June 2022

“Have you tried washing your face?”. An insight into mental health and acne.

This piece is written from my personal experience as a patient and acne sufferer for 15 years. June is National Acne Awareness Month and so I would like to share my personal experience to help others and provide support for future changes for patients with acne.

'Have you tried not eating chocolate?' - Ex work colleague

'My friend had really bad acne and used rose water - clears it right up!’ - Sainsbury’s cashier

'What do you eat? You probably need to improve your diet' - Family

'That make-up on your skin is making your skin bad' - Dermatologist 

‘I can’t see any bad spots. Your skin looks fine. I know someone who gets really bad skin though’ - Friend 

And, finally, the classic line.... 'Have you tried washing your face every day?'

As someone with hormonal acne, I’ve heard these comments, and many more, hundreds of times. I have been to the GP 50 times regarding my skin over 15 years. I have tried face washes, topical lotions, oral antibiotics, contraceptive pills, isotretinoin (Roaccutane®), combinations of these together, and seen several dermatologists. People say they have the secret – “I cured my acne with INSERT SECRET HERE" – but the truth is that there is no secret: you have to find a way to manage the condition that works for you.

                                                             

26th November 2014

Acne is a common skin condition: up to 95% of people aged 11 to 30 in western industrialized countries are affected by acne to some extent.1 It is viewed as a short-term condition that patients are expected to “grow out of” because of the perception that their acne is caused by puberty or other causes, such as diet or hygiene.2 However, it can often be a chronic course, with 20–35% of patients developing moderate or severe acne and requiring long-term treatment.2,3

Managing and living with a long-term condition can make you particularly vulnerable in many ways. In addition to the everyday challenges that most people face, chronic illness adds new stressors, such as coping with pain or discomfort from your symptoms, taking steps to manage your condition and practising self-care, as well as adjusting to new limitations and financial pressures.4 The one aspect that is always forgotten about is mental health.

Acne is rarely seen or discussed in the media, and as a result, many acne sufferers feel ostracised from society for not having perfect skin.2 In research studies, people with acne have said that their skin makes them feel embarrassed and self-conscious. 2 They were frustrated when they felt that the impact of the condition was not recognised by friends and family, or when acne was “trivialised” by health care professionals. Acne is often diagnosed in adolescence, 1 when young people are impressionable and vulnerable to a range of social and physical environmental factors, meaning that pressures are more impactful in this population.6 Even mild acne can affect emotional health, with studies showing that the longer the acne lasts, the more likely it is to affect one’s emotions.5  It can have a significant impact on quality of life both physically and psychologically,2 so early treatment is vital to clear the skin, prevent emotional distress, and prevent acne from worsening and leading to scarring.7

My skin journey

In terms of my journey with my skin, having a recurring condition has always made me feel like a failure. I feel that I need to have an explanation as to why I have spots and, prove that I am aware of the problem, working on the solution and even have a 'back-up plan', if the current treatment option does not work. It never occurred to me as a teenager that acne would still be affecting me now and that I would have been managing the condition for over half of my life. It affects more than just my skin.

In the past, I have prioritised my physical health over my mental health. In anticipation of a milestone birthday, I visited the doctor to be prescribed a drug that I knew would clear my skin quickly, (within a few months) so that it would look ‘good’ for the upcoming celebrations. Previously, my mental health had suffered when taking this drug, but in my desperation for unblemished skin at this time, I thought that I would be able to 'override' any mental health challenges. I am not proud of this approach, and you can guess what happened next. My physical symptoms improved; my skin cleared; I was pleased with the results and the pictures looked great. However, it triggered my mental health to take a turn for the worse. When I visited a dermatologist during this time, he looked at my face and declared there was nothing wrong with my skin. The physical problem had disappeared, and so visibly to others there was nothing wrong, but inside my head it was a different picture. This experience made it apparent to me, that it is simply not the case that one should treat mental OR physical health separately, but both together.

Mental health is something that everyone should spend time, effort and focus on. The first sign that my mental health is suffering is forgetting to take care of myself. This could be something simple and seemingly insignificant, like not brushing my hair, forgetting to brush my teeth twice a day, delaying health appointments, and even skipping meals, or simply not drinking enough water.

A key part of taking control of my mental health has been receiving counselling. It has helped me to open up and address my emotions. I learned that sharing my feelings, can help to relieve some of the pressures. Although it can be uncomfortable at times to share your feelings with a stranger, it is possible to develop a good relationship with a therapist. I began to identify coping mechanisms that worked for me – for example, doing exercise when I feel angry; writing down my thoughts when I feel frustrated or overwhelmed; and using yoga and meditation to relax.

16 November 2019

​​​​​​​A hugely rewarding aspect of my journey has been being able to share my experiences with others. Since I opened up, many have confided in me about their mental health struggles. No one is immune to struggling with mental health, and what triggers you, may or may not be the same as what triggers someone else. If you struggle, or know someone who does, remember that it can start at any time and to anyone. Be kind to others and, importantly, be kind to yourself.

Lucy 

Find Lucy on Instagram here

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References

  1. The National Health Service website. Conditions, Acne. 2019. Available from https://www.nhs.uk/conditions/acne/. (Accessed on 1 May 2022)
  2. Ip A, Muller I, Geraghty AWA, Platt D, Little P, Santer M. Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research. BMJ Open 2021;11: e041794.
  3. The National Institute for Health and Care Excellence. Acne vulgaris. Available from https://cks.nice.org.uk/topics/acne-vulgaris/. (Accessed on 1 May 2022)
  4. Everything you need to know about depression. 2021. Available from https://www.healthline.com/health/depression/chronic-illness. (Accessed on 1 May 2022)
  5. The American Academy of Dermatology Association. Acne can affect more than your skin. Available from https://www.aad.org/public/diseases/acne/acne-emotional-effects. (Accessed on 1 May 2022)
  6. Gwon SH, Jeong S. Concept analysis of impressionability among adolescents and young adults. Nurs Open 2018;5:601–10.
  7. The American Academy of Dermatology Association. 7 reasons to treat acne early. Available from https://www.aad.org/public/diseases/acne/diy/treat-early. (Accessed on 1 May 2022)