Lindsey Emery, a freelance editor in Portland, Ore., asked about her bumpy skin. We passed her question on to Julie Harper, MD, a clinical associate professor of dermatology at University of Alabama at Birmingham, and Paul M. Friedman, MD, a clinical assistant professor of dermatology at the University of Texas, Houston, and author of Beautiful Skin Revealed: The Ultimate Guide to Better Skin.
Q: I've noticed small red bumps on my face, jawline, and neck. Could it be rosacea? Or is it acne?
She's tried almost every drug on the market, from Retin-A to Cleocin T to
tetracycline, not to mention all the drugstore lotions and potions she's
lathered her skin with. But nothing can take back the feelings of
unattractiveness and self-doubt, the devastating days when merely leaving the
house was difficult.
Like Specter, many women are battling acne into their adult years -- and
feeling frustrated about it. And increasingly, many of them are trying a new
approach, one that goes beyond the traditional treatments such as retinoids,
benzoyl peroxides, and antibiotics: They are using the birth control pill to
For Specter, hormone manipulation (which is how the pill works) became an
option several years ago, when she got involved in a serious relationship and
wanted both birth control and a new acne treatment. After talking with her
doctor, she decided to start taking Ortho Tri-Cyclen, a birth control pill
that's shown some success in treating adult acne. Ortho Tri-Cyclen reduces
androgens (male hormones) and regulates a woman's hormones so their swings
aren't as severe and don't throw a woman's body -- and complexion -- into flux.
While all women have some level of androgens, an excessive amount can lead to
Women and Acne: The Painful Truth
The number of women (and men) who struggle with acne well into their 20s and
30s is huge. In fact, a study published in the October 1999 issue of the
Journal of the American Academy of Dermatologyfound that of 749 adults
between the ages of 25 and 58, 54% of women and 40% of men suffered from some
form of acne. What's more, the prevalence of adult acne in both sexes did not
decrease substantially until after the age of 44.
That acne is a teenager's disease is just one of the misconceptions
associated with the condition. Another is that dirt and oil on the skin cause
Acne, in fact, is caused not by dirt or oil, but by bacteria called P.
acnes that live on everyone's skin. During puberty, the body produces
higher levels of androgens, which can overstimulate the skin's oil-producing
(sebaceous) glands, resulting in a greater amount of the oily substance called
sebum. The more sebum, the more likely it is that a hair follicle will become
clogged, resulting in follicular plugs called comedones. These clogged
follicles allow P. acnes to proliferate. Some people are hypersensitive
to P. acnes, says Guy Webster, MD, PhD, vice chairman of the department
of dermatology at Jefferson Medical College in Philadelphia. These people have
excessive immune responses to the bacteria -- similar to an allergic reaction
-- and this results in acne.
But hormones, too, can be the cause. According to Debra Jaliman, MD,
clinical instructor of dermatology at Mount Sinai School of Medicine in New
York City, some women are genetically prone to having more drastic hormone
swings, higher levels of androgens, and oil glands that are more sensitive to
hormones. "When hormone levels stay stable, it's easier on the skin. When
they fluctuate a lot, that's when the skin breaks out." Hence, those pesky
pre-period breakouts with which women are so familiar.