There are certain things that go along with aging — wrinkles, a few extra pounds, sore feet, glasses. But, one thing I didn't expect was acne. Isn't that for teenagers?

Fortunately, in high school I didn't have to contend with pimples, but the last thing I expected at my age is wondering if my grandchildren and I will be sharing Clearasil. "It's very distressing for patients [to have adult acne], especially after college; they want to be taken seriously and acne makes them look like children," said Dr. Victoria Gross, a dermatologist practicing in Fairfield. "A lot of my patients in their 40s tell me that their teenage kids are breaking out and so are they.

"Some people see the funny side and some are distressed and it affects their self-esteem," she said. One of her patients, who asked that her name not be used, started seeing Gross last year at the age of 41 for cystic acne that developed on her lower chin. It is rather upsetting, she said.

"I did have acne as a teen. I'd break out before my period or before a huge test," she said. "I had whiteheads and blackheads like anyone. It's not like I never had a pimple.

"I'm not floored by the whole thing, [but] my friends all tell me it [seems] much worse to me than it is to them," she said. "Sometimes I wake up with a pimple, sometimes I wake up with a wrinkle. I don't think it's any easier for adults than teens."

In the beginning, she was treated with cortisone shots and five months ago started on a low dose

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of Accutane, which she said seems to be working fine.

Gross warns that Accutane may have serious side-effects, including depression, thoughts of suicide and bad birth defects. Women on Accutane must sign a contract under a special program and promise to use two forms of contraception and have regular pregnancy tests to make sure they are not pregnant while on the drug and for a month after going off of it, said Gross.

According to the American Academy of Dermatology, 54 percent of women over age 25 have some form of acne. Adult acne, according to the AAD's Web site, is either a continuation of acne (persistent acne) from youth into one's 30s, 40s and even 50s, or late-onset acne, which develops after years of not having breakouts or never having pimples.

True adult acne erupts on the chin, jaw-line and upper neck, said Gross, while teens commonly get it around the T-zone (nose and forehead).

Another form is more related to rosacea, a skin disease that causes redness and pimples, and is treated with oral tetracycline drugs and topical antibiotics like MetroGel and finacea, she said.

Retinoids, such as Retin-A, which fights wrinkles, might also be prescribed for adult acne, Gross said. "Now patients have a medical reason to be on an anti-aging medication," which health plans may then pay for, she said.

The cause of adult acne can be attributed to several factors, including hormones, stress and even makeup, according to one dermatologist.

"[Adult acne] is almost exclusively in women and first appears in their 20s or 30s," said Dr. Robert Greenberg, a member of the AAD practicing in Vernon. "The acne process, by definition, has to start with a blockage of the pore — that's what leads to whiteheads and blackheads , whether it's an adult or teenager.

"The blocked pores can come about from the use of cosmetics. Using foundations and moisturizers can induce blockage of the pores," he said.

"Once the pores are blocked the sebum [oils] can't get out and you'll get a rupture," said Greenberg who agreed stress is another factor.

Stress can stimulate the adrenal glands to produce more cortisol, an acne-generating agent, as well as androgens, a type of hormone that stimulates the oil glands and hair follicles in the skin, he said.

Birth control pills that contain estrogen and progestins often can control acne, according to the AAD Web site, while birth control pills that only contain progestins may make acne worse.

Cases of adult acne seem to be rising and treatments geared for adults are in demand, said Annet King, director of training and development for the International Dermal Institute in Los Angeles. In the past, she said, women in the 20 to 40 age group have complained of skin problems, but now these problems are creeping into the over-40 category. She blames stress for the increase.

"We're balancing families, careers and we're running on empty a lot of the time," she said.

Over-the-counter products that may work for teens may not work for adults, which is why the Dermal Institute started Dermalogica and developed products for adults. I tried samples of Dermalogic's MediBac Clearing products, an adult acne treatment kit, and at first my skin seemed to get worse before it started improving. King said this was normal.

"Whenever you treat skin with something topical that exfoliates or cleans, it purges it to get out," she said, and therefore there may be a higher incidence of breakouts.

"You'll start to clear after a couple of weeks. What's important is consistency, sticking with it," she said and you should see results in six to eight weeks.

In over-the-counter products, two antibacterial ingredients to look for are salicylic acid and benzoyl peroxide, say the experts.

"What I like to do is use stronger oral medications with topical ones and once [the acne] clears up, stop the oral medications and use the topical," Gross said, adding some hope, "Most people clear up around menopause [although] I have patients up to age 80, but very few."

ACNE CAUSES, TREATMENTS WOMEN

Hormonal fluctuations: Oil chemistry changes post-pregnancy, pre-menses and post-menopause. Stopping use of birth control pills can trigger acne. Acne cosmetica: Pore-clogging powders and other cosmetics lead to blackheads and other flat acne.

MEN Improper shaving: Causes ingrown hairs that block oil glands and become infected.

Poor product selection: Harsh soaps dry out skin; resulting dead skin adds more debris to already clogged pores.

BOTH Stress: Increases cortisol, which changes oil chemistry. This change can lead to acne.

Genetics: Acne is a hereditary disease of the pores.

Mechanics: "Cell phone" acne on the chin; acne from repetitive touching of the skin or wearing hats or helmets.

Diet/environment: Some experts link acne to diets high in salt, changes in humidity and high levels of calcium or magnesium in a city's tap water.

Sources include Dr. Dennis Gross, New York dermatologist and author of "Your Future Face" (Viking) and Julie Anusevicius, Face Reality Skin Care TREATMENTS Solutions vary depending on the cause, severity and type of acne. Remember to wash the face with bare hands and a gentle cleanser and follow with an oil-free moisturizer containing sunscreen.

OVER-THE-COUNTER Always start here. The two antibacterial products are salicylic acid and benzoyl peroxide. Studies prove the 2.5 percent version of the latter is as effective as 5 percent, without the over-drying.

TOPICAL PRESCRIPTIONS If over-the-counter products don't help, it's time to see a dermatologist. He or she will most likely prescribe a topical gel that has two antibacterials in it, usually benzoyl peroxide and clindamycin. If that doesn't work, he or she may try a retinol-based ointment such as Differin or Retin-A, plus an oral antiobiotic. Accutane is prescribed for cystic acne. Most of these treatments cause acne to worsen before it gets better.

EXFOLIANTS Serums and peels containing exfoliating ingredients such as vitamin C or glycolic, salicylic or lactic acids can be administered by a dermatologist or licensed aesthetician on a regular basis. Some experience irritation with this treatment.

OTHER OPTIONS Laser- and light-based therapies are used on those who see little or no results with traditional therapies. Injectable steroids can also be used to spot reduce a pronounced blemish in a matter of days.

Sources include Dr. Jerome Potozkin, of Walnut Creek, Calif.

— McClatchy-Tribune