Lessons from my 30-year war on acne

“There is no such thing as perfect skin. Let’s just get that out the way,” says aesthetician Shane Cooper, who, from his South Kensington clinic, tends to the complexions of Maya Jama, Sienna Miller and Dan Levy, among others. I am here for facial microneedling to improve the appearance of acne scarring. “It creates controlled micro-injuries in the skin,” Cooper explains, “which stimulate the natural production of collagen and elastin. This helps remodel scar tissue and smooth the skin’s surface.”

My pursuit of perfect skin began at the age of 10, when my first spot appeared. Acne runs in my family. In my teens I was diagnosed with pustular acne vulgaris, a condition that has reappeared throughout my life, causing scarring and redness. I have endured lasers, GP-prescribed topicals, vampire facials – where a doctor reinjected my own blood plasma back into my face – microneedling with and without numbing cream, and repeated positive affirmations in the mirror. I have spent tens of thousands of pounds. 

Acne is the eighth most prevalent disease globally, affecting almost one in 10 people. It’s associated with higher rates of depression and suicide. According to the NHS, about 95 per cent of people aged 11 to 30 are affected by acne to some extent. I belong to the 3 per cent of adults who have acne past the age of 35.

Acne affects almost one in 10 people and is associated with higher rates of depression and suicide

Last summer, I decided to take action again. A new outbreak had been particularly galling as, for 22 months, I hadn’t touched flour, sugar, alcohol or caffeine on a nutritionist’s advice, and it had made zero difference. (I had noticed a benefit from avoiding dairy, however.) Under new instructions, I embarked on a three-month protocol using acne-specific brand 47 Skin, which harnesses the antibacterial properties of silver chitoderm, alongside tri-weekly sessions with the CurrentBody Skin LED Anti-Blemish Mask (£399.99) to further eliminate bacteria and reduce inflammation. 

Within a fortnight, my face appeared calmer, but the spots kept on emerging. I moved on to phase two: a dermatologist on Harley Street.  

Revision Skincare gentle cleansing lotion, £43 for 198ml

Avène Cicalfate+ Restorative Protective Cream, £17 for 100ml

La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF50+, £20 for 50ml

Zitsticka Killa Kit microdart patch, £12 for pack of four

Dr Justine Kluk specialises in acne, having herself suffered from outbreaks from the age of 12. After analysing my skin, she prescribed a “pared-back skincare routine to calm down inflammation”, including Revision Skincare’s ultra-calming Gentle Cleansing Lotion and Avène’s Cicalfate+ Restorative Protective Cream (£19 for 100ml) – and two prescription topicals: Finacea – azelaic acid with an antibacterial, anti-inflammatory, exfoliating and anti-discolouration effect – and a retinoid cream, Differin. Kluk describes Differin as “the gold-standard topical acne treatment” for its ability to prevent pore clogging. 

Acne treatment typically falls into two categories: topicals and orals. The former includes antibiotic lotions such as Dalacin T Lotion (clindamycin phosphate) or Zineryt (erythromycin-zinc complex), which have an anti-inflammatory effect, and topical retinoids like Differin and azelaic acid. Side effects include peeling and flaking with increased sun sensitivity. Oral treatments include tetracycline antibiotics for inflammatory acne; some combined contraceptive pills, which can stop oil production; the diuretic spironolactone; and, for the most severe acne cases, Roaccutane, an oral retinoid. I discussed Roaccutane with a dermatologist in my teens but decided against it due to contraindications in my family medical history. Possible side effects include headaches, nausea, rashes and depression.  

The only patches I would recommend are Zitsticka Goo Getter

Kluk suggested applying Differin at night using the “sandwich method”, applying moisturiser before and after. She also recommended spironolactone, but due to the potential side effects – irregular periods and low libido – we agreed to revisit if needed later on. She also cautioned against using any light masks or facials for a three-month period so that she could see more clearly exactly how the medicine affected my skin. I also began road-testing spot stickers – adhesive patches that conceal and treat spots all at once. The only ones I would now recommend are Zitsticka Goo Getter hydrocolloid patches, which are both calming and discreet-ish, and Zitsticka’s Killa Kit microdart patches, for early-stage spots, which I would use at night. 

In an attempt to keep my make-up to a minimum, yet also searching for some coverage, I found Ilia’s Super Serum Skin Tint SPF30 the most effective. Ilia’s founder Sasha Plavsic is a fellow acne sufferer who says: “It’s not about completely erasing acne but creating balance – strengthening the skin barrier and using products that support long-term skin health.” Plavsic formulated her serum with niacinamide to reduce redness and non-nano zinc oxide to offer sun protection. Due to the sun sensitivity associated with some treatments, a daily SPF is essential. Dr Kluk recommends La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF50+ (non-tinted), which I found less greasy than most.

Dr Kluk’s “simple is best” approach works. After three weeks, the spots stopped appearing and in the follow-up appointment three months later, she confirmed “no current inflammatory acne”. She advised me to keep applying Differin and Finacea for six to 12 months. LED masks were still to be avoided. SPF was and still is a must. And for scarring, she suggested laser to improve texture, especially on the chin area. 

It’s best to wait until flare-ups and inflammation have cleared before experimenting with laser therapy or microneedling. Three months after my consultation, I visited Dr Vali’s wellness centre on the third floor of Selfridges London. I explained that I hadn’t had a spot for a few months, but the scarring and redness still bothered me. Vali recommended a four-hour treatment to “resurface, lift and tighten the skin using the latest technology of Thermage [a radiofrequency treatment] and Fraxel [a laser treatment] along with exosomes to improve laxity, fine lines, pigmentation and scarring.” After an excruciatingly painful microneedling incident previously, I was relieved this was a non-invasive, needle-free laser treatment – but it wouldn’t be pain-free. First, a grid-like temporary tattoo was applied across my face and neck for precision. Then the Thermage laser – which looks like a cross between a joystick and gun – moved across my face and neck. The process took around 90 minutes, and despite the warm then cool sensation, I felt zero pain.  

The Fraxel laser, by contrast, heated up my skin in postage stamp-sized sections with what felt like a burning needle during a 40-minute procedure that became increasingly unbearable. When the cooling fan was turned off, my face felt like a burnt piece of bacon and my face appeared flush. Two more Fraxel sessions were recommended for my chin area, while the Thermage is only needed once a year. The downtime was minimal with redness lasting less than 24 hours and I noticed an immediate improvement.

It’s been 11 months since embarking on my mission and I hesitate to admit success. I’ve only had a couple of spots, my skin is clearer, my scarring has improved somewhat, but my acne may decide to make a reappearance at any time. If that happens, I’ll skip the chaos of Instagram-hyped products and head straight to Dr Kluk. Plavsic agrees: “Acne is often as much about what you don’t do as what you do – simplicity is key.”