Between 40 and 50% of women aged 20-40 suffer from adult acne, and yet, despite the precipitous rise, we still associate it with sullen teens. From increased stress levels and dietary factors, to changing hormones, triggers are tricky to identify, and solutions seemingly harder to find. There’s a lot of misinformation out there – the kind that makes dermatologists seethe with hate for the internet, and likely, the proliferation of oil-based, fragranced and glitter-laden skincare. Yes, stripping skincare back to basics is the first thing Dr Sam Bunting tells her patients to do. After that, it's to “set aside a three month period to take charge of your skin.”
So beyond overcomplicated routines and irritating products, what else is to blame? For many women, it’s hormonal. If you've been on the contraceptive pill from adolescence, when you do break up with it, your hormones are subject to cyclical changes. “These hormonal fluctuations significantly influence skin’s metabolism and increase sebum production,” says Dr Barbara Kubicka, Aesthetic Doctor and Founder of Clinicbe. Underlying conditions such as polycystic ovaries can also cause the body to produce too much testosterone which, for approximately 30% of sufferers, manifests in cystic acne, while pregnancy, postpartum and breastfeeding sends hormones into a frenzy, too. And on top of all of that, there's cortisol to consider. "Stress directly impacts sebum production and disturbs our natural immune response, which ultimately leads to breakouts," says Dr Kubicka. “It peaks in the morning, naturally depletes during the day, and is broken down completely during sleep, which is to say that without enough sleep, the cycle is disrupted entirely," she continues.
According to expert dermatologist at sk:n Dr Firas Al-Niaimi, “a high intake of dairy can stimulate the grease gland”, which means it's wise to cut down. She also recommends starting the day with Symprove (£79 for a four-week supply), a live and active bacteria that regulates the gut and in turn, curbs inflammation.
The majority of adult acne manifests on the lower face on what’s – incidentally – called the ‘surgical-mask distribution.’ And while wearing an actual mask might sound like a fortuitous means of concealment, dermatologists warn that they exacerbate the problem. Hot, clammy and worn everyday, they harbour oil, sweat, dirt and grime, and ironically, are a breeding ground for germs. Read: wash yours as regularly as you would your underwear, which we hope, is every day.
“Go for a non-comedogenic cleanser”, says Dr Bunting, which in this context, means something that doesn’t foam, dry or clog. CeraVe Hydrating Cleanser, £9.50 is gentle and nourishing, while Be Purified Facial Wash, £44, uses glycolic acid to gently exfoliate skin.
Avoid heavy, unctuous formulas if you can. SVR Sebiaclear Hydra Moisturiser, £14, is anything but and includes Niacinamide which will gradually lessen the appearance of acne scarring.
For severe cases of acne, tretinoin (prescription retinol) can be truly transformative. The vitamin A derivative reduces inflammation, regulates the turnover of cells and unclogs pores. If you’re new to retinol start with SkinCeuticals Retinol 0.3, £65, once or twice a week. Once you’ve finished the tube, you can graduate to 0.6%. If you’ve got sensitive skin or rosacea and have struggled with retinol before, La Roche-Posay’s Retinol B3, £38, is for you. Cushioned in soothing, moisturising ingredients, the active ingredient is delivered via slow release technology in order to reduce the risk irritation.
Azelaic acid works wonders on scarring, uneven texture and clarity, and if you’re pregnant, is a good alternative to retinol.
Aside from aging skin immeasurably, the sun - and specifically UVA rays - worsen acne scars and pigmentation, so SPF is a must.
“I always advise patients to steer clear of heavy make-up,” says Dr Kubicka. Lots of foundations, especially long-wear formulas, are heavy and cloying on skin, so instead look for something non-comedogenic.