Until just over a year ago, my skincare routine consisted of ‘miracle’ products, constant inspection, stabs of despair and trying not to cry. I had acne. Bad, sore, ugly (as I saw it), seemingly untreatable, hormonal cystic acne. And I had been dealing with it for over a decade.
The spots started to pop up in my early teens, and only ever on my chin and jawline. I initially thought this was down to my schoolgirl penchant for Maybelline Dream Matte Mousse foundation. Alas, when I switched onto the good stuff (Chanel, of course!), the spots remained. In fact, they only seemed to get worse.
Subsequent years were spent trying a cacophony of methods to rid my skin of blemishes. Skincare potions, contraceptive pills, diet, facials, expensive makeup - you name it, my mother and I threw money at it. Nothing worked.
I hoped I would grow out of it. It wasn’t apparently genetic. Then, when I was twenty, I got an explanation: Polycystic ovary syndrome (PCOS).
You’ve probably heard of PCOS. Maybe you have it, or have a friend who does. I meet more and more young women who do. In fact, it affects 1 in 5 women in the UK.
In layman's, PCOS is caused by an imbalance in a woman’s “male” and female hormones. On the inside, it can make ovulation tricky, but not impossible. From an aesthetic perspective, symptoms can include excess hair, difficulty losing weight and - yes - acne.
Here's how I learnt to live with polycystic ovary syndrome
I’ve treated each symptom in isolation (shout-out, spinning and laser hair removal!) but the acne has been the most complicated. Nothing ever stuck long-term. Then, after having the Mirena coil fitted, my skin went from bad to totally bonkers. I decided it was time to try and fix the problem from the inside out.
I’m not talking about anything to do with ‘wellness’, or meditation, or #selfcare. I wanted cold, hard, medical treatment.
Not that alone, I wanted options that I couldn’t get on the NHS. Brilliant as it is, nothing a GP had prescribed me had worked so far, and I didn’t want to go on roaccutane or antibiotics.
I sought out Dr. Emma Wedgeworth, who works out of Dr. Sam Bunting’s dermatology clinic on Harley Street in London. I went to her via recommendation (a lot of beauty editors rave about Bunting) and the blunt acceptance that it wasn’t going to be cheap. My initial appointment was £350 and every follow up appointment is £225. Ouch.
But it has been worth every penny. I was prescribed a drug called Spironolactone at my first consultation. I’d never heard of it. But if you Google it today, there are various stories of it’s wonder-drug properties as an acne treatment. Within a few months, following the skincare regime set for me by the clinic and on Spironolactone, my skin was unrecognizably clear. It still is.
So what the hell is this magic pill? Largely, anti-androgen (male hormone) activity. It blocks the effects of excess male hormones and in turn, the symptoms of PCOS. As such, it successfully treats hormonal acne in PCOS sufferers.
“Our oil producing glands have androgen receptors,” says Wedgworth, who I quizzed. “So by blocking these, it reduces oil production. In practice, Spiro can be very helpful in getting control of acne, and then you can slow taper down and control it with creams.”
I have three such creams: one containing azelaic acid (which helps unblock pores and reduce sebum), another with erythromycin (and antibiotic) and isotretinoin (a form of vitamin A) and one containing clindamycin (an antibiotic), and benzoyl peroxide (a peeling agent).
In tandem with the medication, I use La Roche Posay, which you can buy at Boots. For cleansing, the Effaclar H cream cleanser or Toleriane Dermocleanser is brilliant, depending on how dry my skin is feeling. I use their micellar water too, but only to remove eye make-up - double-cleansing is prescriptively off the table. Finally, to stop my skin drying out, I use La Roche Posay Toleriane Riche moisturiser.
I also switched my makeup over to Armani and Burberry, because it is non-comedogenic (i.e. will not block my pores). I also cut down on dairy and processed sugar, which was easier than I expected. These small changes have made all the difference.
Today, I’m still taking Spiro and following my routine. It’s a plan for life, or until my skin noticeably changes. And while I might get the odd spot around my period, my skin remains - actually - quite flawless. I concede - it wasn’t the cheapest way to do things. But to look in the mirror every morning and not feel a stab of despair is (forgive the cliche) priceless.
No matter how thoroughly you cleanse your skin or how many portions of vegetables you eat a day, hormones can wreak havoc with your complexion.
Because acne is the result of bacteria that lives on our skin, when our hormones produce too much oil, it's a recipe for complexion disaster.
To help anyone suffering with hormonal acne, we've enlisted the best dermatologists and skincare experts in the business to share their expert tips on acne treatment.
It may sound obvious, but you would be surprised by how few people properly clean their skin every day. When you're experiencing hormonal breakouts, it's even more crucial to ensure makeup is totally removed and the grime of daily life is washed away.
"Although the cause of acne is clogged pores that become infected with bacteria, hormonal changes can trigger acne and make it worse," says Fatma Shaheen, skin expert and founder of luxury cosmeceutical skincare brand Skin Design London.
"If you're prone to acne and hormonal breakouts, you need to give skin a bit of extra assistance and keep it clean," says Shaheen.
Always remove makeup before bed and follow with a wash-away cleanser, like Skinceuticals Simply Clean Gel Cleanser or Avène Cleanance Cleansing Gel, and face cloth to eliminate any residual dirt.
What is double cleansing and should you be doing it?
SUPPLEMENT YOUR SKINCARE
Good skincare starts from within, especially when it comes to breakouts caused by hormonal fluctuations, which is where supplements can be game-changing.
"The best treatment methods for breakouts from a hormone perspective is to balance the hormones," says Dr Sohere Roked, leading expert in bio-identical hormone therapy. "The breakouts are usually caused by an imbalance of oestrogen and progesterone, which is normal before the period, but can play havoc with skin. So taking a natural supplement such as agnus castus to balance hormones in the second half of the cycle can help avoid the breakouts, or using a progesterone cream to balance hormones can also help with improving the skin around the cycle.”
CONSIDER A PEEL
If you're serious about tackling hormonal skin imperfections, you might want to think about booking in a monthly peel with a professional.
"Chemical peels help to regulate oil control and target the bad bacteria within the skin," says KerryLou Herbert, expert aesthetician at Omniya MediClinic.
They may sound scary, but chemical peels are a commonly used treatment to boost cell turnover and restore skin's radiance, as well as inhibiting oil production. While there are many at-home peels available, certain strengths and concentrations of acid will only be available in a specialist clinic.
"An expert will be able to assess your skin and apply a combination of chemical peels to best treat different areas. If you have dry areas, I would recommend a lactic acid peel to rehydrate and calm irritation, and I would opt for salicylic acid to banish blemishes," says Herbert.
What to expect with at-home chemical face peels and everything you need to know
DON'T DRY OUT
While acne-fight ingredients are wondrous at battling blemishes, they can cause the rest of the skin to dry out, leaving it irritated.
To prevent any dryness, Shaheen recommends incorporating a serum with wonder ingredient Hyaluronic acid. "Deficiencies in essential oils and fatty acids prevents skin cells from replenishing themselves and might cause them to overcompensate and produce an overload of oil. A good dose of Hyaluronic acid is a skin staple in boosting moisture levels, keeps skin plump, hydrated and youthful. So, if you're finding your skin is feeling dry, add a skincare product containing Hyaluronic acid and a small dose of retinol to replenish and hydrate. Skin Design London's Retinol Creme is a gel-based moisturiser containing a cocktail of ingredients to tackle dryness while keeping pores clean."