Doctor-Led Aesthetic Medicine
You have tried every cleanser, every serum, and every piece of advice the internet has to offer, yet the breakouts keep coming. They may flare around your chin before your period, or perhaps they have been with you since your teenage years and never truly gone away. Acne is one of the most common skin concerns I see at Aesthetics by Dr Rachel, affecting people well into their twenties, thirties, forties and beyond. Understanding why acne develops is the first step towards finally gaining control of it.
Acne is a chronic inflammatory skin condition that develops when hair follicles become blocked with oil and dead skin cells. It is not just the occasional spot before a big event. For many people, it is a persistent medical condition that can last for months or even years, affecting not only your skin, but often your confidence and how you feel day to day.
Acne can present in several different ways, and most people experience a mixture of these at the same time. You might notice blackheads, where blocked pores remain open at the surface and appear dark due to a reaction between oil and air, alongside whiteheads, where the blockage sits just beneath the skin as small flesh-coloured bumps. Some breakouts appear as papules, which are small red inflamed spots that can feel sore to touch, while others develop into pustules, the more familiar spots with a visible white or yellow centre caused by inflammation within the pore. In more persistent or severe cases, acne can also form nodules or cysts, which are deeper, more painful lumps beneath the skin that can last for weeks and may increase the risk of scarring if not properly managed.
Acne most commonly affects the face, but it can also develop on the chest, back and shoulders. The location, pattern and type of breakouts you experience often provide important clues about what may be driving your acne. Understanding this is what allows me to recommend treatments that are not just effective, but also appropriate for your skin.
Acne is rarely caused by just one factor. Instead, it usually develops due to a combination of internal and external influences affecting oil production, inflammation, skin cell turnover and bacteria within the pores.
Hormones are one of the most common triggers of acne, which is why many women notice breakouts around their menstrual cycle, during pregnancy, when changing contraception, or during perimenopause. Androgens, the hormones that rise during puberty and fluctuate throughout adult life, can stimulate the sebaceous glands to produce more oil, increasing the likelihood of blocked pores and inflammation.
Stress can also play a significant role. When you are under prolonged stress, your body produces higher levels of cortisol. This can increase oil production, worsen inflammation and slow skin healing, which is why many people notice their skin worsening during particularly busy or difficult periods.
If your parents experienced acne, you may be more likely to develop it too. Your genes influence how much oil your skin produces, how your immune system responds to bacteria, how easily your pores become blocked, and how prone your skin is to inflammation.
Your skincare routine can also make a significant difference. Using products that are too heavy or occlusive can contribute to congestion and blocked pores, while overly harsh or stripping cleansers can damage your skin barrier. When this happens, the skin often tries to compensate by producing even more oil, which can unintentionally make breakouts worse rather than better.
Acne rarely looks the same from one person to another, and most people experience a mixture of different types. Understanding these patterns is why effective treatment needs to be personalised, and why a proper skin assessment is so important before deciding the best way forward.
Hormonal acne typically appears on the lower face, around the chin, jaw and neck. It tends to be deeper and more cystic than other types, with painful spots that sit beneath the skin surface for days or weeks.
If you had clear skin as a teenager but started getting spots in your twenties or later, you have adult-onset acne. This is surprisingly common, affecting up to 54 percent of women over 25. Adult skin behaves differently from teenage skin.
This includes papules, pustules, nodules and cysts. The redness and swelling you see are your immune system responding to bacteria in the blocked pore. Inflammatory acne is more likely to leave marks and scars than non-inflammatory types.
Comedonal acne is made up mainly of blackheads and whiteheads, with little inflammation. It often affects the forehead, nose and chin and can make the skin look uneven or congested. Although it is usually less painful than inflammatory acne, it can still significantly affect skin texture and confidence, and often forms the starting point for more inflamed breakouts.
Inflammatory acne includes papules, pustules, nodules and cysts. The redness and swelling you see is caused by your immune system reacting to bacteria within blocked pores. This type of acne is more likely to leave post-inflammatory marks or scarring if not managed appropriately.
Hormonal acne typically appears on the lower face, particularly around the chin and jawline, and sometimes the neck. These breakouts are often deeper and more persistent, forming painful spots beneath the skin that can last for days or even weeks. Many people notice these flare in a predictable pattern, often around their menstrual cycle.
Real Results
Swipe to reveal the transformation. See the remarkable results our patients have achieved.
Find answers to common questions about acne
Pharmacy products are limited to low-strength active ingredients that sit on the skin surface. Professional treatments work differently. Chemical peels use medical-grade acids at concentrations not available over the counter, targeting blocked pores and bacteria deeper in the skin. Microneedling triggers your skin's own repair response to improve texture and reduce post-acne marks. Dr Rachel can also prescribe topical treatments at strengths that pharmacies cannot sell. If you have been cycling through products for months with no improvement, it usually means your acne needs clinical intervention, not another cleanser.
Those marks are called post-inflammatory hyperpigmentation (dark marks) or post-inflammatory erythema (red marks). They are not true scars but can take months to fade on their own. Chemical peels speed up cell turnover and lift pigmentation from the upper skin layers. Polynucleotide therapy supports skin regeneration and helps restore an even tone. For stubborn marks on darker skin tones, Dr Rachel will choose treatments that target pigmentation safely without risking further discolouration. Treating the marks alongside active acne is possible once your breakouts are stabilising.
Recurring breakouts in the same zone usually point to an underlying trigger. Jawline and chin breakouts in women are often linked to hormonal fluctuations. Forehead congestion can relate to product buildup or hair care products transferring onto the skin. Cheek breakouts sometimes connect to phone use or pillowcase hygiene. Dr Rachel identifies these patterns during your consultation and targets treatment accordingly. Persistent localised acne may benefit from chemical peels to clear deep congestion in the affected area, combined with Sunekos to strengthen and repair the skin barrier so it is less prone to recurring inflammation.
I am always happy to help. Please get in touch.
