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Millions of middle-aged American women whose pimples disappeared along with their youth seem to be breaking out again just as they start fighting wrinkles. Blame the trend on an ever more stressful lifestyle--or on baby boomers' insistence on a solution for every problem. "It's partially increased prevalence and partially increased awareness," says Diane Berson, an assistant professor of dermatology at Cornell University's Weill Medical College who specializes in helping women battle breakouts. "We're really seeing an increase in adult women with acne." Soap and water alone generally won't tame chronic breakouts, which are caused by overactive oil glands and pores clogged by dead skin and bacteria. But mild to moderate problems may be easily managed with a trip to the drugstore. The same ingredients that fight acne in teens also work in their mothers. Those ingredients come in creams formulated for thinner and drier skin, says Arielle Kauvar, a dermatologist at New York University's School of Medicine. Cosmetics companies are enthusiastically creating moisturizers and cleansers that combine salicylic acid for pimples, say, with hydrating ingredients. Drug arsenal . For more stubborn cases, a topical retinoid (such as Retin-A) might be prescribed to both clear up acne and help prevent new breakouts, Berson says. Antibiotics can often help women whose skin is severely inflamed. Accutane, an effective medication for serious acne, will soon be tougher to come by. Because it can cause birth defects, new federal restrictions will require women who want it to register, and those who could get pregnant will have to prove they aren't and pledge to use birth control or abstain from sex while on the drug. If topical treatments and drugs don't do the trick, light treatments offer some hope. One type of laser treatment shatters the small blood vessels just under the skin that cause the redness of acne scars or rosacea--a condition that causes acnelike symptoms. Another type temporarily disables the oil glands. "The improvement can last six months to a year," says Kauvar. A promising treatment now in clinical trials, photodynamic therapy, was approved by the Food and Drug Administration in December 1999 to treat precancerous skin conditions. It uses a topical medication that reacts with blue light to kill bacteria and damage oil glands, resulting in lower oil production. Patients typically need about three treatments to see results, which can be significant--although "there are still a lot of unanswered questions, like how long the benefit lasts," says Berson, who is participating in the studies. The side effects can include a flushed face and temporary sun sensitivity, and at $200 to $400 per session, the treatment isn't cheap. But Susan Waldrop, who tried photodynamic therapy at 55, thinks the benefits outweigh the costs. Now, she says, "I look pretty with or without makeup."

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