When Madeleine Spencer finally found the solution to years of troubled skin, the answer didn't come out of a jar...

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I'll never forget the moment that I fell out of love with facials. I was working as a beauty editor at a glossy magazine and had been invited by a brand for their signature treatment in a very fancy subterranean spa.

During my hour down there, I was told that everything I was doing was wrong, that my skincare routine (prescribed by the previous celebrity facialist who’d treated me) would unquestionably aggravate my already angry and acneic skin, and that I should embark on a whole new regimen to reset it completely. But I’d have to go through about six months of it feeling thirstier than the Sahara while peeling. My answer? A firm no, thanks. My spots were already affecting my confidence; this purportedly ‘necessary’ shedding phase would only dent my self-esteem further.

Never again would I let an expert peer at me under bright lights like a science experiment and list the very many things that wrong with me (all of which I was already aware of).

When spots were present, my confidence would plummet, and I’d find myself trying to talk out of the unaffected side of my face

This was the final straw in a long, long line of skincare experts/facialists/aestheticians promising the earth and delivering just another hefty armful of products along with a lovely side dish of guilt and shame. As a beauty journalist, surely more than anyone, I should be able to handle my tempestuous skin.

Only I patently couldn’t. Every month, I would suffer from hormonal cystic spots, along with a smattering of smaller ones every time I traveled to another country, or didn’t cleanse fastidiously right before bed. I wish I were the sort of person who could say I was unaffected by them, but that would be a complete lie. I was mortified every time my face would swell angrily, or when I had tried to squeeze a spot prematurely only to anger it and end up with a scab that took weeks to heal. When spots were present, my confidence would plummet, and I’d find myself trying to talk out of the unaffected side of my face, or wearing lots of makeup and then feeling doubly conscious of both the spot and the potentially caked concealer.

MORE GLOSS: How to prevent and treat acne scarring

Despairing that anyone could help me to better my relationship with my skin, I lowered my expectations and got on with life assuming acne was my cross to bear.

But then clinical aesthetician Pam Marshall (below) who’d then just recently opened Mortar & Milk  on Fulham Road came into my life. I’d followed her on Instagram and she’d followed me back, and then I’d whinged about a cold I had in a post (I like to complain about my health whenever it fails me, rather like a consumptive Victorian), she responded with some suggestions of supplements, I tried a couple and we forged one of those intermittent internet friendships.

And it might’ve ended there had I not been visited by an enormous spot. Reader, please know that a little blemish wouldn’t send me to the depths of despair or prompt me to reach out to strangers for help, but this was a SPOT TO BE RECKONED WITH, right in the middle of my chest, which was very unfortunate as I had just bought a Rodarte  dress to wear to a big party and the delicate gold sequins and shivers of gold lace on the neckline fell just below said gigantic red welt.

I panicked, sent Pam a message asking if she could suggest anything and she gave me practical advice: mask, cleanse, leave alone, repeat. But don’t expect anything dramatic. She sent me a clay mask she was partial to and after following her advice for two days, the spot retreated enough for me to wear the dress without feeling self-conscious.

After that, I decided I’d try a facial with Pam. Perhaps she could both cure me of my acne and of my distrust of skincare experts in one fell swoop.

I was right – and wrong. Pam became my go-to skin guru, not because she worked miracles, but because she was candid about the fact that there was no such thing. She made it clear that there was no ‘cure’ for acne, telling me to ditch that fantasy because no product, treatment, supplement, praying to the gods would do the trick permanently.

But under her tutelage, I have steadily and carefully strengthened and repaired my skin. So, yes, it is now clearer and spots are less frequent. But mostly I am better able to weather spots when they come along because my skin is more robust and healthy. Pam's rules for me included carefully administered acids (but no peeling, ever) which would trigger the healing cascade and rid me of many of my scars. She recommended skincare rich with PHAs (polyhydroxy acids)  which both gently exfoliate and hydrate. She also encouraged me to make some tweaks to my lifestyle; I was to avoid touching my skin as much as possible, change my pillowcase twice weekly, wash my pillows at least every six months and eat a diet rich in organic foods.

Cosmetic changes aside, my relationship with my skin has become better, too. Pam’s compassionate voice has lodged in my mind, and I now don’t feel my spots are the work of some mercurial beast but is instead merely skin, doing its best when hormones, stress, rage and sugar levels spike. And that psychological shift has been massive for me; I suspect anyone who’s ever suffered from acne will know the spot itself is only half the problem, that the accompanying shame is the truly monstrous thing.

So while I may never be fully free of spots (thanks, PCOS ), I am genuinely happy in my skin - and know exactly what to do when one of the blighters pops up, and, thanks to Pam, treating it doesn’t involve even a single week of shedding or redness. Phew.

Clinical aesthetician Pam Marshall's 10 habit changes that helped me beat acne

1. Wash your face after using shampoo and conditioner

"Be discerning about your haircare - hair creams and oils can lead to breakouts on your face. Wash your face after you’ve washed your hair as conditioner is formulated to stick to the hair follicle and so will stick to your fine facial hairs too, potentially leading to clogs at the base which will lead to spots. Side note: make sure you wash your chest and back after rinsing your hair out if you suffer from chest or back acne," says Pam.

2. Make sure your gut is healthy and try a probiotic

"This is of massive importance for any skin issues, but definitely for acne. There are two ways to release toxins: through your bowels, or through your skin. I make sure my clients are doing something daily to reduce inflammation in the gut. While there are a lot of arguments that probiotics can't actually make their way to the gut, I am in the trenches every single day with acne, eczema, and rosacea sufferers and I see probiotics work for them time and time again. I always advise three months of probiotics at a minimum of 30 billion cultures and from multiple strains. Consistency is key, so be diligent about it," advises Pam.

I take the liquid probiotic, Symprove,  every morning, and take Optibac tablets  when traveling and notice the difference in my skin when I’ve been on a course.

3. Wash your sheets in 60°C water once a week

“End of story. If you have acne, I would also suggest changing your pillowcase twice a week because sweat, bacteria, fungus, dust, pollution, and dead skin cells build up, especially on your pillowcase. Bear in mind that unless you wash your hair every night before you go to bed, you are carrying the days ‘grime’ into bed with you and that it accumulates night after night. Dirty sheets will absolutely make your acne worse," explains Pam.

4. Wash your pillows, too

“Our pillows are a cesspool of dust mites, sweat, bacteria and fungus. If they are not white (the same colour they were when you purchased them), give them an occasional wash. Yes, it's a pain because they take forever to dry, but you can dry them in the dryer with no heat, or on a drying rack so that air can circulate completely around the pillow. This method can take a few days. Our bed has four pillows, so we do two at a time. Every six months is good enough, but then always ‘double pillowcase’ your pillows," says Pam.

5. Clean your makeup brushes at least once a week

“We all know this one, but I cannot tell you how many times (almost always) clients come to me saying they either never wash their brushes, or only do it every couple of months. Brushes harbour bacteria, old makeup, your sweat and dead skin cells. Give them a wash at least once a week with a gentle cleanser and hot water. Leave them out to dry hanging the bristles off the edge of the counter so that air can move all around the brush head," says Pam.

MORE GLOSS: How to clean your makeup brushes

6. Clean your phone and use it with clean hands

“Imagine where your hands have been, where your friends’ hands have been, where strangers’ hands have been. I always recommend that my acne clients keep anti-bacterial wipes at their bedside and wipe their phones down completely right before bed, so they are starting with a clean phone the next day. Even if you are out in public and texting, say on the tube and then go into work or home and wash your hands, the second you pick up your phone you are getting all of that all over your hands again. Your keyboard on your computer is the same. Keep them clean daily," says Pam

7. Try very hard not to touch your face.

“We are told this all the time and yet it still happens. So think of it this way: let's say you're a student and you're at school sitting at a desk. You have no idea who sat there before you and what they've done with their hands. You've touched that desk, plus whatever else you've touched throughout the day - and then you touch your face. How many times have your rested your chin onto your hands while listening to a professor's lecture? Think long and hard before you touch that face."

8. Be mindful of unconscious habits.

“I had a client once who had cystic acne and we cleared all of it except one little patch on his cheek. I asked him about his activities from morning until night, so I could try to pinpoint what he was doing that was not allowing this part of his face to clear up. When he told me that after going to the gym he’d take a nap on the sofa, I knew we had it. Every day he was adding sweat and bacteria and possibly even fungus to the sofa, and then lying in it. I told him to shower immediately he got home and then take a nap in his bed on his regularly washed sheets and that area of his face cleared up. So be mindful of your activities because they could be your culprit."

9. Avoid consuming whey protein and dairy where possible.

“Whey protein and whey isolate can often cause breakouts because whey produces an insulin-like growth factor and therefore increases sebum production, which then irritates the hair follicle and sebaceous gland. When I can switch a client to a vegan protein, their acne breakouts will often calm down, or subside altogether. Some people don’t react to dairy at all while others only tolerate some forms: cheese, for example, but not milk and ice cream. I will always ask my clients to first get their gut healthy and then do an elimination diet. I like to do it slowly and one step at a time. Once you've decided where you stand with dairy, move onto sugar and alcohol. I have some clients that can only have clear spirits. It's different for everyone.

"Never do everything at once because you’ll feel deprived and also that way won’t know which one is your skin baddie.” I found that while I’m completely fine to eat goat and sheep’s dairy, any cow’s milk aggravates my skin. I’ve always noticed that sugar in excess is not my skin’s friend, so if I am having any, I make sure to have it with my main meal so the spike of sugar isn’t so intense."

10. Don’t throw too many products at your skin

“I believe in keeping client’s skin routines really simple, and very specific to their skin needs. But there are two products in combination that are incredible acne-busters. First, PHA s (polyhydroxy acids), which gently exfoliate and hydrate simultaneously. The higher up on the ingredients list the better. Look for lactobionic acid, maltobionic acid and gluconolactone. They should be fairly high up on the list. Then combine them with a mandelic acid, which is a very gentle AHA (alpha hydroxy acid) that kills bacteria.

"I recommend the following to all my acne clients:

 Exuviance Skinrise Bionic Tonic Pads , £36.94, which contain both gluconolactone and lactobionic acid (note they contain retinyl so can’t be used during pregnancy), and Exuviance Night Renewal Hydragel , £29.94 – my absolute acne buster, which contains both gluconolactone and mandelic acid to hydrate and kill bacteria."

“When it comes to AHAs, I advocate the use of mandelic acid because it does not dry out the skin and will keep your barrier function intact. However, I have never found that excessive (daily) use of glycolic acid toners works on acne. When using a strong AHA daily, you are actually causing inflammation and compromising the barrier function of your skin. In small doses such as in treatment, it is unbelievably good. But never daily.”

Want more? Read our guide to using exfoliating acids

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