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.
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.
Inflammatory acne includes papules, pustules, nodules and cysts. The redness and swelling you see are caused by your immune system reacting to bacteria within blocked pores.
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.
Adult-onset acne is very common. Many people who had clear skin as teenagers find themselves developing acne for the first time in their twenties, thirties or later. Adult skin behaves differently from teenage skin, often being more sensitive and more prone to inflammation.
Cystic acne is a more severe form of inflammatory acne, where large, painful lumps form deep beneath the skin. These lesions can take weeks to fully settle and have a higher risk of leaving permanent scars.
Most people actually have mixed acne, meaning several of these types are present at the same time. For example, you might have blackheads across your nose, hormonal breakouts around your chin, and inflamed spots on your cheeks.
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Dr Rachel answers your common questions about acne
Although acne is most common in teenagers and young adults, it is not unusual to see it persist into the twenties, thirties and beyond, particularly in women. In clinic, I often see adult acne linked to hormonal fluctuations, stress, genetics and lifestyle factors. Adult skin also behaves differently from teenage skin. It is often more sensitive and reactive, which is why products that worked when you were younger may no longer be suitable. Adult acne often needs a more considered, skin-health focused approach rather than the harsh treatments traditionally used for teenage acne.
Acne treatment takes time because the skin renews itself in cycles. In younger skin this can be around 28 days, but in adults it is often slower. This means it usually takes at least 4–8 weeks before you start to see meaningful improvement. Some people also notice their skin seems to worsen slightly at first as spots that were already developing under the skin become visible. With consistent treatment and the right plan in place, most people start to see clearer, calmer skin over 3 to 6 months. Patience really is important with acne. Quick fixes are rare, but with the right plan, lasting improvement is absolutely achievable.
One of the biggest mistakes people make when trying to treat acne is using harsh, stripping products that damage the skin barrier and can ultimately make breakouts worse. Acne treatment should not be about aggressively drying the skin, but about restoring balance. At Aesthetics by Dr Rachel, I take a skin-first approach. This means introducing active ingredients gradually, supporting your skin barrier with the right hydration, and adjusting your routine based on how your skin responds.
We also look beyond just products, considering factors such as diet, stress and overall skin health, including the balance of your skin microbiome, which plays an important role in inflammation and healing. The goal is not just clearer skin, but stronger, healthier skin that is more resilient and less prone to future breakouts.
You do not need to stop wearing makeup if you have acne, but choosing suitable products does matter. Look for non-comedogenic formulas designed not to clog pores, and avoid very heavy or occlusive products if your skin is prone to congestion. Most importantly, make sure makeup is removed thoroughly and gently at the end of the day to avoid further blockage of the pores. Makeup should not worsen acne if your overall skincare routine is appropriate and your skin barrier is well supported.
Hormonal acne often needs a slightly different approach to standard acne treatment. If your breakouts follow a clear pattern around your menstrual cycle, or you have other symptoms suggesting a hormonal influence, I take this into account when planning your treatment. Hormonal acne is very common in adult women, and understanding this often helps explain why previous treatments may not have worked. As a doctor, I can also help you understand whether hormones may be playing a role and whether further medical assessment or treatment options might be worth considering alongside your skin treatment.
Pharmacy products can be helpful, but they are limited to lower-strength ingredients designed for general use. Professional skin treatments work differently, focusing on improving skin function, reducing congestion and supporting long-term skin health. For example, chemical resurfacing treatments use carefully controlled acids to help clear blocked pores and improve skin renewal, while medical microneedling can support skin repair and improve post-acne marks and texture. Alongside treatment, a structured skincare plan can often make a significant difference when you have been trying products without success. If you feel like you have been cycling through different products for months with little improvement, it often means you need a more personalised and structured approach rather than just another cleanser.
The marks left after acne are often post-inflammatory hyperpigmentation (dark marks) or post-inflammatory erythema (red marks). These are not true scars, but they can take months to fade naturally. Professional skin treatments can help support this process. Chemical resurfacing treatments can help improve skin renewal and gradually lift pigmentation from the upper skin layers, while medical microneedling can stimulate skin repair and improve overall tone and texture. For more stubborn marks, particularly in darker skin tones, it is important to choose treatments carefully to avoid triggering further pigmentation. It is often possible to start addressing these marks while also treating active acne once breakouts are starting to stabilise. Early treatment can also help reduce the risk of longer-term scarring.
This depends on the type and severity of your acne and your overall treatment plan. Initial consultations include a full skin assessment and a personalised plan based on your skin’s needs. If your plan includes chemical resurfacing treatments, these are typically spaced around 4–6 weeks apart to allow your skin time to respond and repair between sessions. Medical microneedling is usually performed at similar intervals. Between clinic visits, your home skincare routine does much of the daily work in supporting your results. I review your progress at each appointment and adjust your plan based on how your skin is responding. Most patients are then able to move to less frequent maintenance treatments once their skin is more stable and under control. The aim is always to get your skin to a point where it needs less intervention, not more.
Yes, but the treatment approach needs to be chosen carefully. Some treatments can carry a higher risk of post-inflammatory hyperpigmentation in darker skin tones if they are too aggressive or not selected appropriately. When treating acne in skin of colour, I carefully choose treatment types, strengths and treatment intervals based on your skin type and how your skin responds. Chemical resurfacing treatments can be performed safely when the right formulations and protocols are used, and medical microneedling is also generally well tolerated across all skin tones when performed appropriately. Careful planning and gradual treatment are key.
Every treatment plan is adjusted according to your individual skin response to improve acne while protecting your skin tone and reducing the risk of unwanted pigmentation
Recurring breakouts in the same area often suggest an underlying trigger. Jawline and chin breakouts in women are commonly linked to hormones, forehead congestion can relate to product build-up or haircare, and cheek breakouts may be influenced by friction such as phones or pillowcases. Persistent localised acne may benefit from treatments that help reduce congestion and inflammation in that area. Depending on your skin, this can include chemical resurfacing to help clear blocked pores, polynucleotides to help calm inflammation, or treatments that help regulate excess oil production. The aim is not just to treat the spot, but to make that area less prone to repeated breakouts.
I am always happy to help. Please get in touch.
