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Image by Susan Wilkinson


We define acne as a chronic disorder of the hair follicle and sebaceous glands, with blockage and inflammation of the hair follicles. We tend to use the term to refer to more stubborn or troublesome skin lesions, but in essence the occasional spots we all experience are technically mild acne. 


Different types of spots

Acne can have different features and those clues can help guide dermatologists towards the right treatment for each individual patient. When clinically assessing a patient with acne I am interested in the appearance of...

  • Comedones (blackheads and whiteheads)

  • Inflamed pustules

  • Larger and deeper nodules or cysts

  • The presence of post-inflammatory marks and scars

What the experts say

Dermatologists will often classify acne as ‘inflammatory’: with red areas and pustules, or sometimes ‘comedonal’:  with blackheads and whiteheads. I also frequently see overlap with rosacea, which can be another reason to explain limited responses to treatment.  It is also important to look for any medical conditions or medications that may be exacerbating the problem. 


Adult onset acne vs teen acne

Most people associate acne with teenagers and whilst it is a common and complex issue in teen skin, teen acne tips can be found here, in my clinical practice I frequently see patients in their 30s with adult onset acne.  There is also evidence to suggest that the spectrum of onset of acne is changing, with cases emerging both earlier and later than what has been noted in the past. Late onset disease occurs in about 20% of women and 8% of men. The data suggests women are more frequently affected by adult acne compared with men. The exact reason for this is unknown, but felt to be related to fluctuating hormone levels: during periods or from birth control pills, and also during and following pregnancy. Your genes also play an important role and it’s not uncommon for there to be a significant family history of acne in close relatives. The role of stress is also becoming more apparent. At times of stress the body naturally produces more androgens which stimulate oil glands and hair follicles in the skin. 

Frequently Asked Questions

Developing acne at any stage in your life can be distressing and difficult to treat. Here are some tips to help you eliminate acne triggers and regain control of your skin.

Image by Bernard Hermant

Adult onset acne tends to be more resistant to treatment and carries a significant risk of post-inflammatory marks and scarring.

Acne can be aggravated by internal triggers such as hormones, external triggers such as occlusive make up or skin care products, environmental triggers such as high levels of pollution or high humidity environments, dietary factors- especially very high dairy intake and medication triggers –some tablets can cause severe acne eruptions.

Image by Susan Wilkinson


Rosacea is a particularly challenging type of acne.
It comprises of three features

  • Red spots and pustules

  • Dryness

  • New blood vessel formation on the skin causing redness and flushing


Management is more challenging because the treatments available tend to treat only one aspect for the rosacea, so usually treatments have to be combined or introduced in a structured way. If you suffer with rosacea I will tailor your treatment plan to to your skins needs.

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