapped in pores. There weren't many comedones, but each, once formed, immediately got inflamed. Cysts also started to appear, but excluding sugar from my diet happened to be helpful in this respect (unfortunately, papulopustular spots were still there).

And another weird thing was that my breakouts usually took place in the first half of my menstrual cycle, rather than the traditional second half. Seems that my hormones just went out of order, although the cycle was still clockwork regular. The blood tests came back normal (they didn't measure estrogen, FSH or progesterone, alas, but testosterone, prolactin and DHEA-S were quite OK). Also, I had normal - even rather low - blood sugar and cholesterol.

After 2.5 months of this acne, I got on BCP for three months - basically, to get rid of the ovarian cyst. It is gone now, and the skin became clear the second month on the pill. However, the hematologist is not happy with my going on the pill for a long time at this age, and so presently I am quitting it. Naturally, I am afraid that the acne will be back.

I have managed to gain the lost weight. I have also switched to a healthier diet - no sugar, no coffee, no fast food, moderately low carbs. The dermatologist has also advised me to take B vitamins (B1+B6+B12 - alas, B5 is not on sale in Russia), retinol (not high doses), vitamin E (also not high doses), omega 3-6-9 fatty acids, and something to calm me down during stresses. I am also taking zinc, which seems to improve my physical condition and mood greatly. Unfortunately, it seems that I cannot take evening primrose oil, because it gives me... well, not exactly headaches, but a VERY bizarre feeling, perhaps due to its effect on intracranial pressure. I'll try to raise the dose gradually, but there is not much hope.

As to topicals, my experience with BP wasn't exactly good, because the acne marks became very red and didn't fade at all. I am quite happy with Skinoren (azelaic acid), although I don't think it can solve my problem completely. No experience with retinoids.

So - my questions.

1. What, in your opinion, could be the most likely reason for such a breakout at this estimable age? (approaching premenopause? ovarian cyst? stress? weight loss?) What hormones, etc., should I check now, after going off the pill?

2. What can you advise me to prevent future breakouts without going back to the pill? I know about spiro and saw palmetto, but my levels of androgens don't seem to be high, so I don't know if these things can be efficient.

Thank you very much for reading this! My case isn't really severe, it is just that I feel at a loss. Or maybe your situation is somewhat similar to mine - then share your experience, please!

Edited by Natamar

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You need to get your estrogen and progesterone tested. It sounds like it could be low estrogen since you lost weight, you breakout i the beginning of the cycle, and your test was low.

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You need to get your estrogen and progesterone tested. It sounds like it could be low estrogen since you lost weight, you breakout i the beginning of the cycle, and your test was low.

Yes, this is one of my suspicions (although the thickness of the endometrium was normal on the ultrasound). But if it is low indeed - can anything be done without BCP? Since my menstrual cycle is still regular and I even seem to ovulate nearly every month, it seems that nobody will discuss HRT with me now?

I have read your answer in another topic - that gaining weight and including carbs in your diet was good for you. I don't have PCOS, but I am really interested in what else helped you.

Edited by Natamar

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Unfortunately at our age doctors don't usually like to prescribe BCP or HRT. You case sounds like hormone fluctuation due to abrupt physical changes...ie pregnancy, breast feeding, and now most likely high stress or perimenopause. You may have totally normal hormone readings but still be sensitive to androgens. This means that when extreme hormone fluctuations occur you respond negatively to the increase in androgens. This is why spiro works so well...it blocks the androgen receptors in certain areas of the body such as the skin. Have you ever tried spiro?

I know what it is like to dread what might happen! Your body seems to go in phases as opposed to constantly breaking out like most of us here. I wish I had your situation! This seems to be the pattern in your adult life so it will most likely continue this way and is unlikely to suddenly change and become constant. If you are worried about going through a rough patch every several years then you may want to talk with a dermatologist about the best approach. You could put in place a good skin care regime to address keeping pores as clear as possible. Then when your hormones go haywire you are prepared for the increase and change in sebum. Hopefully that will mean less breakouts!

My derm promotes microdermabrasions every month or so to really exfoliate and keep pores clear. You may want to use an exfoliating cleanser a couple times a week. Having a topical antibiotic on hand might be helpful. You could wash with a BP cleanser. That will fight any lingering acne bacteria. I too can't tolerate BP as a topical but as a cleanser it works fine.

I too cannot tolerate evening primrose oil. My doc says to stick with fish oil. I would shy away from B vitamins except for in your multivitamin because some of the B's in high doses have been known to aggravate acne. Try instead eating a low GI diet, avoid sugars, dairy, alcohol, red meat, junk foods, etc., and concentrate on whole grains, fresh foods, organic, etc. --- this will give you eneough B's.

Take a probiotic from the health food store. It should be refrigerated. Tell staff that you need a good one for skin health. There are different strengths and formulations. This becomes much more important as we age because our gut doesn't work as well. When hormones go haywire it affects the whole body...and some doctors think this may originate in the gut when bacteria get out of whack. The result is an increase in inflammation everywhere and if your weak area is your skin it will manifest as acne.

Since you don't break out all the time it will be hard to know if your regime is working or not. But your skin should look healthy and bright.

Hope this helps! Just finished reading a novel that took place in Russia. Sounds like an incredible place!

Edited by cvd

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Thank you very much for your concern! Actually, I will be very happy if this issue is really temporary. I am just afraid - can't it become more permanent now that I am entering early perimenopause (the only sign so far being a shorter menstrual cycle)? Or maybe the skin will adjust somehow? Who knows... it is very frustrating at this age, and I was unprepared.

I know about spiro, but seems it will be the last resort in my case - so before it I'd better try something else. I also know about saw palmetto, which is said to act in a subtler way. So there are still some things to try. But... so far I want to attempt going without them. If zits become unbearable - well, at least these things are always at hand. In Russia we can buy them without a derm's prescription. Also, I can try peppermint tea or licorice, or some other 'estrogenic' herbs.

I am not experienced in exfoliating. Can you advise something for moderately dry skin? I'll try to find analogs in our pharmacies.

What is a BP cleanser - I mean, what is the concentration of the active agent? And how should I use it - after washing and before applying the moisturizer? Or in some other way?

Avoiding dairy didn't help me at all (I've tried). But a low GI diet seems to be good indeed. To tell the truth, I have been a poor eater most of my life (coffee - sandwich - coffee - biscuit - milk - coffee...), but I am becoming a good girl at last. Hope this will help, at least partially.

Again, thank you very much for your concern! It is so important for me to be able to share my problem with somebody!

Wish you good luck!

p.s. By the way. I am just worried - is my written English OK? I know that it is quite understandable, but does it look 'obviously translated' or not? After all, acne isn't everything, I also have to think about my professional skills. :-)

What is the title of the novel that you have read?

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You need to get your estrogen and progesterone tested. It sounds like it could be low estrogen since you lost weight, you breakout i the beginning of the cycle, and your test was low.

Yes, this is one of my suspicions (although the thickness of the endometrium was normal on the ultrasound). But if it is low indeed - can anything be done without BCP? Since my menstrual cycle is still regular and I even seem to ovulate nearly every month, it seems that nobody will discuss HRT with me now?

I have read your answer in another topic - that gaining weight and including carbs in your diet was good for you. I don't have PCOS, but I am really interested in what else helped you.

You really need a complete hormonal panel and that includes estrogen/progesterone, etc.

My cycle was like clockwork, but I wasn't ovulating. I didn't believe the MD's when they told me that, because how could it be so regular if I wasn't ovulating? I got an ovulator test kit and sure enough, I wasn't.

My acne and hair issues (androgens) got really out of whack when I tried the no sugar/no carbs diet. It got better when I went back to a regular healthy diet.

Later, antiandrogens helped, but they messed up my stomach very badly so I just finally stopped taking them. I'm now using Bp. The only supplement I take is omegas. I sometimes chew on a vit. C tablet, but I am easing into that since it's an acid and I had GERD & ulcers from the AA's. I'm not a big supplement person.

You could have perfectly normal hormones, I did, but still be sensitive to androgens like the other poster said. But you need to find out if your estrogen and progesterone are normal first to rule that out.

I suspect I'm perimenopausal now, because most people my age are.

If a low GI helps you then you should do that. You may be IR.

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Hi Natamar

The cleanser I use is called "Panoxyl 4". It has benzoil peroxide in a specially formulated solution that is gentle to the skin. I have very sensitive skin and thus far it is okay. I'm not that experienced in exfoliating either. It was my dermatologist who recommended the monthly microdermabrasions (I've had 2 thus far) and the lady who does it recommended I use an exfoliating cleanser once or twice a week. I am calling my dermatologist tomorrow to ask what he recommends. Exfoliation is usually done with a cleanser that has microbeads in it. It is used just like any other cleanser only less frequently depending on your skin type and issues. And then moisturiser is put on.

Your english is great. The book I read is called "Alicia" and is the autobiography of a Polish Jewish girl who survived Hitler. She meets many sympathetic Russians who help her survive. You get a feel for that part of the world and the Russian people. I was very moved by her story and the bravery of people who opposed the Nazi regime.

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Actually, I suspect that I do ovulate (there are certain objective mid-cycle changes, I would prefer not going into details). The month I didn't ovulate, the cycle was several days longer, and it was probably then that I got the ovarian cyst.

The no carbs diet is probably bad when a person is skinny (I guess you are also on the underweight side?). No carbs = less body fat = less estrogen. But a moderately low GI diet can be fine.

Did you hair/skin situation improve with age? They say that is often happens to women in perimenopause who have PCOS.

I don't know if I am insulin resistant. I have normal blood insulin level, low (somewhere near the nadir reference value) fasting glucose level, low "bad" cholesterol and, as I have already said, no signs of obesity. What should I check to know for sure?

Doing a complete hormonal panel is a good idea (albeit expensive). I'll try to find the information as to what hormones should be measured on what days. My gyno doesn't seem to be interested in the problem, so I'll have to take matters in my own hands (and, alas, for my own money).

Thank you very much for replying!

Edited by Natamar

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Hi Natamar

The cleanser I use is called "Panoxyl 4". It has benzoil peroxide in a specially formulated solution that is gentle to the skin. I have very sensitive skin and thus far it is okay. I'm not that experienced in exfoliating either. It was my dermatologist who recommended the monthly microdermabrasions (I've had 2 thus far) and the lady who does it recommended I use an exfoliating cleanser once or twice a week. I am calling my dermatologist tomorrow to ask what he recommends. Exfoliation is usually done with a cleanser that has microbeads in it. It is used just like any other cleanser only less frequently depending on your skin type and issues. And then moisturiser is put on.

Your english is great. The book I read is called "Alicia" and is the autobiography of a Polish Jewish girl who survived Hitler. She meets many sympathetic Russians who help her survive. You get a feel for that part of the world and the Russian people. I was very moved by her story and the bravery of people who opposed the Nazi regime.

Thank you very much, I'll look what Panoxyl is. And I am looking forward to hearing about exfoliation!

Yes, there are quite a number of compassionate people in Russia (I sometimes work for various charities, and it is always a pleasure to see people willing to help). However, I don't think that we are unique in this regard. ;-)

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Actually, I suspect that I do ovulate (there are certain objective mid-cycle changes, I would prefer not going into details). The month I didn't ovulate, the cycle was several days longer, and it was probably then that I got the ovarian cyst.

The no carbs diet is probably bad when a person is skinny (I guess you are also on the underweight side?). No carbs = less body fat = less estrogen. But a moderately low GI diet can be fine.

Did you hair/skin situation improve with age? They say that is often happens to women in perimenopause who have PCOS.

I don't know if I am insulin resistant. I have normal blood insulin level, low (somewhere near the nadir reference value) fasting glucose level, low "bad" cholesterol and, as I have already said, no signs of obesity. What should I check to know for sure?

Doing a complete hormonal panel is a good idea (albeit expensive). I'll try to find the information as to what hormones should be measured on what days. My gyno doesn't seem to be interested in the problem, so I'll have to take matters in my own hands (and, alas, for my own money).

Thank you very much for replying!

I know what you're talking about re the mid month changes. I had them too, but when I tested, no ovulation. It was hard for me to believe too, but Ovulation kits don't lie (I don't think).

I was thin, but not underweight, but didn't have a lot of body fat. After I started the diet, I was very underweight.

My hair and skin issues have gotten worse with age.

A GTT (Glucose Tolerance Test) is the best one, but it's a pain and probably expensive.

Good luck!

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I know what you're talking about re the mid month changes. I had them too, but when I tested, no ovulation. It was hard for me to believe too, but Ovulation kits don't lie (I don't think).

I was thin, but not underweight, but didn't have a lot of body fat. After I started the diet, I was very underweight.

My hair and skin issues have gotten worse with age.

A GTT (Glucose Tolerance Test) is the best one, but it's a pain and probably expensive.

Good luck!

Thank you very much! Good luck to you, too! Hope your BP regimen will be efficient.

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Hi Natamar - I have recently discovered a very good, gentle exfoliator. It's by Dermalogica and it's called 'Gentle Cream Exfoliant' - you use it like a face mask 2-3 times a week. It is non-abrasive and has lactic acid in it. After using it my (sensitive) skin feels very soft and smooth. There are some good reviews of it on Makeup Alley.

I am struggling at the moment, so not really in a position to give advice, but so far the main things that I have learnt are that gentle exfoliation and disinfection are key to dealing with acne.

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Hi! If you find your hormones are out of whack, there are herbs you can take to help balance them back out, especially during the 'change' or even pre menopause. I haven't taken them so I can't say from experience but I will say that I have seen on infertility boards the discussion about hormones and the lack of ovulation. The ladies there swear by certain herbs that get their hormones in line and they start ovulating. i don;t know if that might be something you want to look at or not. If you are ending your hormones ride, you might just want enough balance to ease into menopause so it's not so rough. lol There are herbs that do that or I suppose you could look into phytoestrogens like lignans from flax. I have read that lignans will bind to receptors in the body just like estrogens and if you are low on estrogen these will help make up the deficiency. However, phytoestrogens have a weaker impact, so I am not sure how that would translate into reducing acne. Anyways, for sure have a thorough hormone check and then you can go from there! :) Best wishes!!!!!!

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Hi Natamar - I have recently discovered a very good, gentle exfoliator. It's by Dermalogica and it's called 'Gentle Cream Exfoliant'

Thank you very much! I'll look its composition on the Internet and try to find something like it at our pharmacies.

Hi! If you find your hormones are out of whack, there are herbs you can take to help balance them back out, especially during the 'change' or even pre menopause. I haven't taken them so I can't say from experience but I will say that I have seen on infertility boards the discussion about hormones and the lack of ovulation.

Thank you very much! My problem is not lack of ovulation per se (three kids are quite enough for us rolleyes.gif) but general hormone imbalance. Who knows what caused it...

Yes, I know about phytoestrogens. Soy is controversial, or so they say, but mint and licorice must be fine. I have even bought some but haven't started them yet.

Two weeks off the pill. I wonder what the next few months will bring.

Thank you for your concern!

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smile.png

By the way, I have read that you have stress-related issues. My derm advised me to take magnesium additives (better in combination with calcium, and preferably in water-soluble form rather than just plain pills). I take them twice a day, after sleep and before sleep. It seems to work. I am generally nervous and irritable but now seem to be more relaxed. So you may want to give it a try.

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Thanks for the info! Very much appreciated. :) I was looking over some posts on the site about adrenal fatigue and thyroid problems. Magnesium is said to be important for both functions so I am going to check into adding it. I'll try to find one with the traits you described (water soluble, calcium). Thanks again for letting me know it helped you! I have been a bit more irritated lately..just quick to get snappy. I'm also tired and just run down. Maybe this will help! :)

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My first thought upon reading acne as a new symptom was of course perimenopause, then thyroid possibility. The exfoliation will probably help a lot. Many people enjoy the mechanical exfoliation of the Clarisonic cleansing brush. Chemical exfoliants include glycolic acid, lactic acid, salicylic acid. I myself use glycolic acid and it really helps keep down the comedones and it brightens and refreshes my skin as well.

You've gotten lots of good suggestions above and I have nothing further to add. :) Good luck in your search. PS: your English is FANTASTIC.

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My first thought upon reading acne as a new symptom was of course perimenopause, then thyroid possibility. The exfoliation will probably help a lot. Many people enjoy the mechanical exfoliation of the Clarisonic cleansing brush. Chemical exfoliants include glycolic acid, lactic acid, salicylic acid. I myself use glycolic acid and it really helps keep down the comedones and it brightens and refreshes my skin as well.

Thank you very much! I still hope that it may be partly due to vitamin deficiency, weight loss and really bad stress, and the onset of perimenopause was just the last straw. But maybe perimenopause was the main culprit (which is much worse for me, because it means that the problems will only develop further over time). The thyroid hormones (TSF, fT4, anti-TPO) seem to be all right, although my thyroid has been enlarged for years, and I even had a lump removed from it at a young age.

I've heard that hydroxyacids, including glycolic, are good. How often do you use it? Say, 2-3 times weekly? I am afraid to overdo it, you see.

And thanks for flattering me. rolleyes.gif

Thanks for the info! Very much appreciated. smile.png I was looking over some posts on the site about adrenal fatigue and thyroid problems. Magnesium is said to be important for both functions so I am going to check into adding it. I'll try to find one with the traits you described (water soluble, calcium). Thanks again for letting me know it helped you! I have been a bit more irritated lately..just quick to get snappy. I'm also tired and just run down. Maybe this will help! smile.png

I take Natural Calm (it is commercially available in Russia). A teaspoonful twice a day. But there are also other brands.

And zinc was also good for my mood. I take zinc sulfate, since it is easy to buy here, but they say zinc picolinate or aspartate is better. Some people take it in megadoses for skin issues - don't know if it is advisable - but even moderate doses help with fatigue.

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I take Natural Calm (it is commercially available in Russia). A teaspoonful twice a day. But there are also other brands.

And zinc was also good for my mood. I take zinc sulfate, since it is easy to buy here, but they say zinc picolinate or aspartate is better. Some people take it in megadoses for skin issues - don't know if it is advisable - but even moderate doses help with fatigue.

Thanks! I try take zinc everyday. I have read that more than 50mg a day can suppress the immune system. I don't recall what mine is, but i think it is chelated zinc, which supposedly helps absorption??? :)

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I take Natural Calm (it is commercially available in Russia). A teaspoonful twice a day. But there are also other brands.

And zinc was also good for my mood. I take zinc sulfate, since it is easy to buy here, but they say zinc picolinate or aspartate is better. Some people take it in megadoses for skin issues - don't know if it is advisable - but even moderate doses help with fatigue.

Thanks! I try take zinc everyday. I have read that more than 50mg a day can suppress the immune system. I don't recall what mine is, but i think it is chelated zinc, which supposedly helps absorption??? smile.png

Sorry - seems that I just didn't notice this message several days ago.

I take about 30 mg daily in the form of sulfate. The chelated form must be much better.

Some fellow sufferers take mega doses, but it is not good in the long run. Such doses may alter the metabolism of copper, smth like that.

Good luck!

Presently 4 weeks off the pill. So far so good, but it is still too early.

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Sorry - seems that I just didn't notice this message several days ago.

I take about 30 mg daily in the form of sulfate. The chelated form must be much better.

Some fellow sufferers take mega doses, but it is not good in the long run. Such doses may alter the metabolism of copper, smth like that.

Good luck!

Presently 4 weeks off the pill. So far so good, but it is still too early.

lol Not a problem! :) I think I read about the copper depletion thing, too.

Hope all is going well for ya! :)

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