It seems that, just a generation ago, we would go through our teen years with the threat of acne hanging over us but, once the hormones had settled down, the pimples slowly disappeared and our skins were free. Now things are changing. The scientists tell us this has nothing to do with the fact we now eat less healthy diets and exercise less. Perhaps it's a change in the environment. There's all this talk about more pollution thanks to all the vehicles driving around and the coal-fired power stations. Who knows. All we can say is the problem is now affecting up to half the adult female population and up to about a quarter of men aged more than 25. This is a real and significant change. Just when we all thought it was safe to go out and show our faces in public, we're suddenly hiding away again and looking for quick fixes over the counter in the drugstores.

Let's get the boring biology out of the way. The hormone levels in women have always been changeable both through the menstrual cycle, the menopause and, particularly, during pregnancy. In the last century, a small percentage of adult women always did have acne problems. This was tolerated during pregnancy because it's only a relatively short-term event. Now these fluctuations of hormone levels are growing more pronounced, more women are affected during menstruation and, much to their surprise, during the menopause. One of the standard ways of combatting this is to use oral contraceptives. This reinforces the level of estrogen and helps keep the skin clear. Exfoliation or using a microdermabrasion product can help. Skin products containing benzyl peroxide or salicylic acid will keep most outbreaks under control. Other than this, it usually comes down to wearing less make-up and considering the use of an anti-inflammatory or, even, an antibiotic if the skin does not clear naturally. The bad news, however, comes from the American Academy of Dermatology, showing that outbreaks of adult acne are lasting longer and increasingly affecting people into their 40s. Perhaps it's a general increase in the stress of modern living. If it's affecting you, talk to a doctor about any drugs you might be taking. Some can affect the skin.

If all else has failed, Accutane is the answer. To keep the risks to acceptable levels, you should discuss the issue with your primary care physician. There are risks to all if you exceed the dosage or take the drug for too long. For women, there remains the problem of avoiding pregnancy. Within the system, this is achieved by the iPledge program. If you find this too intrusive, you must use at least one guaranteed method for avoiding conception. In this, note the irony. Taking an oral contraceptive often relieves acne. So, always take the right precautions. This should allow the Accutane to work its magic and cure the problem during the first round of treatment. If the first round is not completely effective, wait and then try a second. But if you still have the problem, always take medical advice before taking any more.