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The Angst of Adult Acne

Just when you think that blemishes are a thing of the past, they rear their ugly black or white heads once again. Up to 70 percent of adult women experience bouts of acne -- and they're especially likely when you're expecting a baby.

Regardless of your age or reproductive status, pimples develop when the sebaceous glands, attached to hair follicles under the skin, produce excessive amounts of the oily lubricant sebum, explains Elizabeth Carr, M.D., clinical assistant professor of dermatology at SUNY Health Science Center in Brooklyn, NY. The sebum accumulates and mixes with shed skin cells as well as acne-causing bacteria, and a plug develops in the follicle. This can take the form of a whitehead (a pore clogged underneath the skin), a blackhead (a pore clogged on the surface of the skin), or a cyst (a painful pocket of pus). And as everyone knows, when this happens, the results aren't pretty.

Hormonally Yours

What triggers these oil slicks? Hormonal fluctuations are often to blame—and nothing drives hormones wild like motherhood. "During pregnancy, the skin may react to the body's increased level of progesterone, which can induce acne," says Carr. (Some women, on the other hand, find that the corresponding rise in estrogen curbs sebum production and reduces acne.) After delivery, when progesterone and estrogen levels drop, acne frequently clears up. At the same time, however, the body's higher proportion of androgens (acne-causing sex hormones) can mean new or continued outbreaks for some moms.

In addition to hormonal changes, external factors can bring on adult acne as well. Some medications—including corticosteroids, androgenic steroids, phenytoin, and progestin-only oral contraceptives—can spur oil production. And while many women use abrasive scrubs, astringents, masks, and exfoliators to help keep zits at bay, these products can backfire, triggering an overabundance of sebum, aggravating acne, and irritating the skin; oil-based facial and hair products may also clog pores. Another common culprit is stress, which can contribute to a surge of acne-inducing androgens. Finally, although many women find that downing a chocolate bar or an order of greasy fries invariably provokes an outbreak, dermatologists disagree about whether such foods are actually to blame.

Zap Those Zits

Fortunately, a slew of recently approved acne treatments are coming onto the market. Unfortunately, many of these are off-limits to pregnant and nursing women. That's why it's vital to discuss acne treatments with your obstetrician as well as a dermatologist who knows that you're pregnant or breastfeeding, even if you plan to use an over-the-counter (OTC) preparation. A look at your treatment options:

The clean routine

The first line of attack is unclogging the pores—and that doesn't mean popping. "Picking, squeezing, or scrubbing can irritate inflamed skin and make acne worse," Carr warns. "Plus, it can lead to scarring." Instead, wash your face twice a day with a mild cleanser, such as Neutrogena Cleansing Lotion or Cetaphil.

Topical solutions 

If acne is stubborn, the safest treatments for expectant or nursing moms are OTC gels or lotions that contain salicylic acid, glycolic acid, or benzoyl peroxide -- which help dry up surface oil and increase the shedding of skin cells. If these don't work, a dermatologist may prescribe a topical antibiotic, such as T-Stat or Emgel, that contains erythromycin to curb inflammation or a new medication (Azelex) with azelaic acid, a skin-bleaching agent that speeds cell shedding and kills bacteria.

Other drugs called retinoids—tretinoin (Retin-A) and adapalene (Differin)—can be applied to the skin to stop oil plugs from forming. But dermatologists don't prescribe them to pregnant women, since their oral formulations can cause birth defects and it's unknown whether topical retinoids pose a similar risk. For the same reasons, doctors don't prescribe gels or lotions that contain the antibiotics clindamycin, sulfur-resorcinol, and metronidazole.

Oral medications

Like retinoids, oral antibiotics—such as tetracycline, minocycline, doxycycline, and amoxicillin—can cause birth defects and contaminate breast milk. The only oral antibiotic that's considered relatively safe is erythromycin, but many doctors are still reluctant to recommend it to expectant or new mothers. "If the acne is causing emotional distress, I might prescribe it in pregnancy—but only after the first trimester, when the early stages of fetal development are completed," says Carr.

And although taking birth control pills containing estrogen often helps to clear up acne, that's not an option for women who are pregnant or breastfeeding.

An Ounce Of Prevention

Since the treatments for expectant and new mothers are limited, the key to fighting pimples is preventing them from forming in the first place. A healthy lifestyle goes a long way toward keeping your skin blemish-free. So reduce stress, drink lots of water, eat well, exercise regularly, and get as much sleep as possible, advises Elizabeth Hughes, M.D., chief resident at the Stanford Dermatology Clinic in Palo Alto, CA.

When it comes to skin care, "look for the words 'noncomedogenic' or 'nonacnegenic,' meaning non-acne-causing, on the labels of facial products and cosmetics," says Hughes. Also, keep your face clean, choose an oil-free moisturizer, and, while you're at it, an oil-free concealer or foundation to mask occasional flare-ups. Most important, don't despair. Your skin may not rival a baby's for beauty right now, but with proper care and a little time, it can come close.