Living with adult acne

Adult acne is a condition that affects millions of people, often causing significant emotional distress and having a negative impact on various aspects of life. 

I have struggled with adult acne myself and I still remember how it made me feel, and it still pulls at my own pain when I see or talk to another person who is unhappy with their skin.  

So I have written this article to gently shed some light on the emotional toll of this condition, share some practical tips and advice and explore how therapy can offer valuable support.

Understanding adult acne

Adult acne is more common than many people realise. 

Acne as a whole is a very common skin condition, characterised by blackheads, whiteheads and sometimes the more painful pus-filled spots or pustules. It generally starts during puberty and it varies in its severity, anywhere from a few spots on the face, back and chest which most teens will have occasionally, all the way through to inflammation, infection and scarring. 

I think it is expected that most people will grow out of it. But what happens if you don’t? Or if you develop it, out of the blue, for the first time in your twenties or thirties, or later?

Persistent or new onset acne has been on the increase. Dr Penelope Pratsou is a Consultant Dermatologist with the British Skin Foundation and in 2021 when speaking about this she reported that when she began her training in dermatology 10 years earlier, nearly all of her acne patients were teenagers. Now, at least half of her patients with acne are adults.  

I said earlier that it is more common than most people think, and I include the past version of myself in that, because, when you are in the throws of it, it really feels like you are on your own. It can be very isolating, and it is so heartbreaking when all you seem to be able to see around you are your friends, colleagues and peers with their ‘normal’ skin.

Because, although they may have the occasional spot or blemish, mark or line, or even a breakout should they be particularly stressed, or if they change their brand of cleanser and their skin protests, all these things are seen as ‘normal’ whereas acne in your twenties and thirties is not.  

The rise in adult acne

The reasons for this rise in the numbers of people experiencing acne into adulthood are unclear, although research provides us with some information which shows the demographic profile of adult acne and offers us some suggestions…

The inherent causes seem to be much the same as for acne in teenagers, which tends to be a combination of genetics, hormones, pore blockages, excessive oil and bacteria.

Cases of adult acne are found predominantly in the West, suggesting that our modern lifestyles could be contributing to the increase in numbers here.

Women account for more cases of adult acne than men and it is thought that this could be linked to hormonal fluctuations caused by their menstrual cycles, contraception and the menopause.

What does this mean for adults with acne?

The social and romantic impact

Social interactions can become daunting when dealing with adult acne. It’s not uncommon for individuals to withdraw from social activities, fearing judgement or negative comments about their appearance. This isolation can strain friendships and lead to a sense of loneliness.

In romantic relationships, the fear of rejection can be overwhelming, making dating, or even the very thought of dating, a particularly challenging experience. Constant worries about their appearance can really overshadow the positives or the excitement of connecting with others and can create a real barrier to forming meaningful relationships.

The workplace and professional life

In the workplace, adult acne can affect confidence and performance. Job interviews, meetings, and daily interactions can all become real sources of anxiety. Feeling worried that managers or colleagues are judging on appearance rather than ability can hinder professional growth and progression, as a person may feel that they can’t apply for that promotion until their skin is clear. A lack of confidence can also lead to avoiding opportunities that require visibility and interaction because of the fear that others are looking at their skin while they are presenting.  

I wrote an article previously about ‘othering’ and I think that skin conditions can be another way that people can feel othered. 

What can you do to help yourself?

Treating adult acne

People can feel that somehow they must be to blame for the condition of their skin, wondering if they are doing something ‘wrong’ with their diet or their skincare and they can get caught in cycles of trying different foods, products or treatments until they find the ‘miracle cure’.

This can be expensive, time-consuming and frustrating.

I know that I tried all manner of skincare ranges, over-the-counter products, facials, scrubs, masks, detoxes and laser treatments. I tried a couple of different contraceptive pills and a six-month course of Roaccutane.

For me in the mid-2000s being on Roaccutane meant regular reviews at the hospital, having to take the contraception pill and being required to take pregnancy tests before your next prescription was issued because of the risk of birth defects if you were to become pregnant.  

Roaccutane itself can cause very dry and peeling skin and for me, this happened on my hands which was painful, especially between the fingers as the skin cracked and flaked.  I worked in a jewellers at the time, where my hands were very much ‘on show’ so I also remember feeling very self-conscious about how that might have looked to customers.  

Roaccutane or Accutane (which are brand names of the drug isotretinoin) also have other potential side effects including low mood, anxiety, agitation, depression and suicidal thoughts. 

So there have been concerns raised, both back when I was taking it, and more recently, around the impact of these medications on mental health and whether the side effects have been taken seriously enough.  

I also remember at the time, my parents wondering which was going to be the lesser of the two evils, the mental health issues caused by the acne or the potential mental health issues caused by the acne medication.  

What a position to be in.

If you are worried about adult acne the best thing to do is to seek advice from your GP, or if you can, try and find out whether there is a doctor within the practice that has a special interest in dermatology. One day I got lucky and happened to get an appointment with a GP who referred me straight away after a few false starts with a number of, arguably, less informed or less interested doctors over the years.  

And I can confirm that the course of Roaccutane did help my skin immeasurably, but this isn’t the only option and it wasn’t an easy journey.

Please don’t suffer in silence. There is support out there so don’t be afraid to ask for help, to ask questions about possible treatments and to discuss any concerns that you might have so that you can find the best solution for you.  

Practical tips and advice

Alongside seeking medical advice, here are some practical tips for those struggling with adult acne to help manage the emotional impact:

• Journaling: Keep a journal to express your thoughts and track your emotional progress. Writing can be such a therapeutic way to process emotions and gain insights into your feelings.
• Self-care: Prioritise self-care routines that make you feel good about yourself. Practising self-compassion and focusing on your strengths can help mitigate the negative impact of acne on your self-esteem. Engage in activities that boost your confidence, such as hobbies or skills that you excel at.
• Seek support: Surround yourself with supportive people who uplift and encourage you. Don’t hesitate to reach out to a therapist who can guide you through this challenging time and offer a professional space to explore your feelings and develop coping strategies.
• Support groups: Consider joining support groups or online forums or communities where you can connect with others facing similar challenges. Sharing experiences and advice can provide comfort and reduce feelings of isolation.

You can find further information, advice and support about acne from the British Association of Dermatologists.

Therapy as a supportive tool

Therapy can help individuals with adult acne in many ways including:

• Offering a non-judgmental and empathetic therapeutic relationship which allows clients to express their feelings and thoughts freely and honestly.
• Speaking to a therapist can reshape the stories individuals tell about themselves and their experiences. By reframing these narratives, clients can develop a more positive and empowering self-image.
• In therapy sessions, clients can build self-esteem and develop effective coping strategies. They can learn to challenge negative self-perceptions and cultivate a more compassionate and accepting view of themselves.
• Sitting with an empathic therapist can help individuals see beyond their skin issues and focus on their talents and achievements, encouraging them to begin to enjoy social activities again and engage confidently in professional settings without the weight of self-doubt.  

I realise that I am speaking now as a therapist, but looking back I can genuinely say that I would have benefitted from speaking to a professional as I struggled to navigate my way through adult acne.

It feels like it is a lot to expect other people to really understand how hard it can be to deal with acne every single day. I know I would have appreciated a space where I could have been honest about how much it upset me and how embarrassing and frustrating it was.

Because every now and then you just need to be able to vent without a loved one telling you to be positive and that you are beautiful anyway. You are beautiful anyway but sometimes being allowed to be brutally honest, and vulnerable and being allowed to ugly cry without your tears being dried away too quickly, is just what you need.

Adult acne can be a daunting experience, but it’s important to remember that you don’t have to face it alone. This is not a trivial condition and there is expert advice and support out there to help you manage your skin. The right adjustments, treatments or medical interventions can really improve physical symptoms and therapy offers a supportive space to work through the emotional hurdles and build resilience. 

Remember, your worth is not defined by your skin, and with time and support, you can overcome the unique challenges that adult acne presents.