What the Dermatologist Doesn’t Tell you About Having Acne
The year is 2018. It’s my senior year of high school and I’m sitting with my two best friends at our usual table. I am complaining, probably somewhat whining, about my recent flare-up of acne which seems to have come out of nowhere (and by “nowhere”, I mean I stopped using my Old Standby benzoyl peroxide because I thought I was cured *hallelujah*). Tensions quite literally rose, as in I jumped up from my seat, hands on the table and towering over, when my one friend suggested that I had acne because I ate so much hummus. She was joking obviously, but my temper and the weeks of built-up insecurity couldn't deal. I remember being flustered which isn't usually something I feel when I’m angry.
It wasn’t the joke so much that set me off but everything that it carried with it. This friend of mine was someone who washed her face infrequently and slept in makeup but only struggled with the occasional blackhead (if I sound bitter it's because I am, but I'm trying not to be). Meanwhile, I had been using my cocktail of benzoyl peroxide and clindamycin since I was fourteen and having to deal with the dry, lifeless skin that it bore me. At the time I was doing everything under the sun to make my skin happy. I was exercising, I was meditating, and I was already vegan so I knew it wasn’t just a reaction to dairy. It also wasn’t genetic, no one in my family had ever dealt with it before. So really, it wasn’t the joke, it was the injustice of it all.
Photo by Gracia Lam
I have to admit for the sake of transparency and absolution from the skincare gods, that I was using coconut oil as my sole moisturizer. Coconut oil is extremely notorious for clogging pores. This being said, it wasn’t the instigator of my acne. I haven’t let a drop of coconut oil, or any other oil for that matter, touch my face since 2018 and I am still dealing with breakouts.
Having acne is the quintessential rollercoaster ride. One month your skin is healing, dare I say, glowing. The next, or really the next four, your face is red and painful and you're making any excuse to hideaway. What’s worse is that there’s something so isolating about having acne, especially when there is no one else in your life who also struggles with it. At home, with my family, I felt like an anomaly. Every time they looked at me I felt like they were puzzling over my skin. Sometimes they would offer advice like the insanely unhelpful, “Maybe you should try proactive” or “Have you tried cutting out peanut butter”, and while they were well-meaning, their comments only served to ostracize me even more. At school, it was so much worse. I stopped wearing makeup, I stopped wearing my favorite clothes. I wore this one red hoodie three out of five days a week, it became a kind of safety blanket for me. I wanted to be as inconspicuous as possible, which is incredibly hard when you have two hot best friends who dress to the nines. Yeah, yeah, yeah, comparison kills and all that but I was seventeen and all I wanted was perfect skin.
GIF by Rosemary Health
The world of internet skincare has changed a lot since 2014 when I was basically putting the natural equivalent of a nuclear bomb on my face, but there is still so much misinformation and gimmicky sales pitching. Even more difficult to find than reliable skincare info is honesty. Honesty about self-esteem with acne, about dealing with friends/family who don’t understand it, and about accidentally on purpose missing the school bus on a particularly bad skin day (just me? ok).
But really, there is a startling lack of dialogue online about the psychological effects of dealing with long-term acne. It’s true, I think that people don't notice the changes in your skin as much as you do, but that’s really not as comforting as it should be. Honestly, with acne, the way you perceive yourself is the way you believe everyone else perceives you. It’s like when someone says they like your new haircut even though you hate your new haircut, it doesn’t make a difference. Acne dysmorphic disorder (ADD), like body dysmorphia, is characterized by obsessive thoughts about your skin and often leads to a distorted perception of how severe your acne actually is. Over time ADD can wear down your confidence, your social skills, and your self-esteem.
I won’t pretend that my acne was the worst, even if it often felt that way, but I still found myself feeling utterly hopeless and, more than I’d like to admit, crying in the bathroom stalls at school. I think sometimes people confuse this kind of desperation and obsession with vanity. I’m not going to lie and say I’m not vain (aren’t we all?), but dysmorphic disorders aren't about self-absorption, they’re about self-worth and about a culture that prioritizes physical appearance above all else.
Photo by Rosemary Health
Despite being one of the most common skin diseases, acne is more often than not, completely misunderstood. This discrepancy leaves young people at a loss at one of the most vulnerable times in their lives and therefore more prone to depression and anxiety.
I’m currently writing this from my living room couch with a peeling face, á la tretinoin. My skin is probably the worst it’s been since that last year of high school. Maybe I wrote this as a trip down memory lane or as a way to grapple with the emotions that have largely been dormant for the past three years. With the prevalence of face masks during the pandemic, I have felt much more at ease moving about the world with breakouts but I wonder whether or not I would have taken the dive to start retinol if I weren’t working and taking classes from the safety of my own home. This poses a lot of questions for me about my self-image and whether or not it has evolved since I was a teenager. Detangling my self-worth from my appearance is an ongoing process and intersects with basically every way I present myself to the world. I’d like to think that one day I’ll be able to look in the mirror and not care whether I have breakouts or not, but that day isn’t today, it’s probably not tomorrow either and that’s ok too.