Accepting Adult Acne

6 minute read

Sometimes I think about what I would change if I had the opportunity to alter one thing about my appearance. When I quizzed my friends, one of them answered her boobs – she’d like them to be bigger – another replied her hair – she’d like it to be thicker – and for one other, there was nothing – she’s the most well-adjusted woman I know. If I could blink away one aspect of my appearance tomorrow, it would be my temperamental skin. I’m constantly managing and medicating against cystic acne, scarring and rosacea. I’m fortunate to have found a way of keeping the worst effects at bay. But for many women with problematic skin, there is no remission, and even for the lucky ones like me, the emotional effects of the condition need medicating for much longer than the dermatological effects.

It took years of GP visits, then dermatological appointments for me to find a formula that keeps my skin looking reasonably clear, and it’s a combination of the pill (Dianette specifically), laser treatments and Retin-A creams. I tried several antibiotics over the years but they only worked for the duration I was taking them. Once the course ended, I was stuck in a depressing waiting game, which never ended in my favour. The pill offered a longer-term alternative that worked.

As a teenager in the 1990s, I knew little about any of these things (the pill was simply a contraceptive as far as I understood) and neither did my mother, who has beautiful skin – I got my paternal grandmother’s complexion. So my most potent memory of secondary school is dragging myself around the narrow corridors thinking of nothing other than the Lilliputian-sized volcanoes on my T-zone; their constant throbbing a warning to me that they may erupt in an embarrassing spit of blood or puss at any time, in front of anyone. If only face masks had been a legal requirement back then.

At night I would smother them in Sudocrem, hoping by the morning they’d be gone, just as my baby teeth had disappeared from under my pillow when I was a child. By day I tried in vain to cover them up with a cheap stick concealer, but it looked as if I’d crayoned over a crusty scab. So I learned quickly how to hide myself when in full view, by hanging my head, avoiding eye contact, keeping quiet and standing on the periphery. There were many ways of lessening others’ awareness of me, I discovered – though it’s not the skill I wanted to become most proficient at in these formative years. My two best friends both had exquisite skin. Neither even suffered a period-induced pimple or a puffy under eye.

How I envied them. I still do because apparently, the drop in oestrogen we experience in perimenopause and menopause can trigger an outbreak of acne, especially in those who have suffered as teenagers. According to Wikipedia, acne affects 633 million people globally, making it the eighth most common disease worldwide. In 2018, The Guardian reported that an estimated 25% of women over the age of 30 still suffer from the condition. Two years later in 2020, the skincare company La Roche-Posay conducted an exclusive scientific review of all existing studies relating to the impact of skin conditions such as acne on quality of life. It found that 46% of acne patients are more likely to develop major depression than those without, 50% of acne patients self-isolate, and 350,000 days of work or school are missed every year in France due to the disease.

The only thing worse than having acne as a teenager is having acne as an adult. The last couple of times I came off the pill, thinking foolishly that I was a grown-up now, and just as I had overcome my adolescent anger and petulance, so too would my skin, but no. Within weeks, I could feel those menacing lumps beneath the surface of my skin threatening to ruin my complexion and my hard-won confidence. Although I went straight for those tablets at the first telltale sign of a reddening bump, on one occasion I did wind up with what a colleague described as “barnacles” on my face. I remember so well how incredibly vulnerable I felt at that time; as if the real me had been laid bare and the well-dressed, nicely-groomed version exposed as a total sham.

In a professional environment, it’s common for people to doubt your competence if they have misgivings about your appearance. For many of those with no experience of it, acne is still associated with poor lifestyle choices – bad diet, inadequate hygiene, too little sleep, overindulgence in alcohol, and worse. I recently read of one woman in the UK with severe acne who was mistaken for a junkie by a policeman. As my dermatologist told me early on, “Nothing you eat or don’t eat will make any difference to your complexion.” My skin type, and the kind of acne I’ve experienced, are down to hormones and genetics. A 2017 article in The Guardian confirmed that this is often the case, explaining, “[Acne] is a condition largely caused by genetics and hormones not, as myth would have it, through dirty skin and too many chips.”

Irrespective of what causes it, the long-term emotional effects can be devastating. When you have acne you become an expert at avoiding situations that may require a makeup-free face; like swimming and going to the gym, or joining a running group, or having a facial or enjoying a makeup consultation (sit makeup-free at a beauty counter in the centre of a department store?!), or heading away with friends. You've worked hard to build a facade and there’s nobody you’ll drop it for. New romantic relationships are complicated by this unrelenting fear of being seen bare-faced. Saying no – to activities, outings, dates, and desires – becomes instinctive, and the more you avoid, the more protected you feel – from judgment, criticism, and hurt. It’s no wonder then that isolation, depression, and lack of confidence are a consequence of a less than perfect complexion.

Unfortunately, acne can rarely be cured, only managed, and although this may never change, what is changing is people’s perception of the condition. The phrase ‘acne acceptance’ has been buzzing around the internet of late, with influencers and celebrities (including Lorde and Victoria Beckham) talking openly about their skin difficulties. But the most heartwarming and encouraging thing I’ve seen in a very long time is the latest ‘Skin Is More Than Skin’ advert by La Roche-Posay. It features non-actors with real skin issues who have had no retouching, and the first time I saw it, it felt like a big hug; warm, inclusive and honest. What I would have given to see this advert 30 years ago.

According to publications from Vogue to The Guardian, there’s an entirely new cohort of adult women now getting to grips with having problem skin as ‘mask-ne’ – the term coined to describe the pimples, spots, and sores many women have developed over the past year from constant mask-wearing – wreaks havoc with previously flawless faces.

At least now, though, the narrative is beginning to change; acne is not ugly or freakish or grubby, it’s normal, and it can happen to anyone at any age. It’s no more that individual’s fault than the shape of their nose or the colour of their eyes.

The push for diversity we’ve seen over the past decade continues to broaden, as acne (adult acne especially) becomes the next taboo to be blown wide open. Finally, there’s a real understanding that nobody should feel ‘othered’ or alone because of who they are and how they look. In an interview with Muse By Clio, a website that covers creativity in advertising, Lauren Haberfield, the art director behind the La Roche-Posay advert, explained: “For us, the first step to combatting the isolation people [with acne] feel was to include them – to champion real people as they are, and show that fighting skin issues is way deeper than we’ve acknowledged so far. We hope that people will watch...and feel a little more courageous and empowered...because they know they’re not fighting alone.”

Perhaps one day, then, acne will simply be a condition that affects our skin, and not the very core of our emotional wellbeing. Let’s hope that other skincare brands follow La Roche-Posay’s lead.

Marie Kelly, July 2021