As children, we grow up knowing the acne thing is going to happen during our teen years. As parents we watch our kids pretending everything is cool while desperately looking in mirrors. It’s pointless to say acne is just "spots". It’s cruel and unrealistic to blame our children for inflicting this emotional trauma on each other. It’s going to take a revolution to change society and make anything less than perfect skin acceptable. Except. . . Except it’s no longer just a teen problem. More adults now find acne never really goes away. Or perhaps it’s that more adults now ask for treatment. Either way, it’s estimated about 15% of adult women up to the age of 45 years now use an acne treatment. Why is this?

Well, experts (people who sound as if they know what they are talking about)discuss changes in lifestyle. They blame increased levels of stress, poor diets and too much exercise. OK, remember balancing myths against facts can be difficult. There may be a link between acne and eating food with too much fat in it, or drinking too much alcohol. Smoking or exposure to secondhand smoke can damage your skin. Changes in hormone levels can trigger the release of more oil in the skin, i.e. as testosterone levels rise in men and women. If your stomach and bladder are not working as well as they should, toxins can build up and encourage acne.

There’s clear evidence women are more likely to be affected by hormone shifts during adolescence, the menstrual cycle and pregnancy. Taking an oral contraceptive can even out the balance between hormones but some find this a difficult choice because of their religious convictions. During pregnancy, the safest course is simple over-the-counter products like benzoyl peroxide. A recent small-scale trial at Stanford University found an increase in acne during exam times. When anyone experiences stress, the adrenal gland produces more androgens. This makes skin problems more likely. Stress also reduces the effectiveness of your autoimmune system making your body in general and skin in particular more likely to be affected by infections.

A research trial in Australia studied two small groups of young adults, one with a regular diet of processed foods with high sugar and salt levels, the other with a low-GI diet based on fresh fruit, vegetables, lean meat and wholegrain foods. After three months, the low-GI group saw a reduction of 50% in the severity of their acne — a better result than using any of the over-the-counter products. Even exercise can cause problems because, as the skin produces more sweat, this produces a warm moist environment encouraging the growth of bacteria.

Even though Accutane is the proven solution to the problem of acne, women face real problems in using it. Given the slow accumulation of evidence showing lifestyle can contribute to acne, it’s better to start off with these changes. Only if they fail to produce an improvement, and other treatments are unsuccessful, should you turn to Accutane. Remember the absolute need to prevent pregnancy if you are taking this drug. The risk of damage to the unborn child is too great. No level of personal pain due to acne would justify damaging the fetus by using Accutane.