How I Beat Adult Acne And Discovered The Pervasive Nature Of Skin Privilege
‘I'm really sorry about my skin,' I said quietly to the A-list facialist. She said she could uncover my long-lost cheekbones with a sculpting massage, but it only made my complexion angrier. Later that night, in bed, I apologised to my partner about the state of my flare-up. I knew it didn’t bother him, but after witnessing my skin pulsate with red, painful, pus-filled pimples (sexy, I know), I felt it was necessary.
I have adult acne – defined as acne occurring after the age of 25 – and when I’m not apologising for the state of my skin, I find myself justifying it to beauty professionals and strangers who tell me that I’m ‘quite pretty, actually, but it’s the spots…’
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After more than a decade trialling endless products, painstakingly watching my diet, and consuming more [insert supplement du jour here], I finally went on a course of isotretinoin – also known as Roaccutane – a strong form of vitamin A, which has been used to treat spots since the 1980s. It was the best decision I have made, not only for my skin but also my peace of mind, despite isotretinoin’s reputation for having adverse side effects on people’s mental health.
It cleared my blemishes and, more importantly, I no longer wake up feeling anxious about what I might find brewing under my skin. I stopped worrying about how every part of my daily life – from the pizza I had to the way my partner touches my face – might trigger another blemish. Beyond the aesthetics, it was the physical pain that made me feel constantly on edge. Two years ago, my face ached when I laughed too hard. Now, I feel as though a weight has been lifted off my shoulders.
The relationship between acne and mental health is one that psychoderm and consultant dermatologist Dr Alia Ahmed sees first hand in her clinic. ‘It works both ways – acne affects mood and mental health, with patients reporting depression, social anxiety and body-image issues, as well as feeling much better when their skin improves,’ she explains. ‘Emotional distress is also reported by many as a driver of acne. It’s a vicious cycle.’
The severity doesn’t dictate the impact. ‘Someone with few spots can be just as distressed as someone with a severe issue,’ she says. A survey by the British Skin Foundation found that only 6% of sufferers said acne had no impact on their daily life. The others linked a decline in confidence and self-esteem to their breakouts. According to Dr Ahmed, a meta-analysis in 2020 connected acne with depression and anxiety, the latter prevalent in up to 68.3% of sufferers. She adds that ‘a multi-centre study of adults with acne from 13 European countries reported that 40.6% were worried about their appearance, 12.3% had suicidal thoughts and 4% attributed their suicidality directly to their acne’.
Research focusing on adults is sparse, but Dr Jason Thomson, head of medical at the personalised-skincare brand Skin + Me, shares that the ‘prevalence of acne is increasing globally in all age groups, including the over 25s; around 8% of adults now have acne, with women more likely to experience it than men’. It’s a relatively low number, but given the mental-health impact it presents, it’s not something to ignore.
‘Adults with acne can feel alone and experience shame and guilt about their skin. They say to me, “I’m doing everything right, I exercise, I practise good hygiene, I eat well, I use skincare. Why is this still happening?”’ says Dr Ahmed. While lifestyle management is beneficial, professional help is often essential, as breakouts can be caused by things beyond your control, such as genetics and hormones. For Dr Ahmed, it’s never too late or too early to seek medical support, especially as ‘effective treatment in most cases improves mental health’.
She’s right. But I’ve also noticed a certain privilege that comes with having clear skin. My complexion is still dappled with a constellation of scars and indents, but unsolicited advice rarely comes my way any more. Skin clarity seems to be the baseline of beauty standards, and since blemishes are more readily treatable (and easier to disguise) than vitiligo or extreme psoriasis, it’s rare to see spot-prone people represented anywhere in the media.
Whereas we demand honesty from celebrities when it comes to their tweakments and surgeries, there is a quiet privilege that comes with clear skin. Stars who claim to have experienced complexion problems rarely detail the work it takes to keep spots under control. We gloss over the fact that ‘glass skin’ often means courses of lasers and microneedling, not just some buttery moisturiser. ‘We need more transparency, especially since our world has become so online and influencer-led,’ says model and content creator Lou Northcote.
She set up the @freethepimple page on Instagram seven years ago. ‘I just wanted any one person to say, “I have acne, too. Let’s talk.” I wanted someone to relate to,’ she tells me. She has since gone on isotretinoin to remedy her debilitatingly painful spots, but stresses that @freethepimple is for anyone affected by acne, no matter where they’re at in their journey. ‘It’s about trying to make people feel they aren’t alone.’
It should go without saying, but if you know someone with acne, don’t bring it up unless they do. If you receive unsolicited remarks, I’ve found honesty helps. ‘I’m taking care of it’ or ‘I am comfortable with my skin as is’ usually stops comments in their tracks – although you don’t owe anyone an explanation.
Northcote’s page made me feel seen when I felt isolated, but there is also Acne Support and the British Skin Foundation, which provide professional advice and community forums. Changing Faces is a UK charity that supports people with visible differences, including those with acne. To democratise professional treatments, consultant dermatologist Dr Emma Craythorne launched Klira, which offers prescription creams, while GetHarley connects you to skin experts virtually from £40. The NHS is helpful, too, but waiting times can be lengthy and there’s often a lot less hand-holding throughout the process.
With stronger medications, your practitioner should ensure proper physical and mental-health care, or offer alternatives. Will my skin break out again? Most likely – but knowing that there are now plenty of solutions and support systems available has given me a clarity that goes beyond skin-deep.
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