Take cover. Pimply has replaced peachy as the default complexion of the average British woman. That is according to the British Association of Dermatologists, which says that 14% of women aged 26 to 44 have acne. But, as that figure is based on only those who have sought professional help, the true figure could be as high as 50%. What is really troubling the average woman, however, is the fact that acne is increasingly an adult issue.

If you popped into your local pharmacy 15 years ago, the acne products on sale were aimed at teenagers. Now, grown-up, premium brands such as Aveda and Clinique have acne ranges. Some, such as Boots No 7 Beautifully Clear Age-Defence Blemish Clear, are an anti-ageing and an anti-acne product in one.

So, how are teen and adult acne different? Well, they look much the same, except for where you get it. “A characteristic of adult acne is that spots cluster along the jaw line and around the neck, rather than on the forehead or cheeks,” says the acne specialist Dr Tony Chu, a consultant dermatologist at Hammersmith hospital, in west London. There is also a difference in the psychological impact, he says. “Acne can be devastating in your teenage years, but in my experience it has an even deeper impact if you have it in your thirties and forties.”

Why it’s happening now

The main explanation for the growing number of adult sufferers, Chu says, is the increasingly stressful nature of daily life. “Chronic stress can cause acne to return in someone who suffered from it in their teens, or trigger it for the first time in adulthood,” he says. However low grade it may feel, stress can cause the adrenal glands to produce more androgens (male sex hormones), leading to increased oil production by the sebaceous glands in the skin, which, in some people, results in acne.

John Tsagaris, a practitioner of traditional Chinese medicine, is seeing an increasing number of women for acne problems in his west-London clinic. He blames diet: “Poor food quality and an increase in additive and sugar consumption have led to an increase in inflammatory reactions in our bodies and skin,” he says.

Late-onset spots in women can also be hormone-related. High levels of oestrogen and androgens at ovulation stimulate the sebaceous glands in some women, as does the peak of progesterone that can occur after ovulation. Those with polycystic ovary syndrome (thought to affect up to 30% of women) often have acne-prone skin. And the hormonal fluctuations experienced when coming off the contraceptive pill, during late pregnancy and after childbirth and even during the menopause can also trigger adult acne.

Laser, peels, pills or cream?

The unfortunate fact is that as your chances of getting adult acne increase, your likelihood of seeing an NHS specialist is getting smaller. Last year, a government white paper detailed plans to move dermatology away from hospitals and into GP-led care. “You may get successful treatment from a GP, but it’s easy to misdiagnose rosacea as acne, but rosacea, a condition also common in the thirties and forties, needs completely different treatment,” Chu says.

Many women have now wised up to what their American counterparts have known for years – if you want great skin, you need a great private dermatologist. Those in the know see Chu privately, or visit Prof Nicholas Lowe, a consultant dermatologist who practises at the Cranley Clinic in London and in LA.

The traditional treatments offered for acne – oral or topical antibiotics – are fast becoming obsolete, as bacteria develop resistance to the drugs. Retinoid creams (such as tretinoin, derived from vitamin A) are another option: they work by unblocking pores, although the side effects can include red, sore skin and extreme skin sensitivity. Hormonal-linked acne often responds to Yasmin or Dianette, brands of contraceptive pill that reduce levels of androgens in the body. Noninvasive light-based treatments are increasingly popular, too. Chu has seen an improvement in 80% of his patients with NLite, a pulsed-light laser that calms the inflammatory response of the skin and reduces scarring. There is also Aknicare, a new product from Italy, which combines vitamin C and linoleic acid and, according to Chu, reduces oil production by 68%.

Ask any long-term sufferer what treatments they have tried, and most will name all of them. That is because there is no one-size-fits-all treatment for acne. Your only option is trial and error until you find one that works for you. Sarah Hardy, 30, a fashion marketing executive, has finally found the solution at a cosmetic surgeon’s clinic. She sees the Harley Street skincare expert Dr Satish Sood every few months for a 30-minute chemical peel, which, she says, not only keeps her skin clear but improves the appearance of past scars. “We use a product developed in Brazil called M-zuri, which, unlike conventional peels, isn’t harsh and doesn’t leave the skin red,” says Sood. “It takes off the clogged, oily, sticky cells of the epidermis, breaking the cycle of acne development.”

For some, the solution is a change in diet. “I got spots for the first time last year,” says Laura Morris, 27, a PR. “I went to see John Tsagaris about headaches, and he started talking to me about my skin. He told me to give up dairy products and red meat and cut right back on sugar, and gave me a herbal tincture made from goldenseal, milk thistle and calendula to drink and two acupuncture sessions. My skin has hugely improved, although if I slip from the diet, it tends to get worse.” Tsagaris believes hormones, indigestible protein compounds and antibiotics in dairy products kill good bacteria in the stomach and intestines, allowing the bacteria that cause acne to multiply. “But the worst enemy for the skin is sugar,” he says. “It allows any infection to multiply and spread in our digestive system and on our skin. Meat is another inflammatory food.”

Roaccutane – the good, the bad and the anti-ageing

For many, the only real improvement comes from taking Roaccutane, a controversial drug that is derived from vitamin A and reduces sebum production. The well-publicised downside of the drug is that it may cause severe depression. “I took Roaccutane at 23 for eight months, and my skin was pretty much perfect, but it was wasted,” Sarah Hardy says. “I felt so depressed on it that I never went out.” It can also cause dry skin and liver damage – most people give up alcohol while they’re taking the medication. In addition, there is a risk of birth defects if taken by a pregnant woman. About 50% of people also experience a return to spots when they come off it.

But not all of its side effects are negative. It’s not something that is openly talked about, and it’s not what the drug is licensed for, but a small group of adult acne sufferers, mainly in the fashion and media industry in London, have discovered that Roaccutane also has an anti-ageing effect. “Unlike most women in their early forties, I can honestly say I don’t have a single wrinkle,” says Ella Lord, 43, a magazine editor, who has been taking a low dose of Roaccutane for several years. “People say I have the skin of a 20-year-old. I have to admit that I’m a bit addicted to the effects, and I’m not sure I am prepared to come off it in the foreseeable future. After decades of bad skin, I feel I deserve it.”

Insider acne contacts

Tony Chu; 020 8383 3264. Nicholas Lowe; 020 7499 3223. Satish Sood; 020 7935 4000. John Tsagaris; 020 7224 6088

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