When some women pass their 25th birthday, they begin to think about keeping their skin looking young. Some even start experimenting with anti-age products. But others are shocked to discover that blemishes--not wrinkles--are their problem. Oily skin, pimples, whiteheads and blackheads--which many associate only with adolescents--are plaguing women into their 50s.
Although post-teen-age men also experience breakouts, adult acne affects more women than men, according to a University of Chicago study. The problem has become so prevalent that many skin-care salons offer as many blemish procedures as traditional massage-and-emollient facials for wrinkled skin.
In fact, some women who seek dermatologists' care for acne are now referred by their doctors to skin-care salons. "Facialists and dermatologists should not be competing with each other because they both have something to offer," says Dr. Robert Sherman, a New York City dermatologist. "Treating acne with medicine only is not the answer."
Acne facials are deep-cleansing procedures that rid the skin of excess sebum that clogs the pores and leads to inflamed breakouts. The facials include a thorough cleansing of the skin surface, usually with steam, a granular scrub and a clay-based masque. Some also involve the removal of oil plugs with an implement called a comedo extractor.
"In an acne facial, we devote most of the hour to cleansing the skin in many different ways," says Ilona Meszaros, owner of the Ilona of Hungary salons in Palm Springs, New York, Chicago, Houston, Dallas and Denver. Deep cleansing is often part of a dermatologist's treatment, she says, "but doctors usually don't have the time to be so thorough. They devote their time to the medical side of the treatment."
In the last decade, dermatologists have become more aware--and appreciative--
of the benefits of facials. And some dermatologists now have facialists on their own staffs.
Sherman and skin-care specialist Trish McEvoy work side by side in their Fifth Avenue office. "I found that my patients really needed care from both experts," Sherman says. "I diagnose the conditions and prescribe the medicines. Trish's staff does the cleansing and the pampering. When you're working with adults, the pampering is very important."
Many of Sherman's clients are women with professional and managerial positions, he says. "They cannot afford to have blemished skin any more than they can afford to walk out of their doctor's office with skin irritated by topical acne prescriptions." But after a facial, he says, the client leaves ready to face the public.
Dr. James Sternberg, assistant clinical professor of dermatology at UCLA Medical School, also has a facialist on staff at his Westwood office. "Most dermatologists still laugh at facials, but I'm convinced that the deep-pore cleansing helps," he says.
Aida Thibiant, who has had a skin-care salon in Beverly Hills for 14 years, recalls that clients being treated for acne in the '70s "wouldn't dare tell their doctors they were having facials until the doctors started seeing the results. Now dermatologists frequently refer
patients. But it took a long time to win their confidence."
Sternberg cautions that deep cleansing, if not done properly, can aggravate some acne. "If there's still redness on the day after a treatment, the facialist was too rough," he says.
Many factors can trigger adult acne, Sternberg says. They include medications--"from kelp pills to lithium"--and oral contraceptives that contain a high level of progestogen. Hormonal imbalances also can be a culprit. A condition called acne cosmetica has been traced to oils in moisturizers and makeup that clog pores and cause blemishes. But Meszaros believes that stress is responsible for most adult acne. "More women are pressured to support themselves and / or their children. They have full-time jobs and families to care for," Meszaros says. "They don't have time to do it all. The stress shows up on their skin as acne."
Sternberg, however, says that although stress can aggravate acne, it cannot cause it. "Stress can make any condition worse," he says. "A person has to have a predisposition for it. Otherwise, we'd see many more cases of adult acne."
Skin-care experts agree that adult acne should never be ignored. "It is a myth to think that it will go away by itself," Thibiant says. Treating it improperly with over-the-counter pimple creams aimed at the youth market can be very damaging to adult skin, she adds.
With two lines of defense against acne--the physician and the facialist--adult women have a better chance of controling the condition than if they rely on only one kind of specialist, Sherman says. "Women who have acne have felt that they had to choose between going to a doctor or going to a facial salon," Sherman says. "What's different is that now they can draw from the best of both kinds of experts."
Photographed at Aida Thibiant salon; model: Thibiant staff member Judy Scanlan.