Acne Files

I’m A Derm With Chronic Acne & Here’s The Skin Advice I’d Give My Younger Self

Photo Courtesy of Dr Anjali Mahto.
Welcome to Acne Files, a month-long series where we get real about whiteheads, blackheads, cysts, and every bump or blemish in between. From skin-soothing products R29 editors swear by to exclusive deals on the most breakout-friendly beauty brands, we’re kissing the concept of “bad skin” goodbye and exploring why acne goes so much further than skin deep.
I first became aware of my acne when I was around 12 years old. It was a very difficult time in my life: My father had just died, and I’d recently moved to Wales from Saudi Arabia and started a new school — all within a matter of weeks. I remember looking in the bathroom mirror and running my fingers over the acne, covering up certain areas and trying to visualize what my face would look like without breakouts.
The effect it had on me was monumental. I avoided certain activities at school, like swimming, in case my makeup washed away, and I was painfully shy. I wanted to blend into the background because I was so fearful of how people would react to my skin. I thought that if my skin would improve, so would my life. My self-worth was inextricably tied to my skin.
After trying all manner of lotions and potions, I eventually saw a dermatologist. It was recommended that I start taking a drug called isotretinoin, more commonly known as Accutane. It worked, and my skin started to clear up. Unfortunately, though, it resurfaced a few years later. Around that time, I was also diagnosed with a condition called polycystic ovarian syndrome (PCOS). Acne and oily skin are both symptoms of PCOS — and that’s exactly what I experienced. Between then and now, I’ve had intermittent isotretinoin treatment when I need it.
My long history with acne is one of the reasons why I wanted to become a dermatologist: I’ve walked in my acne patients’ shoes and know the journey all too well. My aim is to catch the acne in those who visit me before it causes scarring, which is often much tricker to treat. However, one of the things I’ve come to accept over the years is that acne, at least for me personally, is a chronic condition which waxes and wanes. I don’t dare hope (even as a dermatologist) there will be a permanent “cure.”
Knowing what I do now, I often think about 12-year-old Anjali and what I would like to say to her about her acne. Here are the 7 key pieces of advice I would encourage her to take on board.

Look for these ingredients when shopping for skin care.

There are certain ingredients that will really benefit acne-prone skin. Salicylic acid is what's known as a beta-hydroxy acid (BHA), and it's a chemical exfoliant that helps to unclog pores. Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant, is good and includes enough salicylic acid to have an effect on skin. Benzoyl peroxide is another favorite of mine as it has the ability to destroy acne-causing bacteria. It's useful for both inflammatory acne (red, swollen, and sore bumps) and non-inflammatory acne (blackheads and whiteheads). Products containing benzoyl peroxide can be bought over the counter, such as Panoxyl Acne Foaming Wash.
Then we have retinoids, which is the family name for the different types of vitamin A. Retinoids reduce the blockage of pores and help prevent blackheads from forming. I usually recommend that treatment needs to be built up gradually, as retinoids can have a tendency to irritate the skin if not introduced slowly. Start with a couple of applications a week initially before building up to daily usage. Retinoids should be applied at night to clean skin and sun protection, such as a high-factor, broad-spectrum sunscreen, should be worn in the day, as these creams can cause sensitivity to sunlight.
If none of the above measures are having an effect on your acne, or your acne is turning cystic (sore, pus-filled spots under the skin) then I would advise trying to see a dermatologist or your primary care doctor as soon as possible so you can nip it in the bud.

Don't blame your acne on your diet.

I am absolutely an advocate of nutrition, movement, sleep, and stress management as important pillars of health. However, I am always a bit disappointed to see “super-foods” and recipes touted as a “fix-it” for skin issues, especially when it comes to vulnerable acne patients. Most skin conditions are hugely complex and multifactorial. Creating a narrative that pushes food alone as the answer is problematic.
The link between whether or not diet can cause acne remains controversial. There are mixed results and no clear answers despite decades of research. Take dairy, for example: Considering the data we have now, we can't categorically say that it causes acne at all. For most people, cutting out dairy products is unlikely to make a big difference to their skin based on this. When it comes to sugar, there is emerging evidence that foods with a high glycemic index (GI) may have a role to play in acne. However, this does not mean you should cut out sugar altogether; rather, you might like to consider limiting it in your diet.
There are still a lot of misconceptions about acne and its causes — it’s because of your makeup; it’s because you don’t clean your skin properly; it’s because you eat chocolate. But acne is a complex and multifaceted skin disease and it does not discriminate. The vast majority of the time, it starts for reasons beyond your control. 

Be wary of who you see for your acne.

In the US, the only people who should be treating acne are “board-certified” dermatologists. (In the UK, that would be “consultant” dermatologists.) These dermatologists have undergone the highest level of training in skin and are the only professionals who should be prescribing one of the most common oral medications for treating acne: Accutane. There are a lot of experts out there who will claim to be able to treat aggressive cystic acne with a course of in-office topical treatments or the skin-care line they stock in their clinic. I often have patients in floods of tears when they realize how much they have been mis-sold over the years. It’s better to see a dermatologist from the very start to nip it in the bud.
In the US, you can check whether your dermatologist is board-certified through the American Academy of Dermatology website. In the UK, you can check who is a registered consultant dermatologist by seeing if they are on the specialist register for dermatology via the General Medical Council’s website

Try not to use abrasive skin-care products.

This was a huge mistake I made when I was younger and it’s still something that I see in my clinic now. I thought that using very abrasive products (think: exfoliators with ground-up shells in them) would help rub away the acne. Instead of taking a gentle approach, I would scrub my skin to within an inch of its life. The result would be sore, inflamed skin, and my acne would be so much worse off. Chemical exfoliants such as glycolic, lactic, and salicylic acids are a much better option here. These work by helping to clear dead skin cells from the skin’s surface, thereby increasing skin cell turnover to reduce blockages. Look out for polyhydroxy acids (PHA), which are a great introduction to chemical exfoliants as their larger molecular size means they’re one of the more gentle forms. 

Accept that there is no cure for acne.

As mentioned earlier, my own acne flares up from time to time — even now. Unfortunately, there is no one cure for acne. Instead, it is about finding a way to manage and control it. That said, there are ways in which we can treat and manage acne to leave you feeling more confident and in control of your skin. This ranges from oral medications such as Accutane (which belongs to the retinoid group), spironolactone (a diuretic drug that helps treat hormonal acne in women), and topical prescription treatments as well as in-clinic treatments like BroadBand Light (BBL), not to mention chemical peels and at-home skin care. There is no one-size-fits-all approach, though, so clinical assessment in a dermatology clinic is recommended for a truly personalized treatment plan. 

Understand that acne can have a significant impact on your mental health — and that it’s okay to seek help.

When I started my medical training, I recognized that I could empathize with patients having problems with their skin. My aim is to catch acne before it creates long-term physical damage in the form of scarring, or psychological damage due to deteriorating mental health. It’s one of the reasons it was imperative to have psychological support at my clinic, Self London. Psychodermatology is an emerging practice welcomed by many dermatologists around the world. It can address unhelpful thoughts when it comes to your skin and help you put strategies in place that allow you to manage your skin concerns in your day-to-day life. I understand, however, that not everyone will have access to psychodermatology, so my advice is to speak to your primary care doctor as soon as possible if you feel your skin is affecting your mental health. They will be best placed to find you the support you need.

Lastly, act fast to avoid acne scarring.

This would be my number-one recommendation to anyone who is dealing with acne. The National Health Service (NHS) reports that 95% of people aged 11 to 30 will experience acne to some extent, and acne scarring is common. We can absolutely treat acne scarring; in fact, it’s one of the main offerings at my clinic, as we specialize in acne. However, you significantly reduce your risk of scarring if you “switch off” the acne early by seeing an expert as soon as possible. In the first instance, for many people, this will be their doctor. It’s important you communicate how your skin is making you feel when you see them. As I mentioned, acne can have a huge impact on our mental health, and you should tell your doctor if yours is having that effect. Some people may prefer to go directly to a dermatologist for a diagnosis.
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