Fed up with dealing with pimples, Georgia Lewis sought the advice of a Harley Street expert

There was a brief window in my late twenties when my skin was lovely. Unencumbered by zits or lines, I thought I was finally free of the acne that blighted my teens. But hormones are fickle things and joy of joys, I found my spots came back in perimenopause.

Thankfully, it’s nothing like the late ‘80s/early ‘90s burst-into-tears-in-front-of-the-bathroom-mirror era. But it was tiresome to still be reaching for the Clearasil when I had a husband and a mortgage. And burgeoning crows’ feet.

I’d officially entered the glamorous wrinkles-and-pimples era

And at the age of 48 I started to wonder if it was ever going to end. I’m not bothered about the wrinkles, even if I suspect I’m the only person I know who doesn’t do Botox. But pimples? Seriously, this is ridiculous…

So, I booked an appointment with dermatology nurse practitioner Emma Coleman. The original plan was to visit her Harley Street clinic, braving the rush hour tube with no make-up on. Quelle horreur!

As I work from home, I usually wear a full face of makeup when I catch the tube, because I’m going somewhere nice, like the theatre. The thought of going into town sans slap didn’t fill me with joy. Even though I was highly unlikely to be papped for a Heat magazine “LOOK AT HOW HIDEOUS THESE CELEBS ARE WITHOUT MAKE-UP!” article.

But (fortuitously?) the winter lurgy felled me. And rather than infect my fellow passengers, we had a skin consultation by video call.

Emma quickly got down to business

She asked me about my age, HRT medication, diet, and skincare routine before I put my phone right up to my face to show her my zones of concern.

There was a zit threatening to emerge right beside my nose, presumably to keep the zit already on my nose company. On either side of the bridge of my nose, where my eye sockets begin, I’ve permanently had cystic acne for decades. They’re the annoying headless horsemen of the pimple world. At least there’s no temptation to pick or squeeze these bad boys, because they don’t develop an angry red and yellow head like garden variety spots. My forehead is home to whiteheads that come and go as they please, like presumptuous, pus-filled houseguests.

Then I showed her my bumpy, reddish chin. This has looked like a relief map of the Yorkshire Dales for decades. On the upside, my cheeks are generally smooth, clear and kissable.

So what was the verdict?

Emma diagnosed mild to moderate acne vulgaris with some post-inflammatory hyperpigmentation, AKA the red marks that gave me uneven skin tone. As well as the fun bonus of acne lesions that fall into the primary and secondary categories.

But why was this happening to me at the age of 48? Why was I getting chin acne at levels last seen when John Major was still PM? The short answer is that hormones are mostly to blame, especially androgens, better known as male sex hormones.

During perimenopause, the ovaries are in their last gasp of hormonal activity and they’re still secreting androgens, as well as oestrogen. When the oestrogen falls sharply and the androgens drop gradually, a hormonal imbalance is created. And when the balance tips in favour of androgens, acne can either get worse, if it’s already a problem for you, or it makes a comeback that’s about as unwelcome as bodysuits with crotch studs. Why are they back in the shops? Is everyone too young to remember the crotch crop circle debacle of 1995? But I digress…

Or the imbalance can present as hirsutism. I’m pleased to report that I’m yet to become hairier. Although friends over 50 keep warning me that chin hairs could be just around the corner. At least for now, I can just focus on eradicating the spots on my chin and save the tweezers and electrolysis for later.

So, what can I do about all this?

As a gastritis patient, my diet is already low-acid and low-fat, which is good for keeping the spots at bay. But what about the stuff I put on my dial? As a low-maintenance woman – at least when it comes to skincare – I have a mantra. “If I can’t get it at the supermarket, I’m not interested”.

As such, I wash my face with an Asda tea tree foaming cleanser to keep the oil at bay and balance it with Simple moisturiser, another product I can buy with my groceries. Surprisingly, Emma didn’t baulk at my bargain basement routine.

I wasn’t doing horrific damage to my skin, but I could probably try something with a bit more oomph. So I swapped my supermarket buys for Emma’s Luminosity Face & Body Wash with glycolic and salicylic acids, and daily collagen-boosting SPF 50 moisturiser.

To zap existing zits, prevent new breakouts, and reduce acne scarring, Emma recommended a topical prescription called Differin, which contains retinol, a form of Vitamin A. Finally, she recommended oral probiotics, usually taken to aid digestion, as there is evidence they help acne as well.

It sounds like a lot, but this simple product-swapping didn’t add hours to my minimalist skincare routine. Plus it’s easy to just pop the probiotic at night, along with the other medication I already take.

Did it work?

In short, yes. Within a week, my skin was noticeably clearer and brighter. When I had my six-week check-up with Emma, she was pleased with the improvement, noting my skin tone is now far more even. I’m definitely more confident when I leave the house without makeup, although I still don’t enjoy catching sight of myself in a self-checkout camera. But those bloody things turn us all into Crimewatch mugshots.

The three main problems – the lumpy cystic acne, the whiteheads and the relief map chin – all started to look much better. In true middle-aged style, it was in Facebook photos that I really noticed the lumps had calmed down.

Meanwhile, the Differin prescription was working wonders on the horrid little whiteheads, as well as any other errant zits. All I had to do was pop a Differin dot on a spot before bed and it’d be pretty much gone by morning. Shamefully, my main pimple eradication method previously was an insect bite relief pen. A temporarily effective trick I discovered by accident on holiday, but probably not a great long-term solution. And my chin is not looking angry and red anymore. Yorkshire Dales relief map, begone!

It might seem bombastic to say that a new skincare routine has been life-changing. But it really has improved my quality of life. The confidence boost that comes with feeling better about how you present yourself to the world is hard to put a price on. After years of going through the motions with the same old routine, I was stuck in a skincare rut. But seeing real results so quickly was a great motivator.

As well as being happier about leaving the house bare-faced, finding a good moisturiser that works well under makeup is another advantage. When your foundation goes on smoothly over a good base, you don’t end up with that cakey, craggy look.

Looking ahead

Everyone’s skin is different and I’m pleased to have found a personalised solution to tiresome middle-aged acne. I can highly recommend having a consultation with an expert. Especially as Emma didn’t berate me for my cheapskate cleanser ways. It was good to have replacement products recommended to me, rather than loads of extras. I remember the obsession with toner in the ‘90s – and I remember using gallons of toner for no discernible improvement.

As well as her own products, Emma was happy to recommend alternatives, which is always reassuring. For people who aren’t keen to use retinol products, she says to start by using them less frequently. Or seek out products with Vitamin A, E or C for similar results. Silver’s own Pro-Ageing Stem Cell Regenerator Serum is an example, with mandarin peel oil for a hit of Vitamin C. And it goes really well under makeup.

An easy-to-follow skincare routine that fits in with your lifestyle is essential to committing to change. While I’ll never look like Titanic-era Kate Winslet, who was always my absurd clear skin role model with her china teacup complexion, I’m happy to look more like Mare of Easttown Kate Winslet. With a refreshing lack of vanity, she played a woman whose personal and professional life was crumbling. And her crows’ feet were proudly on show.

I’m more than happy for the world to see where the crows have stomped around my eyes and I’m happier still that they’re no longer competing with intrusive acne vulgaris. This really is the face I have earned and I’m not going to hide it.

Find Emma Coleman here