A Skin Disturbance

Hi friend,

There’s a new phrase for the middle phase of adulthood. Coined in 2020 by psychology professor Clare M. Mehta, “established adulthood” describes the period “from age 30 to 45, when most people are deeply absorbed in career development while fulfilling the responsibilities of an intimate partnership and caring for children.”

Mehta debuted the term in an academic paper, calling this time “the most intense, demanding, and rewarding” years of life. It’s not “young adulthood” — a squishy category that can span 18 to 45 — nor is it “middle adulthood,” which can extend to 65 and doesn’t quite capture the heavy lifting and responsibility pile-up Mehta is interested in.

This phase also coincides with, per the results of a new study, its own epoch of brain wiring. The study found that adolescence, starting roughly at age 9, can last all the way to 32. “While in our society we may think of 18- or 21-year-olds as adults, this research adds to a growing body of work suggesting that the brain isn’t fully developed or stable until our late 20s or even early 30s,” says the Washington Post. This explains a lot; those 20 year olds are just teeny-tiny tots, brain-wise. Adulthood, which they classify as after 32, is pretty stable for our brains — which are still changing, but in a less dramatic fashion than they did prior.

We’ve heard “established adulthood” referred to as “The Mule Years,” given the heavy load we’re hauling. And the mules (us) are tired. Particularly in December, which writer Evie Ebert describes as “ten pounds of month in a five-pound sack.”

But the burdens continue. Such as a persistent skin condition that can be caused by throwing a ton of anti-aging products at your face. More information on that, below. Proceed with caution!

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Your friends at Gloria

This is the era of a solution for every skin problem. Wrinkles? Reach for retinol. Melasma? Brighten your skin with niacimide. Generally feeling dull? Nothing a little ascorbic acid can’t fix. But these treatments can create another skin problem, one that’s particularly pernicious: dermatitis. 

“I see it every day,” says Dr. Tyler Hollmig, professor and director of dermatologic surgery at Dell Medical School in Austin, Texas. “Skin sensitivity is more common now than it ever has been.”

According to the National Institute of Health, the prevalence of atopic dermatitis has increased two to three-fold in recent decades. Perioral dermatitis, which develops around your mouth, eyes, and nose, is also on the rise, according to a study by JAAD, with those ages 30-39 exhibiting the highest incidence.  

There are multiple factors to blame, such as “physiological changes, including hormonal ones,” says Dr. Hollmig. “But then you have this other piece: Are we breaking down our own epidermal barrier by using too many skincare products?”

The question is, of course, rhetorical. “Skincare, in general, is powered by this enormous marketing industrial complex, so there's a ton of snake oil out there that can be misleading,” he says. “You quickly get into this confusing alphabet soup of skincare. Certain things may be helpful, certain things may be a total waste of money, and certain things may actually be harmful to the skin, especially using multiple products, all of which have an irritating or exfoliating effect. That can really spin up a cycle of skin problems, particularly in sensitive skin.”

Daniela Ezratty, an Atlanta-based nurse practitioner who specializes in hormone replacement therapy, nutrition, and aesthetics at Ezratty Integrative Aesthetics, puts it even more bluntly. “People are prescribing their own skincare through TikTok,” she says. “They're throwing an acid on, then moisturizer because they've burnt their skin. It’s often been in the fall that people who are very sensitive to [dermatitis] will get it, but now we're seeing it even in young kids because of all the products.”

If you suddenly find yourself with persistent flaking, itching skin, or small red or pus-filled bumps – especially around the nose and mouth – hold off on products like topical steroids, which can be a contributing cause. A dermatologist can help you figure out what’s to blame. “Are you using a topical serum on your face? A minty toothpaste? Hydroxys? If so, let's calm the skin down,” says Dr. Hollmig. “First, we'll use a really bland moisturizer with as few ingredients as possible to reset. If you have a clear causative agent, let’s remove it, and then go really gently after that.” 

Hollmig is not against using active ingredients to target skincare problems. “You can climb this therapeutic ladder, but you want to do it correctly,” he says. “It has to be a targeted approach.” That means using only one active at a time, at least to begin with. “Once a patient's skin proves that it can handle that ingredient, then you can add in another active.” 

In middle age, says Dr. Hollmig, “we lose estrogen and have a difficult time hanging on to water, so we have what's called increased transepidermal water loss. We can't retain moisture as well. We also lose production of certain fatty elements of the skin barrier over time – ceramides are the ones that are well known. The epidermis changes in a way that's more prone to damage and drying. That's part of this process that we see with dermatitis and perioral dermatitis.”

Which brings us back to use, and overuse, of products designed to irritate the skin. “Having a weaker wall makes us more prone to irritation,” he says. “If your epidermis can't stand up as well to something that is stripping it or damaging it, you're going to have more sensitivity and inflammation.” This is particularly tricky when using products intended to increase cell turnover. “A lot of the good things that we do in dermatology involve controlled damage. If you think about lasers or microneedling, those are microscopic injuries placed in a controlled fashion that lead to regeneration,” he says. “Skincare can be the same, but if you're going into that battle with a weak, thin epidermal barrier, you're more likely to get too much damage, too much inflammation, which looks like red, irritated skin.”

Perioral dermatitis is a tough adversary, and oftentimes product elimination is not enough. “A dermatologist can offer medical-grade treatment options such as safe anti-inflammatories, oral antibiotics, or other medications,” says Dr. Hollmig. Recurrence might require an oral antibiotic instead of a topical anti-inflammatory cream, or even a stronger medication like a systemic retinoid such as isotretinoin. 

Mild cases of perioral dermatitis should improve within days to a week or two, with decreased irritation, scaling, peeling, redness, and irritated bumps, but more severe cases may not clear for several weeks. “Recurrence is a possibility but is usually caused by repeated introduction of a skin irritant,” he says (and FYI, many toothpastes can be triggers). “So, the goal is to remove the offender(s), treat the associated inflammation, give the skin some time to settle down and heal, and then educate the patient on likely exacerbating factors so they can avoid these in the future.” 

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TO WATCH Our hand was forced when it came to the Eras Tour documentary of 2023 (child’s party). But for some reason, we genuinely want to watch her second documentary about the tour. Whereas the former felt like a concession for those of us who couldn’t afford concert tickets, this episodic production is more of a behind-the-scenes look at how she pulled it all off — plus lots of footage of personal moments.

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TO LISTEN In a new podcast, The Guardian explores The Free Birth Society and the damage left in its wake. This is a group that promotes pregnancy and birth without any medical assistance – no midwives or doctors, and no imaging or prenatal testing, meaning risk factors like multiples and breech positioning aren’t discovered prior to labor. 

TO TRY If you see this bag of corn flakes in your local grocery store, buy it. We picked one up a few weeks ago on a whim and were honestly wowed at what a delicious and nostalgic treat a bowl of plain, crunchy corn flakes and milk was. Yes, they are pricey and a bit precious, but they’re really good.

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What a delightful story about purchasing a pickup at 40. • Come for the article about menopause symptoms, stay for the illustrations featuring all sorts of parched devastation. • “The saddest store in Soho.” • Can (will) politicians help middle-aged adults caring for their parents?

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