Spot the difference

Acne hounded Rowena O'Connell like a persistent stalker - until she ditched the over-the-counter 'cures'

Thisis the story of somebody with spots. Not a 15-year-old with pimples on his chin, but a grown woman with a career and a sex life who, from the age of 25 to 32, had skin that could have come straight out of a Stephen King novel. Horror wasn't the half of it.

It started small: I began to suffer from acne break-outs and the excuses that go with them. "It was the champagne/the chocolate/the peanuts in the satay sauce/my new make-up," I explained. In my mind it had to be anything other than acne.

Reality loomed with the appearance of my brother, a GP. "Looks like serious acne to me," he said one day, over the family dinner table. "Better get that seen to." By now, my spots were spreading across my cheeks in a join-the-dots fashion; then (here is the Stephen King bit) they started to swell. Doctors call this condition cystic; all I know was that a pimple on my jaw-line could make the glands on my neck pump up like a Gladiator's pecs.

Hoping it was just a (hormonal) phase, I popped a few homeopathic pills, gritted my teeth and prayed the spots would go away. But acne is like those pathetic inadequates who stalk film stars: it never just goes away. It follows you about and taunts you, scarring your skin and your soul.

Grudgingly, I trailed down to my GP. Most GPs, in the early days of acne, will treat it themselves with a variety of antibiotics and sometimes, if you are female, a particular brand of contraceptive pill. My doctor took one look and said: "I'm referring you to a skin specialist."

I had a work-provided health insurance which secured me an immediate appointment with a consultant at a private hospital. (NHS treatment is also available for acne, and appointments with specialists can come through quite quickly.) First, the dermatologist blood-tested me for everything under the sun, including Aids (acne can be a sign that the immune system has broken down). To my relief, the results came back negative.

The cure was supposed to be some heavy-duty antibiotics (erythromycin), topical lotions (clindamycin, brand name Dalacin) and, of course, tretinoin, brand name Retin A, the wonder cream of the late Eighties that claimed to transform women's skin into a wrinkle-free zone, like a fairy godmother waving an airbrush wand. All this medication worked for a while, especially with a dose of Majorcan sunshine thrown in.

"Your spots are cured," said my friends.

By November, when fogs had replaced warm sunshine, my acne was back with a vengeance. The quality of my skin had deteriorated to such an extent that I was slapping on heavy panstick foundation with the dexterity and desperation of a drag queen with bad evening shadow.

I tried a different dermatologist, a different set of potions and lotions (benzoyl peroxide, brand name Benoxyl 10) and an even stronger dose of antibiotics. My skin got a bit better. It was never clear but it was not a mass of acne. The following summer and its UV rays dried my oily complexion, giving me a suntan and making my skin look healthier.

"Your spots are cured," said my friends.

By the following November, one of my friends was sending to Jamaica for supplies of a special herbal toner to help my skin. It was as bad as ever. Seriously spotty, seriously sallow.

"It's time for Roaccutane," announced my third and final dermatologist.

Roaccutane is the brand name for isotretinoin, a drug derived from vitamin A. It is the caped crusader of the acne world, the last hope of the truly desperate. It is also toxic to unborn babies and must be taken with great care and a contraceptive pill. This is medication so powerful that it could damage your liver; it has to be accompanied by monthly blood tests. Don't joke with Roaccutane and don't drink with it, either.

Three months after starting the drug, the skin on my chest and back was as clear, healthy and glowing as that of the models in a bathtime products promotion. My face was getting there. Under make-up it looked marvellous, but it still was not completely spot-free. However, for bad skin it had come a long way. Six months later I was able to stop taking the tablets: my skin looked perfectly normal.

My doctor brother says adult acne is increasing. He is seeing more and more cases in people over 25. Personally, I did not much like being a statistic with spots, and I did not much like having to consult more skin specialists than Michael Jackson, either. But the truth is, adult acne needs prescribed medication; over-the-counter cures and herbal tonics are unlikely to do it. Zits need to be zapped, preferably by people wearing white coats with the label "dermatologist".

Adult acne may be embarrassing but it is curable. In a world full of sickness and disease, acne is one condition for which medical science already has the answers. All you have to do is ask.

Acne - causes and treatments

Acne spots occur when the hair follicles become blocked with sebum - the oily substance secreted by the sebaceous glands. When a plug of sebum becomes trapped in a follicle, bacteria multiply and the follicle becomes inflamed. Causes of increased sebum secretion include hormonal changes (which is why most acne is suffered by adolescents), drugs, exposure to certain chemicals and oils, and oily cosmetics. There is no evidence that diet causes acne.

Treatments for acne include topical lotions that unblock the pores - the most common are benzoyl peroxide, retinoic acid, antibiotics and creams containing sulphur. Ultraviolet light and exposure to sunlight can be beneficial.

Where topical treatments have failed, long-term antibiotic treatment helps to fight the inflammation. Retinoid drugs, used to treat severe acne, work by reducing oil production. They can cause liver damage and foetal malformations.

Acne cysts can often be treated by a direct injection of drugs into the spots themselves, which also helps to reduce scarring. In cases of severe scarring, dermabrasion - removal of the top layer of affected skin - can help.