I Developed Acne in My Late 20s—This Is Everything My Dermatologist Taught Me

As a beauty editor who spends every single day consuming information and learning about skin from some of the top experts in the world, it’s safe to say that I know a thing or two about what we should and shouldn’t be doing in our quest for healthy skin. However, my years of experience in this job have also taught me that this does not mean I have the know-how on how to treat a medical skin condition.

You see, as like every other organ in our bodies, the skin and the way in which it functions is different for every individual. The advice that I give through my work is very much targeted at those that would like to give their already relatively healthy skin a helping hand. When it comes to skin conditions, whether it be eczema, rosacea, psoriasis or acne, there is little a beauty editor, friend, family member or influencer on Instagram can help with.

How do I know this, you ask? Because without blowing my own trumpet, I feel confident in saying that I know a lot more about skin and skincare than most. And, when my typically clear, glowing complexion started showing signs of acne over a year ago, I simply didn’t know what to do. I tried every tip and trick that I had learned. I tried acids, I tried no acids, I tried retinol, I tried no retinol, I tried countless different cleansers, as well as stripping my routine back to basics. And despite actioning everything I thought I knew to work, nothing helped. 

In the grand scheme of things, my acne isn’t terrible. However, as someone who totally skipped the teenage breakout phase, breaking out in painful, cystic acne in my twenties didn’t make me feel great. The spots themselves were based predominantly on my chin, around my jaw, and were often so painful that I couldn’t talk or leave the house.

Knowing that acne on the jawline is often linked to hormonal imbalances, I even came off my contraceptive pill in an attempt to start from scratch. At first, coming off my pill seemed to help and my breakouts died down a little, but six months later they were back and worse than ever. I knew that I needed medical guidance, but trying to see a dermatologist for acne on the NHS is no mean feat at the best of times, let alone during a pandemic.

After 18 months, I finally booked in to see a dermatologist at London’s Cadogan Clinic. And I would like to take this opportunity to tell everyone reading this that I know being able to book into a private clinic for any sort of skin condition is a 'luxury' that not everybody can afford. If your skin is impacting your mental health and you can’t afford to see a private dermatologist, I urge you not to give up with your NHS GP—skin conditions should not be overlooked. 

And while a part of me felt silly for seeing a dermatologist over seemingly mild acne, when my aesthetician, Pamela Marshall at Mortar & Milk (who by the way is considered London’s acne whisperer) advised I get a dermatologist to take a look, I knew it’s what needed to be done. So, two weeks ago, I had my appointment with consultant dermatologist at Cadogan Clinic, Dr Thivi Maruthappu. I have worked with Dr Maruthappu before and leant on her for insights to many articles, so I knew that I would be in good hands.

After a half an hour consultation, Dr Maruthappu had diagnosed me with acne vulgaris on my jawline and prescribed me a couple of prescription-only creams and a tablet to take every day for the next eight weeks. And while she explained that treating acne is a process that sometimes includes trial and error (meaning this might not be an immediate cure for me), she gave me some valuable insights on adult acne that I think are really important to share. This is everything Dr Maruthappu taught me…

One of the first questions that Dr Maruthappu asked me was if I was stressed. My initial answer was no more than normal, however it turns out what many of us deem to be ‘normal’ is often too high. Over the past few months, I have been juggling a house move with an exceptionally busy time at work, meaning I have been averaging roughly five hours of sleep a night. “Five hours is less than optimal,” warned Dr Maruthappu. She explained how high stress levels can exacerbate acne due to an increase in cortisol levels. 

To help me get a grip on my stress (and maybe my acne), she recommended I invest some time in meditation. In a bid to help reduce my cortisol levels, I have been setting the time aside for 10 minutes of guided meditation on YouTube every evening.

One thing that Dr Maruthappu was very keen to get across is that the aggressive diet culture around acne and skin conditions needs to stop. “I have patients that have gone to extremes to cut out certain foods from their diets,” she admits. But the truth is, it can be really damaging for your mental health, and often isn’t founded in science.

She told me that, providing you’re getting a relatively balanced diet, rich in fatty acids, it’s likely not food causing your issues. With that being said, she did warn me that excessive dairy, sugar and protein powder consumption can risk exacerbating acne, so try to enjoy them in moderation.

While my diet is mostly balanced and very rich in fatty acids, I do know that my diet could be more nutrient rich, so I also take daily supplements to give me a helping hand.

It’s important to remember that the skincare we buy in shops can only do so much for our skin. Sure, it can do a really great job at giving our skin what it needs to work at its best, but if there is something going on at a deeper level, medicated products are often required. 

When I told Dr Maruthappu that I came off my pill, she asked if I had been experiencing any hair loss (I had). “Hair loss can often be a side effect from coming off certain pills as estrogen creates a good growing environment for hair. When you come off the pill, those estrogen levels can drop,” she explains.

She also revealed that acne along the jawline can sometimes (but not always, I would like to highlight) point to the sort of hormonal irregularities that come with polycystic ovary syndrome (PCOS). “However, with PCOS, acne is commonly accompanied by hirsutism (excessive hair growth on the face) and irregular periods,” she adds. She advised that if I have any concerns, to visit my GP for blood tests.

I was prescribed spironolactone to help limit hormonal fluctuations, a tretinoin gel (retinoid) to increase cell turnover and an azelaic acid cream to minimise breakouts, bacteria and scarring. Although, please remember that this prescription is individual to me and might not be suitable for every individual’s wants and needs.

When using a topical retinoid such as the one I have been prescribed, it’s absolutely imperative that you don’t use any other acids or exfoliants in your skincare routine if you want to avoid damage to your skin barrier. Dr Maruthappu advised it was important I use a moisturiser free from acid exfoliants and one that I already know doesn’t worsen by acne.

The key, when using any retinoid treatment (prescription or otherwise) is in being vigilant with your daily SPF application. Not only can retinoids made your skin more sensitive to sunlight, but applying SPF every day will also help protect skin against long-term scarring. And with so many great facial SPF products out there now, we really have no excuse.