I am a dermatologist. I suffer with acne.
I have often thought about writing about my experiences and then promptly talked myself out of it. And when I've tried to psychoanalyse why, it is because at times, I still feel resounding shame and embarrassment of my skin.
My acne started age 12. I am now 36. I have not "grown out" of it and I now realise that I probably never will - we all have a cross to bear and this happens to be mine.
As a teenager, I went from the odd white pustule to widespread nodular acne. Deep, red painful bumps under the skin, dozens of them. I was awkward and painfully self-conscious. A girl in my year, Leila, called me ugly, and it still stings now thinking about it. I did well at school, so not only was I spotty but I was swotty too. Never a great combination.
I started caking myself in make-up. It didn't hide the bumps but at least it hid the horrible redness on my face. Being told by my mother that I was only making it worse did not help. There was no way I was going to school without it. Make-up was a crutch. At the end of each day, I couldn't bear taking off my painstakingly created mask. I hated looking at my face in the mirror. I felt ugly.
It's funny how those moments when you're younger can have such a profound effect on the person you end up being as an adult. I'm still not very good at talking in front of small groups of people, I feel uncomfortable with people looking at my skin close up. I can be socially awkward in meetings. Larger groups worry me less because they are usually seated far enough away they can't really catch sight of what I look like. I wouldn't dream of going to work even now without any make-up, even though my skin is currently free of spots.
There have been times I have caught a glimpse of my spotty reflection on the tube and all I feel is overwhelming despair. There have been evenings out I have cancelled at short notice because I just don't want anyone looking at me. Friends and family think it's vanity, it's not. It's just life with acne. It doesn't matter how much someone says, "no one notices it but you", because all you see in the mirror is your spots.
Then there are other practicalities. I enjoy hot yoga and anyone that's done it will confirm how much of a sweaty mess you turn into by the end. But when my acne has flared, I wont go, as my makeup doesn't hold. I don't want strangers seeing my naked face. And not even strangers, when is the point where you let your boyfriend see you for the first time without your make-up? Will he go running when he sees you beneath the perfectly applied veneer? And will he think you're ugly too? Then there are social events like birthdays and weddings. If you're having a bad skin day, do you go? Will everyone be looking at how hideous you look? Will they be judging you? Or even worse, will they acknowledge it and start giving you "helpful" tips?
What I am describing is something that will resonate on some level with everyone that has had troublesome acne. Acne is a common condition that affects nearly 80% of the population at some point, yet its psychological burden often goes completely unrecognized. For those lucky people that have never suffered, it sounds like melodrama. Often those close to us are only trying to make us feel better by saying "its not that bad" but even those words invoke feelings of "you're not acknowledging how bad his makes me feel and you don't understand."
A survey last year by the UK's leading skin charity, the British Skin Foundation showed that over half of people with acne had suffered with verbal abuse because of their skin. Another 20% had contemplated or attempted suicide. These figures are of huge concern considering the high prevalence of acne.
It is well recognised that acne can cause a huge number of psychological issues including poor self-esteem and body image, social withdrawal, difficulty building relationships, and depression. I see patients on a daily basis, that won't make eye contact with me, grow their hair long to hide their face, refuse to go swimming because of acne on their back, or alter their career choices because of their skin.
Times are changing and dermatologists are increasingly aware of the interaction between mind and skin. Acne is treatable for most people and it is important to seek help before any long lasing physical or mental damage is done. If acne is stopping anyone from living their life the way they want to, help should be sought from a dermatologist. There are lots of good doctors out there that understand and may be able to relate more than you first realize.