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. See 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, the first thing Dr Sam Bunting tells her patients to do, is to strip their skincare back to basics and “set aside a three month period to take charge of your skin.” (More on that, below.)
So aside from overcomplicated routines and irritating products, what else is to blame? For many women, it’s hormones. They might be prescribed the contraceptive pill in adolescence and stay on it well into adulthood. When they do break up with it, hormones are subject to cyclical changes, albethey normal. “These hormonal fluctuations significantly influence skin’s metabolism and increase sebum production,” says Dr Barbara Kubicka, Aesthetic Doctor and Founder of Clinicbe. In addition, underlying conditions such as polycystic ovaries cause the body to produce too much testosterone which, for approximately 30% of sufferers, manifests in cystic acne. Then pregnancy, postpartum and breastfeeding send hormones into a frenzy. “On top of all these instances,” Dr Kubicka reminds us, “there’s increased cortisol levels to consider, because stress directly impacts sebum production and disturbs our natural immune response, which ultimately leads to breakouts. Cortisol is also why it’s crucial to get ample shut eye. “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”.
Dairy is also an issue. According to expert dermatologist at sk:n Dr Firas Al-Niaimi, “a high intake can encourage certain growth hormones to stimulate the grease gland to become more active which will then in turn cause acne to form.” Alongside dairy alternatives, try starting your day with Symprove (£79 for a four-week supply) which is live and active gut-regulating bacteria. “Inflammation of the gut leads to a build of toxins that can have a profound effect on skin,” continues Dr Al-Niaimi.
The majority of adult acne manifests on the lower face on what’s - incidentally - called the ‘surgical-mask distribution.’ And while the fact that we’re now required to wear an actual mask might sound like a fortuitous means of concealment, dermatologists are warning that they’re exacerbating the problem. Hot, clammy and worn everyday, they harbouring oil, sweat, dirt and grime, and ironically, are a breeding ground for germs. Read: wash yours as regularly as you would your, er, underwear. Everyday!
“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 SkinCeuticals Retinol 0.3, £65, is a good one to start with, once or twice a week. Once you’ve finished the tube, you can graduate to 0.6%. If you’ve struggled to get on with retinol before because you’ve got sensitive skin, or suffer from rosacea, La Roche-Posay’s Retinol B3, £38, cushions retinol in soothing, moisturising ingredients, and delivers it via slow release technology, both of which reduce the risk of 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.