Synonymous with train-track braces and heavy side fringes, you might think you left acne behind in your teenage years. But for many, that isn’t the case. Adult acne – a skin condition that occurs when hair follicles become plugged with oil and dead skin cells – is on the rise. So while most of us have experienced acne at some point, 15% of women are diagnosed as adults. As a result, Cult Beauty has seen a 66% increase in sales within its acne product category.

Refreshingly, the rise in adult acne is being chased by a growing skin positivity movement. Needless to say, blemishes are a completely normal facet of life and a growing number of us have taken to Instagram to share #skinpositivity posts, chipping away at any shameful stigma that was once attached to the condition. The movement also celebrates skin acceptance – the idea that if you’re happy with your acne, that’s great, but it’s also OK if you want to take steps to reduce it.

Last year, Billie Piper guest edited an issue of Stylist, and as part of her beauty takeover she wanted to talk about her experience of adult acne, a subject she often speaks candidly about. Over the years, she’s undergone treatment for it from renowned skincare expert and go-to celebrity facialist Debbie Thomas at her D Thomas Clinic in London. “Debbie had acne as a child, so she understands the impact it has on your skin and your mind,” says Billie.

The issue is knowing where to start with acne treatment – it can be a minefield, especially when you consider the numerous potential causes and the fact that everybody’s skin is different. So, we spoke to Debbie Thomas and dug a little deeper into the five key things you need to know about adult acne.

Type ‘acne’ into Google and the first images to pop up tend to include severe red cysts. However, acne appears in many different guises: even if you only get one or two spots a month, it might still be medically classed as mild acne.

“Acne is simply the medical word for spots,” says Dr Anjali Mahto, consultant dermatologist and British Skin Foundation spokesperson. “Doctors refer to ‘acne’ regardless of whether the problem is a small handful of spots or more extensive affecting the face, chest and back.” There are six types of spots caused by acne: blackheads, whiteheads, papules, pustules, nodules and cysts. But when is a blemish not acne? “These are normally allergy-related bumps which are very small and affect the very surface,” says Debbie Thomas. “Or they’re related to hair growth and can be irritation from shaving or actual ingrown hairs.”

While diet, pollution and lifestyle are often touted as the main causes of acne, hormones – particularly those triggered by women’s menstrual cycles – are the only scientifically proven cause. “During the first half of our cycle, oestrogen is dominant and in the second half it is progesterone,” says Dr Mahto. “Just before menstruation, these hormones drop and our androgen hormones (a type of male hormone) are high. These act on oil-producing glands to increase their size and activity resulting in acne.”

Acne could also signal an underlying medical issue. “Acne can be a common sign of polycystic ovary syndrome (PCOS),” Dr Mahto explains. Studies show that 19-37% of women with moderate or severe acne will meet the criteria for PCOS (having at least two of three symptoms: irregular periods, high levels of androgens or polycystic ovaries).

If acne develops after adolescence, it might be hereditary. It’s hard to pinpoint one reason. “That is why it is so hard to treat and get rid of permanently,” says Thomas. Acne affects people differently, so treatments will vary depending on the severity – from medication such as azelaic acid or isotretinoin capsules (also known as roaccutane) to treatments like microdermabrasion. If you’re unsure whether a blemish is acne, seek professional advice from a GP or dermatologist.

If your acne is bothering you, it can be tempting to slather on all the super-strength acne-fighting formulas you can find, but it’s vital to be patient. In fact, before entering the world of skincare, Thomas’s own acne saw her regularly using harsh products. “None of it helped and, a couple of times, I actually burned my skin,” she recalls.

The best approach is to strip your skincare back to basics (cleanse and moisturise), adding active formulas in gradually. “It can take using an active ingredient like retinol regularly up to nine months to show results, so don’t jump from one ingredient to the next,” says Thomas.

Cleanse your face twice a day. Products that contain salicylic acid and zinc may be beneficial, says Dr Mahto. After a couple of weeks, start using a chemical exfoliant (like glycolic acid) once a week. “This will remove the upper layer of skin cells and help reduce blackheads.”

Once your skin has acclimatised, you can introduce an active treatment. For mild acne, a pharmacist can prescribe over-the-counter creams (containing ingredients such as bacteria-killing benzoyl peroxide), but for moderate or severe acne, prescription medication might be best – speak to your GP.

If you want to try a clinical treatment, book in for a consultation to ensure your skin is suited to what’s on offer. “We work with lasers, peels, light therapy and microneedling, alongside a good home care routine,” says Thomas.

The psychological impact of acne can’t be overlooked. “Acne has been associated with anxiety, depression, poor quality of life, lack of self-confidence, feelings of isolation, embarrassment, low self-esteem and problems with body image,” explains Dr Alia Ahmed, psychodermatologist at Eudelo Clinic.

Social media can be particularly damaging. “The pressure to look perfect can affect the psyche,” says Dr Ahmed. “I have seen patients who cannot look at an unedited photo of themselves as they find their skin repulsive.”

Try following people who encourage positive conversation around skin conditions on social media. And when seeking medical advice, discuss the impact acne is having on your life. “If patients are reporting emotional problems, I encourage them to seek support through talking therapies and/or oral mood managing medications, if needed,” recommends Dr Ahmed, who also flags online resources such as skinsupport.org.uk and changingfaces.org.uk.

Even if your acne fades, scars and pigmentation can be left behind. “There is sometimes an unrealistic expectation of how skin should look after acne treatment,” says Dr Ahmed. “Most scar treatments are not available on the NHS and this can make people feel despondent.” It’s no surprise, then, that ‘scar treatment’ is one of the most popular acne-related searches on Cult Beauty.

Clinical treatments differ depending on the type of scar. They are categorised according to shape, depth and colour and the NHS identifies three main types: ice pick, rolling or boxcar. Scars require different forms of treatment but Thomas tends to rely on microneedling, microdermabrasion and peels, while stronger peeling lasers are used for deeper scarring. “If it is a textured scar, a certain amount of controlled damage to the skin is required to try and stimulate new collagen production to get the area to repair itself,” she explains. “The reality is it’s difficult to get scarring to go completely. Results, which typically display a 30-70% reduction, can take time, with even the strongest treatments often requiring several sessions over one or two years.”

High-tech, blemish-relieving formulas that will soothe and treat your skin…

Main image: Getty Images