Woman taking hormone replacement pill

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Fluctuating Hormones

You may not be a teen, but your hormones may still be riding a roller coaster all the same as an adult. One common time is during perimenopause and menopause. "Estrogen is declining, which is protective against acne," says integrative dermatologist Cybele Fishman, MD. However, ovaries continue to make testosterone, and the imbalance brings about breakouts.

It's the estrogen in birth control pills that helps clear skin, so if you've been on hormonal birth control for years and just get off, you may also see pimples pop up again, adds Deirdre O'Boyle Hooper, MD, of Audubon Dermatology in New Orleans. She often suggests patients take a testosterone-blocking Rx called spironolactone. "It's the most-refilled drug in my office. That's how you know people like it," she says. You may be able to take it for three to six months and then taper off your dose.
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Skipping Yoga This Week

Fact: We all have stress. You're not going to get rid of it completely, but chronically living in a stressed-out state boosts your body's inflammation levels. "Most skin diseases, including acne, are inflammatory diseases," says Fishman. While topical medications will help stress-induced breakouts, controlling stress is a proactive approach that helps you avoid pimples from popping up in the first place. "Prevention by reducing stress is the best thing you can do overall, including for your skin," she says.
Woman washing face

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Following a Too-Tough Acne Regimen

Yes, in a twist of cruel irony, your anti-acne regimen may be prompting your pimples, particularly if you're using the same staples from when you were a teen. "Once you're older, your skin is not supercharged with oil, so you need lower potency products," says Hooper. "OTC [over-the-counter] acne treatments can be irritating, giving you a rash on top of your acne." If you're addressing surface spots, whiteheads, and blackheads, an OTC benzoyl peroxide product can help. Skip "extra- or maximum-strength" formulations and go for 5%, she recommends. Acne peel pads with ingredients like glycolic or salicylic acid can also rid spots. However, deeper, cystic acne warrants a trip to the dermatologist.
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Using Products That Don't Actually Work

You've probably heard the call from dermatologists to use retinoids, both in the fight against aging and acne. So, you pick one up, thinking you're doing all you can for your skin to fight acne. Problem is, "many women think they're using a retinoid but they're not. There's a big difference between a prescription-strength and an OTC," says Hooper. (Most sold as OTCs are retinols.) In general, there are no rules about the concentration, stability or efficacy of retinols used in over-the-counter products, she adds. There's one exception: Differin, the first retinoid to be sold OTC. "There are rigorously tested, double-blind, placebo-controlled studies that show it's effective for acne. Almost no one can go wrong picking up a tube of Differin," says Hooper.
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Indulging in That Carton of Fat-Free Ice Cream

So often people dole out the advice to ditch gluten and dairy as a cure-all for everything—including acne. But there may be a hint of truth in one of those. "There have now been several good studies on diet and acne, and I can say confidently to patients that a high-glycemic index diet with lots of processed foods—especially sugar—is bad for acne," says Fishman, as these foods spike blood sugar and are pro-inflammatory. Cow's milk, especially skim, is also associated with breakouts. The best diet for skin is one of the healthiest for your heart, she says: the Mediterranean diet, rich in fruits, vegetables, whole grains, legumes, nuts and fish. That said, eating a good diet isn't a guaranteed fix, Fishman says: "There are many factors that go into acne. Even if you have the healthiest diet, you can still break out. You shouldn't feel like a failure."