What to do when acne and wrinkles co-exist? Part 1!

This is the commonest scenario I face on a day-to-day basis: a distressed late 20’s career girl with lower face acne (and maybe an early nose-to-mouth line), upper face fine lines (usually around the eyes and between the brows…..), combined with an -over-all lack of radiance and glow…..and almost invariably, a heavy coating of foundation. In fact, I think you’ll find that this describes most of the female members of the recent cycle of The Apprentice down to a T. What to do???

The approach is simple-we make a plan. What to fix now, and what to do in the medium to long-term. The priority is always getting any disease process under control. And acne is a disease. It amazes me how many people just get used to having break-outs on their chin and jaw-line and think its something they have to live with, because they have done so for so many years. Not to mention the consequences of spots, with their pigment-depositing potential and general co-existence with rough texture, excess oil and big pores. No, no, no! These things are eminently improvable, with a bit of time, patience and persistence.

A combination of the following will make a big difference in any acne-sufferer’s skin:

1) A BHA wash (containing 1-2% salicylic acid)

2) A topical anti-inflammatory-2.5% benzoyl peroxide (despite historical associations with the nasty, bleaching products of ones’ teens) works well, and there’s no need to use a higher percentage. Seek out those with a moisturising base, like dimethicone, which will help minimise irritancy.

3) A non-comedogenic moisturiser-to preserve barrier function and to help improve tolerability of the acne ‘actives’ in the early stages of treatment.

4) A non-comedogenic sun protection product (minimum SPF 30)-with broad-spectrum cover, which you’ll need as you must use a retinoid (unless getting pregnant).

5) A retinoid-like Differin or Retin-A. In very mild cases, a more gentle Vitamin A-derivative might be sufficient, like retinaldehyde. But you probably need a prescription product if your spot and comedone count is greater than 10-15 lesions. If pregnancy is an issue, azelaic acid is a safe alternative (and will incidentally help tackle your pigmentation). The acne may well get worse before it gets better-do not stop! Retinoids do tend to push out micro-comedones which weren’t previously visible, a process of cutaneous catharsis, if you ask me. It had to come out at some point, so best to get it over and done with. Always use at night, as the molecule is not stable when UV-exposed.

Give it time, be kind to your self in this challenging part of the process…and if your acne is significant, see a doctor to get oral treatment as a holding measure whilst the topicals kick in-but remember, everyone needs an anti-comedonal agent, so a topical retinoid (or azelaic acid) is essential. You must give it at least 8 weeks….so there’s no rush, go slow and build up frequency of application and amount of product used slowly. Your skin is a remarkably adaptable organ, and if you give it time and support it, it will accomodate to the new order of things.

Next instalment…..what  to do once the acne is under control…

  1. This is so interesting (and pertinent!) considering a recent post of my own http://tinyurl.com/6yz5fa8 on confused skin. I’m going to take your advice and change up my routine to include BHAs and a retinol.

    • Zereen lunn
    • March 23rd, 2014

    Can you recommend a good moisturiser and vit c serum for this type of skin?

    • I’m a fan of splitting function- so I like a separate serum, such as Obagi Vitamin C Serum 15-20%. And I like a non-comedogenic moisturiser with a bit of oomph that’s non-greasy, like Obagi Hydrate or La Roche Posay Toleriane Riche.

    • Francesca goldsmid
    • January 28th, 2015

    How do you use the benzol and the retinol together? Do you pile them on top of each other? Or use alternately? Please help I have suffered now for 11 years! Could you please also recommend a good moisturiser to counteract the drying effect

    • Hi Francesca, the best thing is to apply the retinoid at night and the BPO in the morning (after cleansing and before moisturiser). La Roche Posay Toleriane Riche or Cetaphil Moisturising Cream are both soothing and non-clogging. I also love Obagi Hydrate.
      Dr Sam

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