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Key points
- Acne affects a significant number of teenagers, causes emotional distress when it is severe, and it doesn’t always go away.
- Drug treatments can help, but not always. However, we can reliably make a difference by shifting the way we think.
- The secret is to take control by sending out the signals about ourselves that we want others to pick up on.
My mother said it would all go away when I was 21. Even to my impressionable 14-year-old ears, it sounded overly optimistic that the acne plaguing my skin would magically vanish when I reached that bewitching age, and, indeed, by the time I reached it, I was already reluctantly resigned to the reality that the acne was going nowhere.
It consumed my teenage attention, as I desperately sampled every new treatment and agonized in front of the mirror, bemoaning each new boisterous blackhead, flaming pustule, or stubborn cyst that emerged to join its 10 or 20 fellows, already jockeying for position. It ruined my confidence and led me to slink about, hoping not to be noticed.
So I was pleased to see that, for the first time, the National Institute for Health and Care Excellence (NICE) has issued a guideline for the treatment of acne. Published last month, it emphasizes, along with pharmacological and photodynamic therapies, the importance of mental health support for those suffering severe distress as a result of the condition.
As Dr. Paul Chrisp, director of the Centre for Guidelines at NICE, said, "Not everyone with acne will experience high levels of psychological distress, but it’s important that we find ways to support those that do." Singled out for concern are those with a current or past history of depression, anxiety, suicidal thinking, and self-harm.
Acne is a highly visible affliction, which arrives at an age when, with hormones and sense of identity all in turmoil, we are least equipped to cope with it. And far from disappearing at 21, it may persist well into adulthood for many.
There is now an ‘acne positivity’ movement, with bloggers and influencers who have acne courageously daring to bare it. And, although they suffer some appalling trolling, they are helping hundreds and thousands of others to realize that they don’t have to be defined by their acne.
My life changed when, at age 20, I recognized that I was doing exactly that; I was allowing myself to be defined by my skin. I was even inviting it. So instead of protecting myself, by hiding from the signals (disgust, pity, indifference) that I imagined others were sending me, I started to give out my own signals to them instead. I started to laugh, act vivaciously, be interesting and show interest, conveying in how I spoke and moved that I felt I was an okay and attractive person.
And that was the message I started to get back. The spots didn’t go away. But they did diminish, in importance, if not size, because the personality I had been suppressing was bigger than they were.
I remember a day, when I was already over 30, when I woke to find that a cyst which had been threatening to break through for some time had decided to push its way into the limelight, an inch below one eye, demanding undivided attention. My heart sank, as I had a meeting that day with editors I didn’t know, to pitch some ideas.
Even with my own determined ‘acne positivity,’ I felt disheartened and unconfident as I arrived at the offices for the meeting. I wanted to shield my face with sheaths of paper and I also knew I would feel bad if I did. So I decided, in that moment, to take on the room.
I behaved as if I did not have a football on my face. I sparkled, expressed my ideas fluently, met everyone’s eye, and conveyed all my enthusiasm. Everything that came back to me was positive and my ideas were taken up.
And if they had noticed the cyst? If, once I had left the room, they had perhaps said to each other, "Great ideas! Shame about that football on her face," so what? The acne had trailed in second, denied centre stage, a bit player, if even that.
This attitude, deliberately adopted, was confirmation of my firm conviction that people see whatever part of us we choose to show them. As a consequence, I wrote an article for UK Cosmopolitan, teasingly entitled, “You can be a siren with spots,” which led to a huge and appreciative response from readers, who felt liberated by it.
I like to think that it made a lasting difference to those readers’ lives, just as ‘acne-positive’ bloggers are helping their thousands of followers think differently about their own. No one needs to be imprisoned by their own skin. It is one ‘break out’ that we can feel positive about initiating.
