Since passing 30, I’m finding I’m getting breakouts along my jawline before my period. I’ve always had pretty clear but dry skin most of my life, so I was not prepared for this! They tend to last up to, and sometimes more than, a week and can be quite painful. Why is it happening in this particular place and how can I make them stop, or at least get rid of them quicker? I’ve tried using a topical salicylic acid treatment but it doesn’t seem to do much.
Adult acne is a cruel cosmic joke of enormous proportions. Sure, it sucks having it as a teenager, but at least you’re somewhat united in it, as your friends will probably be suffering too. Plus, you can chalk it up to something of an awkward caterpillar phase along with the mood swings, orthodontia and questionable style choices (you couldn’t pay me to be 15 again, honestly).
Getting it again in adulthood – or for the first time if you made it through adolescence unscathed – feels especially unfair. You’re meant to be at your most confident, your most professional and put-together, but please take comfort in the fact that you’re really not alone. Private dermatology clinics say they’ve seen a 200% increase in the number of patients wanting acne advice in the last two years, and clinical trials ballpark the number of women who suffer from adult acne as anywhere between 12% and 41% of women.
I first asked clinical facialist Kate Kerr, who I’ve entrusted my skin with for the last two years, for her take. "Acne here is very common in your 30s," she began. "It’s often hormonal, but not always. These types of spots you’re describing don’t necessarily mean you have a hormonal imbalance, which is why blood tests may come back with normal results. However, your oil glands may have become sensitive to the levels of hormones you’re naturally producing. Mid-cycle, when your oestrogen production dips and your testosterone levels don’t have anything to hold them back, you can expect to see more breakouts."
You’re not imagining the pain, either. "These kind of spots on the jawline can often turn nodular or cystic. They sit deeper within the skin and create more inflammation closer to the nerves – hence why they’re so sore," added Kerr. As outlined, while your acne might be triggered by hormones, it doesn’t necessarily mean you have an ongoing imbalance per se – it’s more that your sebum production takes any fluctuations as a cue to start whizzing into action. "Lifestyle factors such as stress, poor diet, lack of sleep will all have an impact on our hormones," noted Kerr. "Often with women in their 30s it could be choosing to come off the pill or other hormonal contraception. It can take time for our hormones to balance after a long time on it."
As for treatment, picking and squeezing is not going to help. I’m not totally against pimple-popping (there is a right way to extract, but that’s for another time) but as your spots are under the skin, there’s nothing to 'pop', so to speak – but there is a lot of scarring to leave if you’re not careful. As Kerr told me: "If you exert any pressure on the surface, you can cause trauma underneath leading to more spots, post-inflammatory pigmentation and scarring. Plus, your body will create more white blood cells as a response, which only further inflames the problem."
And as they’re under the skin, a topical salicylic product probably won’t get you very far. I asked consultant dermatologist at the Cadogan Clinic, Dr Anjali Mahto, for some advice on oral options. "After proper, clinical examination and assessment by a consultant dermatologist, drugs such as spironolactone and Roaccutane (isotretinoin) can be helpful for deep, painful spots known as nodules and cysts. This is particularly the case if you’ve got a lot of the spots and they’re persistent and if they result in scarring or affect your mental health and self-esteem. Both medications have the potential for side-effects and a thorough consultation to assess for suitability must take place first."
Roaccutane is fairly well known, but spironolactone is a little newer to the skincare scene. "It’s actually an 'off-label' drug for acne," explained Dr Mahto. "This means that it is not actually licensed for the treatment of acne in the UK and should only be prescribed by a General Medical Council registered consultant dermatologist for safety reasons in this context." It was designed to treat cardiac problems like hypertension primarily, but the reason it’s beginning to crop up for acne treatment is that it’s an androgen blocker, which helps curb the testosterone problem we mentioned earlier.
My advice to you would be to go and see a dermatologist who can take a full skin history from you, look at the blemishes, make note of their details and work with you for a treatment plan. Depending on how severe your spots are and how much they’re impacting you, you can decide on a tailored skincare regime or oral options, but do bear in mind that these nasty nodular ones will be harder to beat topically than, say, a handful of whiteheads.
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