Addressing Acne: Routes to Improved Skin and Self-Esteem

With Dr Anjali Mahto

From skin health to psychology – Consultant Dermatologist and founder of SELF London, Dr Anjali Mahto, reveals proven routes to managing acne, softening scarring and enhancing self-esteem…

Edited by Victoria Smart

What is ‘acne’?

Acne is simply the medical term that doctors use for spots. Acne is a disorder of the pilosebaceous unit of the skin – which consists of a hair follicle and its associated sebaceous or oil gland. Blockage or inflammation of the pilosebaceous units will result in acne.

Acne most commonly develops on the face, back and chest – as oil glands are found in highest density in these areas. It is increasingly being considered a chronic disease, meaning that; whilst it may be controlled, there might be no long-term cure – treatment can be successful, but acne can recur over time.

Tell us about your journey to becoming a dermatologist: what was the inspiration behind focusing on treating acne within your practice?

It was my personal, first-hand experience of acne, and how it can affect one’s mental health, that led me to specialising in the treatment of acne.

As a teenager, my skin problems caused a world of pain. I was about twelve years old when my acne started. Sadly it developed around the same time as a bereavement, which resulted in my personal circumstances changing. In the space of a few short weeks, I was suddenly confronted with bereavement, a new school in an unfamiliar place and trying to make friends, all whilst having dreadful acne. I was painfully shy and it was hard. I didn’t want people to look at me – all I could see in the mirror were my spots, my eye would not catch the normal skin between them. They disgusted me and I was certain that anyone who looked upon me would feel the same. Unsurprisingly, I didn’t make many friends.

As an adult with acne, spots continue to evoke shame, embarrassment and feelings of inadequacy. It also generates anger: I should have grown out of this by now! In meetings, you wonder if others are taking you seriously, when inside you feel like a spotty teenager. Or, if your skin is bad enough, you cancel the meetings altogether for fear of being looked at or, worse still, judged.

I set up my clinic, Self London, to be the UK’s first centre of excellence for acne. I know what it’s like to be in my patient’s shoes and I’m passionate about treating acne before it scars, which is much harder to treat.

As a consultant dermatologist, with personal experience of acne, can you explain how this condition can impact individuals – beyond the physical appearance of their skin?

Acne can significantly impact an individual’s psychological well-being and overall quality of life. The visible symptoms of acne often lead to self-consciousness, embarrassment and a negative self-image. This can result in reduced self-esteem and confidence, making social interactions and public appearances incredibly stressful.

Many individuals with acne experience social withdrawal and isolation due to fear of judgement or ridicule. Additionally, the emotional toll of persistent acne can contribute to anxiety, depression, and feelings of helplessness. For adolescents, who are particularly sensitive to peer perceptions, acne can interfere with academic performance and social development.

You’re an advocate for advances in acne management – what treatments are you excited about right now?

By far the most exciting development in the world of acne management is the introduction of a new laser device called AviClear to the UK. AviClear is an advanced laser treatment specifically designed to target and treat acne. It utilises a 1726 nm wavelength laser to selectively target the sebaceous glands in the skin. By heating and reducing the activity of these glands, AviClear decreases the production of sebum, which is a key factor in the development of acne. This reduction in sebum production helps to prevent clogged pores and reduce the occurrence of acne breakouts. The treatment is non-invasive, requires no downtime, and is suitable for various skin types. AviClear is a promising option for those seeking effective and long-lasting acne management, who can’t, or might not want to, go down the traditional path of acne management, such as medication.

How can we complement acne treatment outside of the clinic?

To complement acne treatment outside the clinic, maintain a consistent skincare routine with a gentle cleanser and non-comedogenic moisturiser, and use over-the-counter treatments containing benzoyl peroxide, salicylic acid, or retinoids. Apply broad-spectrum sunscreen daily and avoid harsh scrubs and picking spots as this can lead to scarring.

You can also support your skin health through lifestyle factors; by eating a balanced diet (a diet that is good for your overall health is good for your skin), staying hydrated, and managing stress through exercise or meditation. Regularly clean makeup tools if you use them and adhere to prescribed medications and follow-up appointments with your dermatologist.

Acne management goes beyond treating active acne to treating acne scarring – how do you approach this in-clinic? And is there anything we can do to support this from home?

There is so much scope for the in-clinic treatment of acne scarring and it’s something we specialise in at Self London. Treatment often involves advanced procedures such as laser therapy, chemical peels, and dermal fillers in some cases – all aimed at stimulating collagen production and improving skin texture. Each treatment is tailored to the type and severity of the scars.

To support these treatments at home, we advise patients to maintain a consistent skincare routine with gentle exfoliation to promote cell turnover – often we’ll advocate the use of topical treatments like prescription retinoids to boost collagen production. We’ll also recommend daily application of sunscreen to protect healing skin.

There is undoubtedly a significant link between skin and self-esteem – do you have any advice for those feeling the impact on both?

Absolutely, the link between skin health and self-esteem is well-documented. Psychodermatology, which addresses the psychological impact of skin conditions, can be very helpful and is a vital service I wanted to include at Self London. For those feeling the impact on their self-esteem, consider seeking support from a psychologist.

Practising mindfulness and stress-reducing activities like meditation or yoga can also benefit both your mental state and skin condition. Additionally, joining support groups or talking to a therapist can help address the emotional aspects, fostering a positive self-image and improving overall well-being.

You have always been open about your acne journey, as you’re passionate about raising awareness of how common this condition is – do you think there has been a positive move towards ‘acne acceptance’?

Yes, in some ways, there has been a positive move towards acne acceptance, with more people openly sharing their acne journeys and promoting skin positivity. This shift has helped normalise the condition and reduce stigma. However, we still encounter many filtered and edited photos, making it rare to see real, unedited skin on TV, in magazines, and on social media. This ongoing prevalence of unrealistic skin continues to impact self-esteem and sets unattainable beauty standards. While progress has been made, there is still a need for more authentic representation in my opinion.

There is a lot of literature regarding the Gut-Skin Axis – what are your thoughts on the link between nutrition and acne?

The gut-skin axis highlights the connection between nutrition and acne. Emerging research suggests that the health of the gut microbiome can influence skin conditions, including acne. Diets high in refined sugars, dairy, and processed foods may exacerbate acne by promoting inflammation and hormonal fluctuations. Conversely, a diet rich in whole foods, such as fruits, vegetables, lean proteins, and healthy fats, can support a balanced gut microbiome and reduce inflammation, potentially improving acne. While more research is undoubtedly needed, addressing diet can be a valuable component of acne management.

What do you do to feel grounded?

I never miss a PT session with my trainer, AJ. Regular physical exercise boosts my mood and keeps me connected to my body. I train around 3 times a week and we do a mix of strength training and callisthenics. I also try to fit in a few cardio sessions too. It’s particularly important for me to maintain an active lifestyle as I was diagnosed with a heart condition this time last year. Thankfully, exercise was already an integral part of my life.

What’s your idea of a perfect morning?

My ideal morning begins with a peaceful wake-up, allowing myself some time to stretch and mentally prepare for the day ahead. I love a cup of freshly brewed coffee while I catch up on the news or read a book.

Engaging in a brief meditation or mindfulness practice helps set a positive tone for the day. Depending on the weather, I might go for a refreshing walk or practice yoga. I’m a qualified yoga teacher and find it a very meditative practice.

If there was one thing we could all do to improve our skin quality – what would that be?

If there was one thing we could all do to improve our skin quality, it would be to wear sunscreen consistently. It’s the answer every dermatologist will give, and for good reason. Sunscreen is the most effective way to protect our skin from the damaging effects of UV radiation, which can lead to premature ageing, sunburns, and an increased risk of skin cancer. Incorporating sunscreen into our daily routine is crucial, as even brief exposure to the sun without protection can cause long-term damage. By making sunscreen a non-negotiable part of our skincare regimen, we can maintain healthier, more resilient skin and reduce the risk of sun-related skin issues over time.