Winning question

I am currently going through the peri-menopause and my skin is suffering. I have breakouts on my chin when my period is due, and I suffer from hard almost under-the-skin spots around my jawline. I have always looked after my skin; I drink water, exercise regularly and eat a largely organic diet. I exfoliate once a week. My skin is fairly sensitive and it can be prone to dryness across my cheekbones, but I also have a fairly oily T-zone.
Sian Weston

So many people send letters about adult acne, teenage acne, post-coming-off-the-pill acne and stress-related skin breakouts. I asked Dr Dennis Gross, a Manhattan dermatologist, creator of MD Skincare, and Dr Howard Murad, LA dermatologist and pharmacist, to look at your question specifically. These days it is not considered right to dry out skin problems, new products hydrate as well as treat the skin and almost every dermatologist line has acne products or are developing one. Apart from the odd product I come across that I am impressed with, such as Visibly Clear Gentle Exfoliating Wash (£3.99, Boots), these are two men whose opinion I rate. Dr Gross says: 'Peri-menopausal hormonal changes/fluctuations may change the oil-chemistry of the skin, which can lead to adult acne. Acne is brought on by one's own oils being too heavy. Genetics plays a large part as well. Tap water can also be a factor depending on a city's calcium and magnesium levels.'

According to Howard Murad, oestrogen levels start to decline in the years prior to menopause and this decline can contribute to breakouts as androgen levels become more dominant.

'This is a good time to utilise skincare products that contain plant-based, or phyto-oestrogen products that may contain soy extract, clover flower extract or wild yam extract for example,' he says.

Dennis Gross recommends looking for products that contain Bisabolol, an active ingredient derived from chamomile extract that helps soothe redness and reduce inflammation. 'Salicylic acid is also a good ingredient and so is sulphur, which controls the oil that feeds the bacteria. I also recommend using products that contain a chelator that blocks the action of calcium and magnesium. Over-the-counter (OTC) products are usually very simple formulae using benzoyl peroxide or salicylic acid. Trial and error with OTC products is usually quite simple because there are only two active ingredients so there is very little difference between the majority of the products out there.'

'Breakouts in peri-menopause are common in the lower part of the face,' says Howard Murad. 'Using a spot treatment that has sulphur and salicylic acid immediately and a few times per day, will reduce the inflammation and often stop the breakout from getting worse.' (Try MD Skincare All-Over Blemish Solution, £21.45 for 75ml, Selfridges or Dermalogica's Special Clearing Booster £31.80 for 30ml, stockists: 0800 591818 ).

'The problem with many OTCs,' says Gross, 'is that they are very drying. Treatment for adult acne has to be consistent and prevention is really the best step because it is important to realise that a blemish can begin to form up to three weeks before it appears on the surface of the skin.' Interestingly, Howard Murad also suggests you reduce the intake of shellfish or iodine rich foods, 'as iodine has been shown to have a direct link to acne breakouts'.

Dr Gross suggests that it is time to see a dermatologist about adult acne 'when OTC products are failing to improve your condition or if you have scarring from acne in the past, painful bumps above or below the skin, pimples that last for weeks or leave red marks behind, or acne that is getting worse and not better.' You might also look at an at-home tool called the Zeno (www.myzenoeurope.com, £129, see Beauty Testing) which is a hand-held device clinically proven to trigger a heat shock response in the micro-organisms that cause skin lesions. A new and even more high-tech version of this gadget is due to launch in spring 2008. Laser treatments are another option although an eminent dermatological surgeon friend tells me that currently none of the lasers comes close to medical treatment for acne.

Murad Resurgence Brand and Murad Blemish Spot Treatment and consultations , treatments and mail order available from www.thepeachtreeclinic.co.uk; MD Skincare® acne collection is available at Harvey Nichols and Space NK.

I am over 50 and use Mary Kay's Time Wise Age-Fighting moisturiser but would like a change - my pigment does need evening out.
Janet Marsh

I think it's a good idea to have a change and at over 50 you need more than just a daily moisturiser to give your skin a lift. You need a good, richer, moisturiser to nourish your skin - Neutrogena Ultimate Moisture Cream (£ 6.99, 50ml) is a very good one. But if you want to even out your pigment you need something more hard-hitting. You could try Shiseido's White Lucency Refining softener (£68 for 150ml, stockists: 020 7313 4774) under your moisturiser or try Biotherm's White Detox Lotion (£19.50) and White Detox Essence serum (£42, stockists: 0800 037 1020) which are designed to even out skin tone. (Incidentally, I've just been in Korea and these products were voted favourites by magazine readers there.)

Kathy's hot products of the month

This is the time of the year to try a new fragrance. Diptyque's coffret of Quatre Eaux de Toilette gives several great options (£50, 020 7727 8673) and Fendi's new deep sexy scent, Palazzo, (90ml, £50, Selfridges) has a fabulous bottle too.

Kathy Phillips is beauty director of Condé Nast Asia. Author of four books, she has her own critically acclaimed aromatherapy range, This Works.

If you have a beauty question, email observer.woman@observer.co.uk. The best one receives a product from This Works, Kathy Phillips's range (www.thisworks.com)