If you think spots are the preserve of pimply teenagers, think again. There is nothing more disappointing than waiting until your 20s to finally have clear skin, then learning the hard way that bad breakouts don’t necessarily end with your teenage years.

There is a growing number of men and women who are struggling with adult acne well into their 40s and coming to terms with it is difficult. Consultant dermatologist Dr Niki Ralph confirms there is a rise in adult acne, but the jury is out on why. More than 80 per cent of teenagers get some form of acne, while 4 per cent of men and 12 per cent of women will continue to suffer into their 40s, she says.

Acne is not just skin deep, though, and it takes a high emotional toll. Loss of self-confidence, changes in self-esteem, depression and anxiety are all common. Acne vulgaris is teenage acne and can continue past puberty into your 20s. It occurs when the pores of the skin become clogged with oil, dead skin cells, and bacteria. It can be treated with prescription ointments, antibiotics and the big gun Isotretinoin, also known as Roaccutane.

Acne rosacea occurs most often in adults between the ages of 30 and 60 and, as well as inflamed spots, includes redness on the forehead, cheeks nose and chin. Treatment options can be similar, but with the added complication that some of the more common treatments, such as the oral contraceptive pill and, in severe cases Roaccutane, are not ideal as you hit your 40s.

We asked Dr Ralph, dietitian Sarah Keogh and image facialist Jennifer Rock for their tips for a zit-free future.

The Dermatologist

There is no one thing you can do to stop acne developing, Dr Ralph says. She has heard lots of suggestions on what causes the condition in her consulting rooms at the Blackrock Clinic and the Mater private and public hospitals.

“It’s not easy to point the finger and say ‘X is the cause’, because we don’t have a set of causes of adult acne. For instance, someone can come in and say the coil has affected their skin. If they did not have acne before, then that may be the case. We work on a plan to minimise and eliminate the symptoms.”

Ralph says symptoms can be triggered by sunlight, alcohol or spicy foods – and the symptoms might vary on a mild-to-extreme scale. She suggests a visit to your GP for prescription creams and ointments as a first step. If that step doesn’t work, you can take a course of long-term antibiotics. Ralph stresses that these are not the same as those you might take for a chest infection, but are prescribed for three to six months to fight the inflammatory effects of the acne.

You can move through a couple of other treatment options right up to Roacccutane, which Ralph stands by as one of the best treatments, although it does cause some controversy because of its link to depression. “We obviously have to discuss it with all patients,” she explains. “In terms of adult acne, I’ve never had to discontinue the treatment, although it does raise a particular problem for older patients, which needs watching. It can raise cholesterol and so you have to be aware of that and monitor during treatment of those in their 40s.”

Eating too many pizzas will not cause acne, she adds, but although your diet cannot cause acne, if you are struggling with bad breakouts, a well-balanced diet rich in vegetables, fruit and protein is needed for skin healing.

The Dietitian

Dietitian Sarah Keogh agrees that once there is a treatment plan in place with a dermatologist then getting your diet in order can result in skin improvements. "Diet itself rarely causes acne, but if you are suffering, there are a number of things, diet-wise, that will make a difference," says Keogh, who practises at the Eatwell Clinic in Dublin.

You are trying to tackle oily skin and one of the simplest and cheapest ways to make a difference is to increase your intake of water, she adds. As a sufferer of oily skin herself, Keogh suggests many people are not hydrating enough. “There is no doubt that the oil sits on the skin and becomes waxy and sticks in the pores. If you can get at least two litres of water in a day, it will help to thin out that oil.”

Next, work on increasing the skin-friendly nutrients in your diet. "Vitamin A can have a big effect on your skin, so eat more oily fish such as salmon, trout and mackerel. If you're not mad about fish, you can increase your orange and red vegetables, like carrots and red peppers."

Boost your vitamin C intake with at least two or more fruit and vegetable portions daily, advocates Keogh, suggesting many of us are still failing to meet the five-a-day guideline. Add in kiwi, oranges and strawberries every day to increase vitamin C, as well as two or three vegetables.

Her final advice: don’t forget your Omega 3s. “Take a good essential oil like evening primrose oil, which helps the skin hold moisture, and take a look at an omega 3 supplement (fish or flax), which is definitely worth adding.”

Don’t expect miracles overnight, Keogh advises. If you increase the water to two litres a day, expect an improvement in two weeks, the vitamin A & C will take 28 days to make a difference and you need to commit to two months for the essential oils to take effect.

The Beauty Therapist

Image facialist Jennifer Rock, aka The Skin Nerd, says adult acne needs a jigsaw approach. Working with a dermatologist and keeping an eye on diet will help, but she warns that too many adults are misusing and abusing products and making the situation far worse than necessary. “There is definitely an epidemic of exfoliation going on and people are stripping their skin of the natural oils necessary to heal,” she says.

Misguidedly, acne sufferers often adopt a “Brillo pad” approach to skincare – using harsh products that strip the skin and only makes inflammation worse, she believes. “The skin is an organ, you do need to respect it accordingly. If you take too much oil from the skin, which is part of the body’s natural eco system, then the body goes into panic mode and produces even more.”

If you are going to exfoliate, choose a product with acid and enzymes rather than scrubs with granules, she says. A good vitamin A serum can help heal the skin and prevent scarring, and turn your attention to other hygiene, too. “Make sure you wash your make-up brushes, pillowcase and face towels regularly, as they also collect bacteria.”