Skin doctor Anjali Mahto on coping with adult acne
Chloe Lambert talks to Harley Street skin doctor Anjali Mahto about her condition and the advice she gives her patients
Anjali Mahto walks into a London hotel looking just as you’d expect a Harley Street dermatologist to: sleek and glossy, with youthful, glowing skin. No one would guess that she has suffered with severe acne for all her adult life. “I’ve had trouble with my skin since I was 11; you get very good with make-up over the years,” Mahto, 38, insists with a smile. “Look at this,” she says, whipping out her phone and bringing up a photo of a recent breakout. “This was only three days ago.”
Having tried every pill, potion, peel, light and laser out there, she says she’s now got her skin under reasonable control. “It is going through a good phase after a course of [acne drug] Roaccutane last summer, so hopefully I will get a good yearand-a-half out of it. But it will be back. It always comes back.”
Though she’s now come to accept that her acne will never be cured, Mahto remains sensitive about her appearance. “I’m nearly 40, and I still freak out when I get spots,” says the consultant dermatologist, who has worked in the NHS and now practises at the Cadogan Clinic and 55 Harley Street. “I still have days when I don’t want to go to work. Having acne is miserable. It really does stop you doing the things you wanted to do. I don’t think that feeling of being a spotty teenager ever goes away.”
Acne – spots and oily skin affecting the face, back and chest – is most commonly triggered by hormonal changes during puberty, but in recent years, experts have been reporting a marked increase in acne among adults. A 2015 study of 92 private dermatology clinics found a 200 per cent rise in the number of adults seeking treatment for acne. Women are significantly more likely to suffer with it than men, thanks to hormonal cycles, pregnancy, changes in contraception, and the menopause.
For most, the problem begins in adolescence and persists, but for a fifth of female sufferers, “late-onset” acne comes as a nasty shock. “I see women who have never had any trouble with their skin develop it for the first time in their 50s,” says Mahto. “As we approach the menopause, the proportion of testosterone to oestrogen becomes higher, which drives the activity of the skin’s oil glands, and can increase spots.”
Various aspects of modern lifestyles have been suggested as the culprits, including stress, pollution and diets rich in sugary, processed foods.
“The evidence is growing for sugar and I do think it has a part to play,” says Mahto, explaining that a spike in blood sugar triggers hormonal changes that lead to an increase in oil production in skin glands. However, she warns against restrictive diets, especially given that eating disorders are more prevalent among acne sufferers. She does advise her patients to establish and reduce any triggers for their acne and adjust their skincare routine. Many of us, she says, overuse skin products, which can worsen acne.
“Facial oils have become really popular over the last few years, and my clinics are full of women that have got blackhead acne because of using them.
“Skincare doesn’t need to be complicated or expensive. I personally never spend more than £30 on a skincare product. Any more than that and you’re being ripped off.” Indeed, this is her biggest gripe. “I often hear people say ‘It costs so much to see a private dermatologist’, and I ask them how much they think they have spent on skincare in the last year.”
A consultation with Mahto costs £250, but for those who want her advice on tap, she has written a skincare “bible”, which offers sound, medical guidance and unaffiliated product recommendations across every age bracket and budget. And if you have late-onset acne, the good news is many treatments also have anti-ageing benefits: “Retinoids and retinols improve lines and pigmentations but they also unblock pores, so they’re an absolute no-brainer.”
Acne’s links with depression and low self-esteem are well-documented: 2015 research by the British Skin Foundation found nearly 20 per cent of sufferers had considered suicide. In the selfie age, life is hard for those with less than perfect skin – whatever your age. “There’s an idea that you grow out of acne, so adults feel like they’re not taken seriously in their role at work,” says Mahto. “I treated a policeman who used to say: ‘I’m supposed to be this pillar of the community and I look like a spotty teenager’.” Others receive nasty comments, often thinly veiled as “advice” on diet and cleansing, she says.
Campaigns such as #skinpositivity, where people share make-up free pictures of their spots, are appearing on Instagram, and Mahto herself has gained a big following with her honest, informed posts about her own skin.
It was Mahto’s experiences in her youth that spurred her to train as a dermatologist. Already suffering with the death of her father when she was 12, she was teased about her spots at her girls’ school, which made her painfully shy. “I used to wear loads of make-up – that was my solution – but as we all know, it can hide the redness but it can’t hide the bumps.” Even at medical school at the University of Wales, she remembers a student saying loudly as she arrived at an end-of-year ball, “have you seen the state of her skin?”
‘We need to build self-esteem that doesn’t come from the way you look’
Despite having a GP mother, she met with little sympathy from doctors: “They were often elderly gentlemen who weren’t interested in a 14-year-old girl with spots. I remember one dermatologist who told me there was nothing we could do about all my acne scars. I started crying, and he just looked at his watch. I thought to myself, ‘I am not going to be like that’.”
Mahto is aware of the irony of advising patients on acne when having a flare-up herself, but believes it has helped her relate to their problems. She never, for example, tells patients to stop using make-up and let the skin breathe. “It’s entirely unrealistic. For a lot of people it’s an emotional crutch that allows them to carry on with their daily routine. Just go for non-comedogenic [non-pore-blocking] products, light gels, mattifying textures, and carefully remove it at night.”
Mahto says the most important step has been learning to see her acne as a chronic condition that will wax and wane. “You’re in a healthier place if you accept that it will come and go, and just
enjoy the good periods.” She would also love to see more people with acne in public life, so her patients could see they’re not so unusual.
“We need to build self-esteem that doesn’t come from the way you look, and I don’t think any generation has got that right yet. My acne doesn’t bother me as much any more. I feel like it’s just kind of part of my face.