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Explainer: Life's milestones — written all over your face

  • I’ve been engaged several times, and each time my skin realized the marriage was a bad idea before I did. I know this because, when it came time to plan the wedding, I would break out in hives. Red splotches the size of half-dollars all over my arms, chest, and stomach. Attractive! The man I eventually married is impossible; still, I knew he was The One when contemplating a life with him did not necessitate massive doses of Benadryl.

    I am hardly alone in having skin that reacts, sometimes dramatically, to significant life events. It happens to most of us: At certain points in our lives, stress, hormones, lifestyle, or all three can play a role in how the skin looks and behaves. “No question: Many life changes are manifested through the skin,” says Ranella Hirsch, assistant clinical professor of dermatology at the Boston University School of Medicine.

    Sometimes the big life event — a new job, marriage, graduation, pregnancy, and so forth — exacerbates a preexisting genetic condition: You can’t get psoriasis from throwing a gargantuan wedding, but if you’re prone to it, this is when it may flare up. Other times, says Hirsch, the milestone causes new problems to arise. What you can do is be prepared to deal with whatever your skin — and life — throws your way.

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  • College

    The skin crisis: It’s not only young-adult hormones that can cause problems; it’s being a student. Academic and social angst, poor diet, lousy sleep habits: All can make a mess of the skin. The culprit is cortisol, the hormone released when we’re under stress of any kind, whether it’s finals or the realization that the great love of your life is schtupping the social chair of the Tri Delts. “Stress causes an increase in cortisol, which in turn causes the body to produce more oil,” says Howard Sobel, clinical attending dermatologist and dermatologic surgeon at Lenox Hill Hospital in New York City. “This leads to clogged pores, which is why in college many otherwise acne-free young adults have breakouts.”

    The treatment: Many mild breakouts can be prevented by more sleep, less booze and better eating. But if taking care of your body is just not going to happen, at least start taking care of your skin. One effective solution: the Pill. “Birth control pills help regulate the hormonal imbalances that contribute to acne,” says Hirsch.

    Of course, there are other solutions. Begin washing your face — twice a day, and after exercise — with an anti-blemish cleanser. David Bank, assistant clinical professor of dermatology at Columbia Presbyterian Hospital in New York City, recommends choosing one with 2 percent salicylic acid (try Neutrogena Oil-Free Acne Wash), 3 percent glycolic acid (such as Peter Thomas Roth Glycolic Acid 3% Facial Wash), or tea tree oil (like Jason Tea Tree Oil Satin Soap). Once a day, apply a lotion with at least 2.5 percent benzoyl peroxide (try Clean & Clear Persa-Gel 5). Do not simply dot it on zits, says Ava Shamban, assistant clinical professor of dermatology at UCLA; smear it all over your face to prevent further breakouts. (Prep sensitive skin first with an anti-inflammatory cream, like Aveeno Ultra-Calming Daily Moisturizer SPF 30.) On top of that, slather on an oil-free glycolic acid lotion, like NeoStrata Exuviance Daily Defense, every morning and night.

    For intractable acne, dermatologists have other prescription tricks up their sleeves: Triaz Foaming Cloths, benzoyl peroxide wipes that can be tucked in your bag; Ovace Wash, an antibiotic cleanser; retinoids like Retin-A Micro; and medications like Solodyn and Accutane, which are extremely effective but can have side effects.

  • Graduation

    The skin crisis: One of the best graduation presents many students get is the magical disappearance of acne. But this time period is not without its issues. These may also be party-hearty days, which come with circles under the eyes, puffiness (thank you, alcohol), and, surprisingly, sun spots. “I’m seeing a disturbing number of 22-year-olds with the skin of 35-year-olds,” says Hirsch. Adds Amy Wechsler, assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City: “If you’ve abused your skin in high school and college with tanning and tanning beds, it starts to catch up with you.”

    The treatment: Now may be the time to dial it back a bit. Put away the acne washes in favor of a gentle creamy cleanser (Wechsler likes Cetaphil and the Dove Beauty Bar). Afterward, cover your face, neck and chest with an antioxidant cream, like Replenix CF cream; it will protect against the damage that environmental free radicals do to the skin. Lastly, slather on a broad-spectrum sunscreen that has an SPF of at least 30, regardless of how little time you spend outdoors. “Wearing sunscreen now is absolutely a hedge against aging, as sun exposure is the number-one cause of sun spots, wrinkles ... all the hallmarks of aging skin,” notes Wechsler, who recommends Invisible Zinc Environmental Skin Protector SPF 30+, which she says feels light on the skin.

    To counteract existing damage, apply a lightener like kojic acid (found in SkinCeuticals Pigment Regulator) or 2 percent hydroquinone (in Ambi Fade Cream), every day; you’ll begin to see results in about three months. And if undereye puffiness is a problem after all those late nights, try the L’Oréal Paris Collagen Micro-Pulse Eye, an eye cream deposited with a small, pulsing roller-ball. “Micromassage gets the pooled fluid under the eyes moving, which helps the appearance of puffiness,” Hirsch says.

  • A new job

    The skin crisis: Again with the stress! First, the agita of getting the job; then, in this shaky economy, the worry about keeping it.

    Image: Stock representation of job search
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    When dealing with job worries, you may not have time for the gym or other stress reduction techniques.

    An unfamiliar work culture can turn the most confident among us into sweaty junior-high students. Never mind the actual work. Who will like us? Who won’t? Whom can we trust? The hours may be long, your eating habits may worsen, and you may not have time for the gym, long walks, meditation — whatever your stress-reduction technique.

    Moreover, this is the time many women start wearing makeup all day, every day, and many don’t take it all off at night. This adds up to increased oil production, clogged pores and blemishes. There is even an occupational hazard for skin, notes Sobel: “touching your face a lot, or pressing your phone to your chin. Both can bring on acne.”

    The treatment: Usually a new job means a temporary flare-up — nothing
    that’s going to go on for months. But this may be the time to revert to a
    more aggressive cleaning regimen. Wash every night with a salicylic acid cleanser (like Noxzema Clean Blemish Control Foaming Wash). “It will help remove sebum and accumulated dead skin cells,” Sobel says. If you redo your makeup during the day — say, after exercising — keep some glycolic pads (like MD Formulations Daily Peel Pads) on hand to remove sweat and dirt afterward. At night, apply a 10 percent (or higher) glycolic acid lotion all over. And once a week, use a sulfur mask. (Sobel recommends his own DDF Glycolic 10% Exfoliating Moisturizer and Kate Somerville EradiKate Acne Treatment, which “provides the highest level of sulfur to clean up bacteria buildup,” he says.)

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  • Getting married

    The skin crisis: “All change is stressful — even good change,” says Wechsler, who is a psychiatrist as well as a dermatologist. So it’s not surprising that the months leading up to a wedding are a time of high anxiety.

    Image: Wedding
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    The anxiety of getting married can exacerbate skin problems like cold sores or zits.
    Any complexion problem is bound to be exacerbated: If your skin tends to be dry, it might now get drier. Cold sores may make unwelcome appearances. If eczema or psoriasis is a problem ... well, right now it may become a big problem. And zits? They can be as routine as dress fittings for brides-to-be. “It’s amazing how many women planning to wear some gorgeous, décolletage-baring gown break out in blemishes on their chest and back,” Wechsler says. 

    The treatment: You should have a routine solidly in place six months before your wedding, so that 50 years from now, your grandchildren will not be marveling, “Wow, Grandma sure had a lot of zits.” This may entail a visit to a dermatologist. Cold sores, for example, can be treated with antiviral medication. Hives may respond quickly to antihistamines or topical steroids. Corticosteroids and retinoids can calm psoriasis. And Wechsler likes to use salicylic acid peels for acne. 

    Even if your skin behaves throughout the engagement period, you’re going to want to switch to a routine that will make it look more radiant in photos. At least three months before the wedding, start exfoliating every morning (unless you have sensitive skin — then try every other morning) with a glycolic or salicylic acid cleanser, such as Olay Total Effects Cream Cleanser + Blemish Control, and once or twice a week slough off more tenacious dead cells with a grainy scrub, like Clinique Exfoliating Scrub. Follow with an antioxidant cream, like Prevage Day Ultra Protection Anti-Aging Moisturizer SPF 30 PA++, to neutralize skin-ravaging free radicals; at night, smooth on a layer of retinol or glycolic acid (we like DermaDoctor Poetry in Lotion). And eliminate any sun spots on the face and chest at the dermatologist’s office with biweekly sessions combining microdermabrasion and a glycolic peel, or with Fraxel laser treatments, spaced about four weeks apart.

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  • Pregnancy

    The skin crisis: The wives’ tales surrounding skin during pregnancy are many and contradictory. (Girls give you bad skin because they’re trying to steal your beauty! Boys give you bad skin because you inadvertently leach their testosterone!) But the skin’s appearance during pregnancy really has nothing to do with the gender of the fetus. It’s all about your hormones, baby. They can make your skin significantly better — or significantly worse.

    Pregnant woman
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    Your skin's appearance during pregnancy is all about your hormones.
    Here are just a few of the fun things that can happen because of estrogen and progesterone fluctuations: acne breakouts; melasma, the so-called “mask of pregnancy,” a brown or tan skin discoloration on the face; spider angioma, a group of abnormal blood vessels shaped like a spider’s web; skin tags, which are tiny outgrowths, often on the neck and the armpits, that are completely benign and deeply disgusting, not that I’m judging; linea nigra (Latin for “black line”), the dark vertical line that appears on the abdomen of about three fourths of all pregnant women; and, of course, stretch marks. Add to that the fact that a number of skin-care ingredients are off-limits while a woman is pregnant or breast-feeding — most anti-acne agents (like salicylic acid and benzoyl peroxide), as well as anti-aging products containing high doses of vitamin A — and this can be a tricky time, to say the least.

    The treatment: It’s best now to keep your regimen simple. Avoid abrasive exfoliants; pregnant skin is a bit more sensitive. Safe options include oatmeal-based scrubs (like Queen Helene Oatmeal ’n Honey Natural Facial Scrub) and deep-pore-cleansing facials at a spa. If acne is a problem, “there are products you can treat it with, but you have to be under the care of a dermatologist,” Shamban says. Stay out of the sun and be diligent about broad-spectrum sunscreen to prevent melasma. (Use products with physical barriers like zinc oxide, such as Neutrogena Sensitive Skin SPF 60+.) And because pregnancy is a time of rapid cell growth (think of your stronger nails and more luxuriant hair), Bank recommends “a skin check to spot any changes in moles before something serious can develop.”

    Beyond that, many of the skin issues of pregnancy will simply resolve with the birth of the baby and really shouldn’t be treated. If melasma doesn’t fade on its own, a series of glycolic or TCA peels at a dermatologist’s office and prescription 4 percent hydroquinone will lighten it. And the red-purple color of stretch marks can be effectively eliminated with a pulsed-dye laser like the Candela Vbeam.

  • Turning 35

    The skin crisis: Fewer zits, as hormone levels once again shift: Yay! More signs of aging: Boo! As estrogen levels decline, skin may become drier, certainly in those areas where it’s thinnest and most expressive — around the eyes, on the forehead — and fine lines are staking their claim. (And let’s not even talk about increased facial hair, mmmkay?) Sun damage, plus the estrogen drop, also means the top layers of the skin do not slough off with the same regularity; our skin becomes duller, and we lose the dewy glow of youth.

    When there are breakouts, says Shamban, they tend to be of the redder and more painful cystic variety, and are more common on the lower face, neck, chest and back — as compared to the teenage T-zone pimple fest. And, possibly because of their shifting hormones, women this age also are subject to rosacea, a chronic skin condition characterized by flushing on the face, swelling and dilated blood vessels.

    The treatment: For dry skin and fine lines around the eyes, dermatologists recommend using a lightweight eye cream that will keep skin hydrated without causing puffiness. (Wechsler’s favorites: the antioxidant-rich Replenix Eye Repair Cream, or good old Vaseline — “just the tiniest bit on the lower lids,” she says.) For overall improvement of skin texture and reduction of fine lines, Sobel says, “my favorite product for age 35 is an exfoliator like 10 percent glycolic acid, either as a wash or a moisturizer in the morning; or use retinol at night.” (Try Peter Thomas Roth Glycolic Acid 10% Moisturizer or RoC Retinol Correxion Night Cream.) For a more intense treatment, go for a peel at the doctor’s office, where the strength may be 30 percent or more.

    And what about acne treatments at this time? The stuff you once used may not cut it anymore. “Benzoyl peroxide, in particular, can dry out the skin so much that it leaves uncomfortable tightness,” says Bank. For deep pimples and cysts, try hot compresses several times a day. “This reduces inflammation,” he says. “The heat also helps soften sebum so the pimple forms a head faster, to ultimately shrink cysts.” Dabbing blemishes with a sulfur-based product, like Mario Badescu Drying Lotion, helps, too. Weschler also recommends a few treatments at the dermatologist’s office with an Isolaz laser, which sucks gunk out of zits, then sterilizes the pores with blue light to keep them from coming back.

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  • Menopause

    The skin crisis: Coco Chanel famously said, “Nature gives you the face you have at 20. Life shapes the face you have at 30. But at 50, you get the face you deserve.” That observation has a certain finger-wagging quality, but it’s nevertheless true, as far as caring for your skin goes.

    Image: Woman
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    Hormone changes during menopause can cause sleep disruptions and skin breakouts.

    This is the time of life when not just nature, but nurture (i.e., shielding yourself from the sun) will have made a huge difference — because your skin-protecting hormones are not quite as spry as they used to be.

    “Estrogen plays a critical role in the elasticity and moisture-retaining properties of skin — and this is when estrogen levels take a nosedive,” says Shamban. “At the same time, more progesterone relative to the amount of estrogen can lead to breakouts.” Sobel adds that “it’s also a time when women need to use heavy moisturizers, but without daily exfoliation, the pores may clog, and acne can develop.” Not to mention dead-cell buildup, which contributes to that grayish look (appealing only on 24-year-old movie vampires).

    The treatment: Your daily regimen should be simple but consistent: Every morning, slather on a moisturizing SPF 30 (or higher) cream, such as Patricia Wexler M.D. Universal Anti-Aging Moisturizer SPF 30; every night, rebuild collagen and elastin with a prescription retinoid, such as Renova or Tazorac.

    Also crucial: eating right. “This is a time when what you’re doing on the inside reflects more on the outside,” Shamban says. “Eating foods rich in antioxidants and foods that don’t pump your blood sugar up and down — it’s critical.” That’s because sugar molecules bind to collagen. “This collagen is more prone to be identified by the body as damaged, and enzymes in the skin then chew it up,” she says. 

    A consultation with your dermatologist will give you a better clue about what will make you glowy at this time. One treatment that yields dramatic results: fractional skin resurfacing with a laser such as the Fraxel Dual 1927. “It improves sun spots and hyperpigmentation with only a few days of downtime,” Sobel says. “Just a couple of treatments can restore postmenopausal skin to its former porcelain glow.” (Cost: $1,000 to $1,500 per treatment.)

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