One of the most common things I hear in the clinic is “I never thought I’d have to deal with spots and wrinkles at the same time.” Unfortunately acne is not just a teenage problem. Around 10 – 20% of women continue to suffer with acne beyond their teenage years, and some even develop the condition in adulthood for the first time. Interestingly, adult acne appears to be on the rise.
Acne is characterised by the presence of comedones and pustules (pus-filled spots). Comedones are those small gritty, grainy, under-the-skin bumps that often appear together in crops.
On the more severe end of the spectrum, acne can also lead to larger, deeper and more tender spots, which us Dermatologists refer to as nodules and cysts. All of these have the potential to leave dark marks on the skin, known as post inflammatory hyperpigmentation, as well as scarring which can be permanent.
Although it is possible to get the same type of blemishes as adults that we had when we were teenagers, women in their twenties, thirties and forties often experience breakouts on the cheeks, jawline, neck and chin. People often ask me what the underlying cause is for their blemishes. There are a number of potential causes for acne and any combination of these may be acting at the same time.
You may have noticed that acne sometimes runs in families. Whilst no specific gene has been identified so far, research shows that genetics can have an impact upon your chances of having acne. For example, genes can determine how effective your immune system is at warding off Cutibacterium acnes (C. acnes), a bacteria that promotes acne.
If both of your parents had severe acne, either in adolescence or in adulthood, your risk for having acne may be higher. Both parents may possess the same genetic components for acne, or varying ones. So, one parent may pass on a hormonal condition which makes you acne-prone, while the other passes on a stronger inflammatory response to bacteria or other genetic factors.
Hormones and their receptors play a role in acne onset and treatment. This is why acne typically appears for the first time during puberty. Shifts in hormones, like testosterone, cause the sebaceous (oil-producing) glands in the skin to enlarge and increase their output.
In women, acne is particularly sensitive to hormonal changes. Almost 70% of women in a particular research study reported worsening of breakouts in the pre-menstrual period.
Although a proportion of women have abnormal hormone levels, current understanding is that acne probably results from an excessive or amplified response of the sebaceous glands to normal circulating hormones in most cases.
Certain medical conditions, such as Polycystic Ovarian Syndrome (PCOS), increase the risk of acne and may be tested for if there are other symptoms to suggest its presence. Examples of these symptoms include thinning of scalp hair or widening of the hair parting, excessive hair growth on the face, chest, back or buttocks, weight gain and infrequent periods or no periods at all.
PCOS has been estimated to affect approximately 8% of women of reproductive age, making it very common indeed. It sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS, the risk of you developing it is often increased.
Stress has been shown to alter the immune functions of the skin and skin barrier function which may lead to increased oil production, pore clogging and growth of the C.acnes bacteria that predisposes us to spots. Interviews, work-related stress, relationship troubles and missing out on sleep may lead to acne flare-ups.
Many of us recognise that stress is contributing to our skin problems, yet we often struggle to know how best to address this issue. Having a plan of action can help take the stress out of trying to manage your spots on your own.
There is lots of speculation and misleading information about the role of diet in acne.
Sugary and processed foods are understood to stimulate acne pathways. There is also emerging evidence that dairy may be a trigger for some people too.
The available research does not demonstrate that food causes acne, rather that it may influence or aggravate existing acne. This goes some way to explain why altering diet is rarely sufficient to control acne on its own, but can work in conjunction with medical treatment.
Although the chance you will continue to get breakouts does decrease with every decade, I still have patients coming to see me for the first time in their thirties, forties and fifties. The following tips are a good place to start if you’ve been struggling with your skin.
In order to bring acne under control, it is important to establish a solid skincare routine and stick to it every day. It is never too late to start. Cleanse your skin well twice daily and use a moisturiser and sunscreen designed for spot-prone skin.
Using products that aren’t designed for people with breakouts or blemishes can actually make things worse so choose carefully. The words “non-comedogenic” (meaning non pore-blocking) on the container or packaging indicate that the skincare brand has thought about spots when formulating the product. Over the counter solutions containing salicylic acid, azelaic acid, sulphur, zinc or niacinamide, for example, may help decrease congestion and calm blemishes if your symptoms are mild. If your symptoms are not mild, going round in circles with over the counter choices may just be delaying effective medical treatment.
There are a number of efficacious treatments and treatment combinations that can successfully bring acne under control and also techniques we can use to maintain the results in the longer run. These can all be tailored to your circumstances.
Most importantly, don’t suffer alone. If you’re already following all of these tips and still struggling to get your breakouts under control, it’s time to share your concerns and get help from a professional.
Taking action by seeking dermatologist input early can improve skin confidence and self esteem, as well as reduce the risk of permanent scarring.
Thank you for everything. For your kindness and repeatedly going above and beyond. The last few years have been really difficult, but you’ve been a major part of me not giving up hope. You’ve been very much appreciated.
Thank you so much for your kindness and expertise. You’ve made a huge difference to my confidence and have made every appointment such a pleasure.
Justine was absolutely excellent. Wonderful bedside manner. Totally professional and in the know of so many different issues.
My treatment has already worked brilliantly and I would happily come back with any other problems. Thank you!!
Dr Justine has completely changed my skin. From advice on products to use, to prescribing and adjusting medication, she has made such a difference. Would happily recommend her to anyone!
5 stars are NOT enough for the wonderful Dr Kluk. She is truly professional, honest in her opinion and she takes great pride in the happiness of her clients. The best dermatologist!
I now see foundation as a choice, and not a “need” like I used to, and I feel so comfortable in my own skin. Dr Kluk is so kind, understanding and knowledgeable.
Dr Kluk has been part of the biggest improvement that I’ve had in my skin journey so far. I’m so comfortable in my skin now and we’ve still got plans for improvement!
Justine is a complete expert about skin. She is so professional and friendly at the same time and I always know I’m in good hands with her. My skin dramatically improved after seeing her, giving me more confidence.
Dr Kluk really listens and gives you an entirely bespoke plan, unlike some of her contemporaries who roll out a one size fits all plan for everyone, which fails to address more nuanced needs. I couldn’t recommend her enough.
Dr Kluk was fantastic. She’s experienced, warm and very professional. She took time to understand my medical history and came up with a combined topical/ hormonal treatment that has really transformed the texture of my skin, reducing blackheads, scarring and breakouts.
Justine was so reassuring and kind in her approach. She also clearly explained my treatment, so I feel really comfortable using the products. Fingers crossed it makes a difference – we’ll see in three months! Thanks Justine.
The big difference with other clinics is that Dr Kluk went into great detail about how each cream should be used, in order to treat spots but avoid making my skin sore and inflamed. Couldn’t recommend more highly.
Dr Kluk is beyond amazing. I haven’t seen my skin like this for years and she’s helped me regain my self-confidence. I would highly, highly recommend this clinic!
I can’t recommend Dr Kluk enough. Her friendly, professional & warm manner instantly put me at ease. A sensible, steady approach has given me improvements beyond my expectations & continues to do so. I feel so lucky to have found her.