Ask the experts…acne and spots

Having spots is nothing out of the usual; up to around 55% of adults aged 20-40 live with low-grade acne. Despite how common it is, however, acne and spots can wreak havoc on our body confidence. Simple acts of self-care play a big role in clearing up skin but it’s important to know when seeking professional help or turn to medical interventions.

That’s why we teamed up with the British Skin Foundation for our acne and spots online clinic.

Our expert panel included consultant dermatologists Dr Adil Sheraz, Dr Zainab Laftah, Dr Anton Alexandroff, Dr Bav Shergill, Dr Rachel Abbott, Dr Emma Wedgeworth and Dr Vishal Madan.

Below are some of the best questions and answers from the clinic:

My son is 13 and has terrible acne on his forehead. He is hesitant to leave the house as he is now paranoid about his skin. Any advice?

Dr Alexandroff: I would suggest that your GP or dermatologist would consider prescribing an antibiotic (e.g. Lymecycline) and a retinoid gel such as Epiduo. Other treatments are also available, such as Roaccutane.

I have some scarring from old spots - what’s the best way to treat this without causing more breakouts (e.g. from extra oils)?

Dr Abbott: Unfortunately, scarring from acne is common. There are several different types of scarring due to acne, such as discoloration, 'ice-pick' or 'rolling scars’. Knowing which type of scarring you have will help to guide any treatment. Further information on the different types of scarring and appropriate treatment is available here:

I am 48-years-old and still have acne. I have avoided and tried things, yet it doesn't go away. This affects my self-esteem. How can I improve my skin on my face and back?

Dr Alexandroff: Have you tried antibiotics in combination with Epiduo retinoid gel for three months? If yes, the next step would be Roaccutane; it helps the majority of patients with acne.

I suffered from terrible acne when I was in my late teens, and have been plagued with spots since. I am depressed, feel ugly and am really in despair as to how I can manage/prevent the breakouts. Help!

Dr Laftah: Thanks for sharing your experience of acne and how it makes you feel. I'm sorry to hear that you are feeling depressed. Emotional support is available and here are the contact details:

Your skincare routine sounds appropriate. I recommend a fragrance-free cleanser/wash. A toner with salicylic acid can be helpful for areas with whiteheads +/- blackheads. 'Polishing' the skin may cause irritation and so I would caution against doing this so frequently.

Given that your acne is closely linked to your menstrual cycle, I also suggest that you seek medical advice to discuss the options for treatment. Further information on acne associated with hormonal changes is available here:

Because of sweating, I clean my face with wipes when out and about. I use masks, cleansers, toners, clarifying gels, plus lotions indoors but never use creams as they are too rich and greasy. What else can I try?

Dr Laftah: I would agree that rich moisturisers and oils should be avoided is you have oily skin as this is likely to lead to a breakout.

If your acne is under control and you are not having significant breaks outs then your skincare regime can make a big difference. Make sure you opt for non-comedogenic cleansers and moisturisers as these are less likely to clog your pores. You can also incorporate 'actives' in your skincare regime, for example, a salicylic based cleanser or azelaic acid at night which can keep acne under control.

How do you manage spots and constant skin irritation in the bottom area? I am 46-years-old and have had this issue in varying degrees of severity since the age of 13.

Dr Laftah: If you are getting breakouts on your bottom, I would recommend you review the products you are currently using and consider using skin products with 'actives'. Conditioning your hair and letting it drip on your back/bottom area can clog skin pores leading to breakouts. Using rich moisturisers can also cause similar problems.

Consider using salicylic acid-based cleansers can help reduce the build-up of dead skin cells and blocked pores which can also lead to breakouts.

I had clear skin until after the birth of my children, since then it has been an issue, I experience frequent breakouts, whiteheads are a continuous issue. What should I do to improve it?

Dr Alexandroff:  I would suggest asking your dermatologist or GP to try Epiduo gel. This can be combined with an oral antibiotic and if you require a more powerful treatment, Roaccutane is also available. 

Dr Madan: Late-onset acne can be troublesome and tends to be persistent and nonresponsive to simple OTC medications. I would recommend, depending upon the severity of acne/location and type of acne lesions, either medicated topical products or oral medications such as isotretinoin. It's best to get referred to a dermatologist for a thorough assessment in the first instance.

I suffered from terrible acne until my 30s and at 56, am now getting sports on my neck and jawline. My skin has also become greasy. Could this be a sign of menopause?

Dr Wedgeworth: Your hormones may be relevant. Around the time of the menopause, oestrogen levels start to fall so relatively, the levels of male hormones (androgens) are higher. This can increase spots and make the skin more oily. Progesterone-impregnated implants (like the Mirena coil) can also on occasion increase spot frequency. I definitely think it would be worth speaking to your doctor about checking your hormone levels to see if there are any relevant changes.

Meanwhile, ensure you're skincare is as light and non-comedogenic (non-pore blocking) as possible. Try a cleanser with salicylic acid and think about adding in a vitamin A-based cream (a retinoid). Both of these ingredients can help regulate the sebaceous gland, which is the gland in the skin responsible for oil production. Try to use light moisturisers and foundations.

I have permanently large pores on my cheeks. Will I be stuck with skin like this for life or is there any way to smooth these out?

Dr Wedgeworth: Large pores are a really common concern. Pore size is partly genetically based, but pores will also get larger over time, and for some can be part of the aging process.

While it's difficult to totally shrink down pores, there are lots of ways to minimise them. Ensure they are not clogged - larger pores are more likely to get clogged - so avoid pore-blocking makeups and other skincare (e.g. oils). Products containing active ingredients like BHAs (salicylic acid) as well as retinoids (vitamin A-based creams) are really helpful to try and maintain pore size so include some of these in your skincare regime. Certain procedures that help to improve skin surface e.g. micro-needling or peels may also help.

Also, be careful about sun protection to ensure that the skin doesn't age prematurely and exacerbate the pore enlargement.

Thank you to all our experts. You can check out the clinic here

Information contained in this Articles page has been written by talkhealth based on available medical evidence. The content however should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands or treatments.

Information written by the talkhealth team

Last revised: 4 August 2020
Next review: 4 August 2023