It would be wonderful if life could always be fair. We could plan our future, confident we would always get our just deserts. Unfortunately, the world can be uncaring, if not actually cruel. No matter how carefully we plan for the best outcomes, there's always a chance for things to go wrong. Worse, even if everything goes right, we can end up the victims of jealousy or even hate for our success. Whether it's at school or in the workplace, people can seize on the smallest things as justifications for treating us badly. It should not be this way, but even the way our body works can end up a trap. We can grow too tall or put on too much weight. We can be too pretty or have a physical disability.

One of the most common excuses for wanton cruelty is acne. As the hormones kick in, the majority of children and young adults find themselves the victims of abuse. Twenty or thirty years ago, this was mostly a problem for teens. Now it's affecting younger children and lasting longer. That this is unfair could not be clearer. Everyone has the same bacteria growing on their skins and so has the same chance of suffering acne. Yet, no matter who shows the first signs, the others are always waiting to sniff the air to detect body odor and hint at the unwillingness to wash or make even more unkind suggestions for the cause of the emerging spots. At a time when most people lack self-confidence, these personal attacks are extremely hurtful and many suffer psychological damage.

It would be good if acne was a one-time event. We could put the trauma behind us and get on with our lives. But several million women are now discovering acne can return as they pass through the menopause. It should not be unexpected because the same hormonal changes that cause acne during puberty are repeating themselves. As it stands, the medical profession has been slow to respond and so the cosmetics industry has been making excessive profits with products to clean the skin and cover up the spots. For better or worse, our society has placed a burden on women to appear perfect, no matter what their age. So what action should the older woman take? It starts with the use of exfoliates. During and after menopause, skin erosion grows more uneven and so it's always better to gently remove the epidermis or outer layer of skin to produce a more even appearance and clean out the pores. In turn, this helps control the acne. But only use the most gentle products to avoid drying out the skin. If this is not effective, you can move up to a retinoid cream. Should the menopause continue, using an oral contraceptive will usually calm down the hormone production.

Should all these simple steps fail, Accutane remains as the ultimate cure. Always remember pregnancy must be avoided at all costs so, if you are still sexually active and able to conceive, you must take comprehensive steps to prevent conception. As an older woman, you are in a high risk category for babies with birth defects. Use Accutane and birth defects become a certainty. Take advice before using this drug.