Acne may occur due to an increase in sebum production, keratinocyte hyperproliferation, colonisation with Propionibacterium acnes and subsequent skin inflammation.1 It is an androgen-dependent condition affecting the pilosebaceous unit.1 It is often considered an adolescent disease,2 but acne can persist into the 30s in approximately 40 per cent of cases.3 Acne often requires long-term treatment due to periodic flare-ups. There can be significant psychosocial sequelae. Clinical features include: seborrhoea, comedones, inflammatory lesions comprising papules and pustules, as well as nodules. Post-inflammatory hyperpigmentation in addition to scarring might be present.4
A 30-year-old lady presented with facial acne that had begun in her teens. Her symptoms had deteriorated over the last few months. She thought stress related to bereavement might have been a contributory factor. She found her facial acne embarrassing and she felt low in mood.