Derm Talk with Dr. Whitney Tolpinrud
You're a woman of a certain (spectacular) age; Why does your skin think you're a teenager?
Hello, Gorgeous!
I’ve received a flurry of questions from some of you recently. I’ll try to tackle topics that come up most often.
This time around, board certified dermatologist Dr. Whitney Tolpinrud helps us understand why our skin might be going through a rebellious phase.
(Catch up on Derm Talk with dermatologic surgeon Dr. Howard Sobel here).
Responses have been edited slightly for length and clarity.
Which hormonal, environmental, and lifestyle factors cause adults to experience teenage-like acne past the age of 40?
Dr. Whitney Tolpinrud said:
While acne is often thought of as a teenage problem, many women experience breakouts well into middle age. This is often due to a complex interplay of hormonal, genetic, environmental, and lifestyle factors. Hormonal fluctuations, particularly increased androgen levels, can trigger excess oil production and clogged pores. Acne appearing on the lower cheek, chin and jaw areas can be a clue for hormonal acne.
While acne is often thought of as a teenage problem, many women experience breakouts well into middle age. This is often due to a complex interplay of hormonal, genetic, environmental, and lifestyle factors. ~Dr. Whitney Tolpinrud
Conditions like Polycystic Ovarian Syndrome (PCOS) can also be a common culprit. A family history of acne also raises the likelihood of adult breakouts. Stress, a diet high in glycemic index foods, dairy products, and sleep disruption can further exacerbate the issue. Persistent or severe cases often benefit from a dermatological and endocrinological evaluation to pinpoint and manage the underlying triggers.
Are over the counter products for teens appropriate for middle-aged skin with acne or other issues? Which specific ingredients should middle-aged people look for/avoid when treating breakouts?
Dr. Tolpinrud said:
Many of the acne products that are used to treat teenagers with acne can also be used in adulthood! As we age, our skin becomes drier so it’s important to focus on skin barrier repair. When treating breakouts in middle age, it’s also important to hydrate the skin and support the skin barrier. I’m a big believer in simple skincare routines with multitasking ingredients—less stress, more results.
People with more mature skin with acne breakouts are often focused on antiaging treatments as well, so ingredients that do double duty are ideal. Look for ingredients like retinoids (great for clearing acne and improving fine lines, skin texture, and dark spots), salicylic acid (helps unclogpores while gently exfoliating dull skin), azelaic acid (soothes inflammation, fades discoloration, and unclogs pores), and glycolic acid (brightens skin tone and smooths rough texture). The key is to treat your skin with care—choose effective, balanced products and skip overly harsh formulas that may have worked in your teen years but could irritate mature skin now.
While many teen-targeted over-the-counter acne products can work for adults, I recommend choosing formulas that are gentle and hydrating. Mature skin is more prone to dryness, so it's best to avoid alcohol-based products (which can be overly drying) and harsh physical exfoliants (which may damage the skin barrier). I would start with lower percentages of active ingredients and increase as tolerated. I also recommend moisturizers that include skin barrier-repairing ingredients like ceramides, fatty acids, and cholesterol. Look for products that combine these with occlusives to lock in moisture and humectants like hyaluronic acid or glycerin to keep the skin hydrated.
Dr. Tolpinrud works with Curology, a skincare brand created by dermatologists. Curology offers personalized prescription formulas which Dr. Tolpinrud says include “clinically proven, multi-tasking active ingredients that can simultaneously tackle acne and antiaging concerns.” The entire line is dermatologist-designed to maximize efficacy and minimize irritation at any age. Dr. Tolpinrud said that when appropriate, they can prescribe oral medications to help treat acne.
As we age, treating acne becomes a bit more complicated—our skin heals more slowly, and the protective barrier can weaken, making it more prone to irritation from standard acne treatments. ~Dr. Whitney Tolpinrud
How do challenges like weakened skin barrier, slower healing, and sensitivity in aging skin complicate acne treatment, and what approach best balances treating breakouts while supporting these age-related skin changes?
Dr. Tolpinrud said:
As we age, treating acne becomes a bit more complicated—our skin heals more slowly, and the protective barrier can weaken, making it more prone to irritation from standard acne treatments. These age-related changes necessitate a more cautious and supportive approach to treatment.
Topical retinoids, such as tretinoin, can exacerbate skin barrier dysfunction and cause irritation, particularly in older patients with sensitive skin. The American Academy of Dermatology recommends the use of topical retinoids but emphasizes the importance of adjunctive skincare to mitigate irritation.
The American Academy of Dermatology recommends the use of topical retinoids but emphasizes the importance of adjunctive skincare to mitigate irritation
Middle-aged individuals should consider formulations that include moisturizing and soothing ingredients to counteract potential dryness and irritation. Products containing niacinamide, ceramides, and hyaluronic acid can help maintain skin barrier function and hydration. Starting off slowly by using lower percentages of active ingredients and gradually increasing the strength can be very effective.
Dr. Tolpinrud is a fan of Curology’s new HydroTretRx which combines tretinoin plus hydration. She said “Tretinoin is compounded with ingredients like dexpanthenol (proVitaminB5) to attract and hold moisture for softer, smoother skin. Plus, it helps skin heal and soothes irritation. Other potential ingredients include niacinamide, which fights free radicals, fades dark spots, and improves moisture barrier function.”
What's happening when adults develop those persistent bumps, blackheads, and congestion around the nose, chin, and jaw that seem resistant to typical treatments? Are these technically acne or something else entirely?
Dr. Tolpinrud said:
In adults, hormonal fluctuations, particularly androgens, can lead to increased sebum production and clogged pores, especially in the lower face. This pattern is characteristic of hormonally influenced acne, often manifesting as breakouts on the jawline and chin. Another common, and often overlooked, contributor is the use of comedogenic skincare products. Even thoughtfully chosen skincare products can include ingredients that clog pores, leading to stubborn breakouts that don't respond to typical acne treatments.
And one final question for Dr. T:
What are some emerging treatments, technologies, or ingredients showing the most promise specifically for adult acne, and how do they differ from traditional approaches used for teenage skin?
Dr. Tolpinrud said:
New therapies like clascoterone, a topical antiandrogen, directly address hormonal triggers common in adult women. Trifarotene, a newer retinoid, provides improved tolerability. Additionally, light-based therapies like photodynamic treatment and blue/red light therapy are gaining traction for their ability to calm inflammation and treat acne with minimal side effects. For adult women with hormonally influenced acne, oral spironolactone in combination with oral contraceptive pills is considered an efficacious treatment option.
Has your chin turned into a late-ish in life teen disaster zone? Let’s meet in the comment section to discuss!
Rachel, Your beauty concierge 💋
Loved this!!!
Excellent interview and info! Thanks