Dear Betsy,

Many women with acne have dry or sensitive skin rather than the oily skin that we associate with teenage acne. They may also have simultaneous rosacea, which is characterized by redness and broken blood vessels on the nose and cheeks. The causes of adult acne a re many and complex. Hormone shifts in midlife and stress may play a part. One variant of rosacea, known as perioral (or periorificial) dermatitis, consists of acne-like bumps and/or pustules around your mouth and sometimes around your eyes too. Perioral or periorificial dermatitis is usually associated with the use of steroid creams anywhere on your face, not just where the rash is located.

Treatment is aimed at controlling the acne without drying out or irritating your skin. Even if your skin is oily or combination, it's important not to over-dry it as this can stimulate oil overproduction. I recommend that you consult a board certified dermatologist for evaluation and treatment. If you've been using  a steroid cream, you should stop it. I find Tretin-X, an acne kit containing prescription tretinoin with an antioxidant cleanser and moisturizer, helpful. If your skin is not very red, ask your dermatologist about a combined alpha and beta hydroxy acid cream such as SkinMedica 15% AG+HA/BHA face cream, which also rejuvenates your skin. Your dermatologist may also prescribe a topical antibiotic such as Metrogel (metronidazole). If topical treatments don't clear up the acne, you may also need a prescription oral antibiotic. The Minocin PAC is effective and economical, as your doctor can provide you with a rebate coupon to cover your pharmacy copay and the treatment comes with free facial cleansing wipes, and a serum and masque containing antioxidants and natural algae extracts to calm skin inflammation.

Hope this helps!

Dr. Hema