Acne and over 40 skin – what are the options?

Hi Dr. Irwin! I love your blog and your book and the fact that you explain everything... Anyway I just need a little guidance with my skin regimen. I'm 41 and struggle with acne since I was teenager. It's now more or less under control with mainly blackheads on nose and chin and an occasional breakout. Also some post breakouts discoloration. My dermatologist prescribed retin-a and minocyclin 100mg bid. I'm also on ortho tri cyclen. I use retin-a for a very long time on and off and it makes my skin red but I'm afraid to use it less then every day. To make the story short AM: CE Ferulic,moisturizer with SPF oil free,replenix eye cream PM: eye cream,retin a micro.oil free moisturizer. Should I incorporate salicylic acid? Can I use less retin a and just buy TNS serum and alternate? I'm just confused because like a lot of people I have both: signs of aging and breakouts (those stubborn blackheads are not leaving my face). I work as an oncology RN and feel stupid complaining about my face but I just don't know what to do anymore. All the best. Agata.

Agata, thank you for writing and also for being an oncology nurse which is a very important and tough job. You can make a difference in people’s lives every day. I’m happy to try to answer this for you. A couple of thoughts:


  • The Retin A/tretinoin is better for acne than TNS serum or the salicylic acid. It’s science and track record for preventing signs of aging is better and it also helps to prevent skin cancer; Learn more information about wrinkle repair creams.
  • You will have less irritation if you wash, moisturize, wait 10 minutes and then apply it. You will also have less irritation if you change to a form of it with a more moisturizing base like the Renova or the Refissa;
  • Your antioxidant in the AM (the C E Ferrulic) is excellent;
  • Consider adding a light scrub once or twice a week or adding the Clarisonic for cleansing;
  • Discuss with your doctor changing the minocycline to the low dose forms of doxycycline which won’t affect your intestinal flora as much or take probiotics daily and eat yogurt.


Hope this helps,  Dr. I


See Dr. Irwin’s recommendations on Anti-Aging and Wrinkle Repair Creams.

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin, and I believe that consumers need and deserve a medically trained and unbiased skincare advocate.

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