Adult-onset acne is one of nature’s crueller jokes. At least teenagers have smooth, young skin lurking somewhere; those of us with AOA have to suffer the twin humiliations of old age and spots. I was lucky enough to enjoy an acne-free youth. I never knew the distress of blemishes. Then, a couple of years ago, I started getting them and, boy, did my skin make up for lost time. Random, huge, crater-like carbuncles, sore to the touch and with a lifecycle lasting up to a fortnight. Not nice.

Speaking to Dr Michael Prager (020-7323 3660), one of London’s top cosmetic doctors and an expert on the vagaries of older skin, the prime culprit would seem to be (as ever) hormones. “It could be the Pill, or another type of contraception,” he says, “but also polycystic ovaries, menopause, peri-menopause — essentially anything gynaecological.” Lifestyle is also a big issue. “Skin is basically a reflection of what happens in your gut,” he explains. “Nutrition is very important: sugar, alcohol, saturated fats — all have an effect. Using too many different products doesn’t help — it confuses the skin.” Stress is also a factor. People who are subject to a lot of stress (ie, people in their thirties and forties) have elevated levels of cortisone, and this suppresses the immune function. In women it can also lead to higher testosterone levels which, while perhaps useful in the cut and thrust of life, is not so good for the skin.

A common response is to prescribe antibiotics, but Dr Prager is not a fan. Instead, he recommends trying to reduce inflammation in the body and to boost the immune system through a healthy diet and an improved lifestyle. Garlic essence, camomile extract, reduced alcohol intake, strictly no smoking — and generally leading a more sane existence.

For those who can’t afford to give up work and move to the country, there are always products. My own personal favourites are Kiehl’s Drawing Paste (£17, 020-7240 2411), which contains juniper tar to draw out oils and impurities; and Repêchage Hydra Medic Clear Complexion Drying Lotion (£15 from www.repechageuk.com), which is a sulphur-based ointment that you apply at night to reduce inflammation. Similar is Malin+Goetz Acne Treatment (£16, Liberty; www.liberty.co.uk) that combines salicylic acid with 10 per cent active sulphur to dry and medicate pimples. Again, apply at night.

Overall, though, you want to try to maintain the skin’s moisture — while treating acne-prone areas (most often the chin). It’s a delicate balance. Dermalogica’s Overnight Clearing Gel (£38.60, 0800 591818) is a gentle formulation, containing 2 per cent salicylic acid, vitamin B complex, zinc and tea-tree oil: a powerhouse of salving ingredients that you can wear under your night cream. Guinot’s Acnilogic (£36.50, 0800 590094 for stockists) is specifically designed to rebalance, reducing surface shine and tightening pores without drying out the skin. It also contains an exfoliant element to reduce build-up of dead skin cells, a contributing cause of spots.

Finally, you could try treating the problem internally with Dr Perricone’s Skin Clear supplements (£66, www.perriconemd.co.uk), which contain a variety of ingredients, including vitamin C, evening primrose oil, omega-3, calcium, magnesium and vitamin D to boost the immune system and provide antioxidant protection.