Abbie

Age at interview: 17

Age at diagnosis: 13

Brief Outline:

Abbie had mild acne from the age of 13. She visited a GP when her skin condition became more severe and tried various treatments. She saw a private dermatologist and found that Accutane (isotretinoin) worked well, despite the side effect of muscle aches.

Background:

Abbie is 17 years old and a sixth form student. Her ethnic background is White British.

More about me...

Abbie developed mild acne at the age of 13. Over the next 6 months, her acne became more severe. This made Abbie feel very self-conscious and she went to see her GP. Abbie tried several prescribed acne treatments, including an alcohol-based ‘dabber’ which was good initially but then stopped working. She then tried topical gels and antibiotic tablets, but these gave her side effects such as nausea and did not work. The stress of GCSE exams made her skin worse and, after about 2 years of different treatments, Abbie and her family decided she should see a private dermatologist. The dermatologist tried Abbie on a topical cream before prescribing a six-month course of Accutane (isotretinoin). Abbie’s dermatologist explained treatments clearly and acknowledged that having acne can be upsetting for teenagers, even if it is a phase of puberty. Abbie had some side effects from Accutane, such as joint paints and muscle aches. This made it difficult to keep up with gymnastics, something which Abbie does for fun as well as coaches for her part time job. 

Acne affected Abbie’s confidence and social life. For example, she preferred parties in the evening so that the lighting was softer and she used striking eye- and lip- make-up to distract from spots. She sometimes used concealer but found she couldn’t wear foundation whilst taking Accutane because the treatment made her skin very dry and flaky. Her friends and then-boyfriend were supportive and reminded her that they didn’t care about the look of acne, but Abbie worried that others would stare at her. Abbie found some helpful blogs and YouTube videos online. The posts and videos gave Abbie some useful advice and made her hopeful that Accutane would work for her. Abbie recently finished Accutane and although she is left which some scars on her face, she sees these as “battle scars” which remind her that she got through a difficult experience. 

Abbie’s advice to young people with acne is to see their doctor and to find out about all the treatment options. She encourages patients with acne not just to expect Accutane immediately and adds that many of the treatments can take a little while to work. She also encourages young people to talk to someone if acne is upsetting them and lowering their self-esteem. Abbie’s advice to healthcare professionals is to be sympathetic and to recognise the emotional impacts that acne can have for young people especially.

Abbie had a skin reaction to shower gel which made her worry that her acne was returning.

This is really recently, I’d started using, like my mum got me some shower gel, some for Christmas, so I started using that. And then I started like after I was using it getting like, I don’t know, I thought it was kind of like a rash. But it was kind of, it reminded me of when I had acne. And I was getting it on like my chest. And I was like ‘Oh, no, I’ll have to-’ and I like, I went off it like straight away. And I think it was just some ingredient in it that my skin didn’t like. But then the rash went away. But I was like really worried then that kind of the acne was coming back. Cos at first I didn’t realise that it was the shower gel doing it. And I was like ‘oh, my gosh, I’m getting acne on my chest again.’ And so that was pretty stressful. But when we figured out it was the shower gel and then I was like ‘oh, that’s okay then.’ 

Abbie was confused about acne causes at first.

Can I ask you a bit more about what you knew about acne before you had your first appointment with the GP?

I’d, like I’d looked some things up on the Internet around, cos I used to like think that eating unhealthily made you have acne, or like that, that you were dirty that you had acne. So I used to like look things up on the computer. And there was loads of things like ‘no, it’s not that. It’s just like puberty and it’s like all your hormones and things.’ And all the GPs kept saying that as well. They were like, “You’re young. You’re, you’re going through, like your hormones are all playing up. So it might just sort itself out.” But obviously that wasn’t what I wanted to hear. I wanted it to be gone. But, yeah, so I looked up that it was like something to do with like blocking like your pores or something like that. I can’t really remember. But I just, I wanted to see if there was anything like I was doing wrong, like to see if I’d got the acne. Because I was one of, I was, obviously wasn’t one of the only people that I knew with acne. But I’d got it like the worst out of some of my friends. And I was kind of like ‘oh, why have I got it this bad and they haven’t?’ and stuff like that. And, because there used to be like girls in my year who’d wear like loads of make-up and like wouldn’t getting it. And I’d be ‘oh, why do I get it? I don’t wear any make-up.’ And I used to kind of, that’s why I started searching up things. And it was helpful cos it, it showed me that it was just kind of luck of the draw whether you got it or not.

Abbie’s treatment history for acne started off with topical medicines.

So when I was about 13 I started getting like spots on my face. And it wasn’t that, like that bad at first. So I didn’t really mind. But then it started getting really bad. It was mostly on my forehead and like I get the T-zone bit. And I started to get like more self-conscious about it. So we went to the GP and he gave me, it was like a dabber like with some, it was more like an alcohol kind of thing that you’d put on your face like twice a day. And then it, it started to work really quickly. So I was like really happy. And, but then it stopped working and it got worse. So then I, I went back again and I got some different cream that I had to put on. Which was different cos it was more like a, like a gel rather than a scrubby kind of thing. And then that didn’t work. So then we went back and then he gave me like a stronger alcohol thing. And then that didn’t work. And in the end I was just getting really like agitated that it wasn’t going away. And it w-, I’d had it for about two or three years and it was just not good [laugh]. So we decided to go to a dermatologist. And my grandad kindly paid for me to go to a private one rather than the NHS one. And so we got like really quickly to go and see him. And he prescribed me another cream thing that only dermatologists can prescribe. But that didn’t work. And then in the end he gave me Roaccutane (isotretinoin).

Abbie was offered the pill but declined for a number of reasons.

And I know another option they gave me was to go on the Pill, which like could help. But I was quite young and I didn’t really want to do that. So I think that’s why they went for the, like the gels and the creams and the stuff before Accutane (isotretinoin).

Yeah. Could I ask why you weren’t keen to go on the Pill at that point?

So I think when like I first started going to the GP then they didn’t even mention that. And I think it was when I was around 15 that they were like, “Oh, yeah, the Pill would work.” And I knew one of my friends had gone on the Pill for acne like purposes. And like she, me and her are quite like sporty and she told me that with going on the Pill she’d put on weight. So I didn’t really want to go on it because I didn’t really wanna put on weight. If that sounds kind of bad. But that was one of the main reasons I didn’t really wanna go on it. And also because I wasn’t, like I didn’t need contraception. And I think that was just, I just found it a bit pointless. I’d rather have done something else specifically for my acne rather than something that might help my acne.

Abbie found isotretinoin made her achy and tired, meaning she had to stop her part-time job as a gymnastics coach for a while.

Yeah, so I do, for my job I’m a gymnastics coach. So, which is a bit strange. But basically one of the side effects is you get muscle fatigue and like joint pain. And I started my job and A-, Roaccutane (isotretinoin) around the time I went back to school. So there was a, like in September, so there was like a lot of stuff going on. So I was really tired in a lot of the times. And also it affected the, my shoulder joint quite a lot. And probably for my job, it didn’t help but it got really sore. And the dry skin. So you get really dry like, mostly it was your lips. So I used to always get like, not cold sores, but it used to crack in the corner of my, my lips. So that used to be quite painful. And it was mostly just fatigue and then the dry skin. But luckily I didn’t get any of the, some people like got nausea and stuff like that. I didn’t get any of that.

How did you deal with the side effects that you had?

Well, I knew that, well, I, I thought it would get better like after a while. Cos I knew that I was taking this and I knew the side effects. So I thought if my skin would get better then I could deal with it at first. And just kind of ploughed through I guess [laugh]. And, yeah, and I kept looking at the, the blogs that I’d found online to see that they’d gone through the whole side effects as well and they’d gone through it. So I thought ‘oh, I can do it too.’

Abbie preferred going to parties where it was dark and talks about doing her hair and make-up to make her acne less visible.

I used to always wear my hair kind of like, like down like this, so that it wasn’t as obvious. Like say if I pulled it back in like a pony tail, then you could kind of see it. And I used to like prefer going to like parties or things when it was dark, so you, you couldn’t really see it that much. And I used to wear, I used to do my eye make-up like really nicely. So then people would kind of l-, notice that rather than looking at my acne. And, cos I couldn’t really wear any foundation or anything. So I used to do like eye make-up and then like really bold lipstick, so people would kind of like notice that rather than the spots.

Abbie found a good group of people who she could be frank with about her acne.

But, yeah, it was just nice to have kind of like a network of people who you could just complain to and just be like, “Oh, I’m having a bad skin day today.” And they’ll be like, “Yeah, that’s okay.” And like sometimes if I didn’t wanna go out cos I’d been having like a bad day, then my friends would be like, “That’s okay. We can just, we can just come over to my house and we can just stay there.” So that’s really nice, rather than you feel like forced to go somewhere that you really don’t wanna go to.

When Abbie started sixth form, her acne was clearing up and she had a nice group of friends who accepted her as she was.

Yeah, so we made, cos not many people actually came to our sixth form from other schools. And in my like friendship group there was only I think two people from other schools that we made friends with. And at that time my acne was kind of in the process of getting better, so I didn’t really mind. And then there was my friend with the, the acne that I said about earlier. So we were both, I guess people are just really accept-, more accepting now than they, than they would have used to. Like they, you, people wouldn’t even mention it like if you spoke to them and you had a face like full of acne. They just, they just like accept you for who you are. Which I think is nice.

The pressure of exams, plus having acne and going through different treatments, was all quite stressful for Abbie.

I think when I had it when I was younger, it didn’t really affect me that much cos like I didn’t have any exams or anything to study for. But when I started going on the Accutane (isotretinoin), so that was September, like cos I’d just started sixth form. And during like the lead-up to my GCSEs as well, that was when it was quite bad. And it used to stress me out a lot, like all the exams like plus me having acne as well and I was doing all the treatments and things. And it was quite a, like a build-up of things kind of made it, made it worse. And especially when I went on the Accutane, cos then I got the side effects. And obviously sixth form, cos I started A-levels. So it was all a big like change. And that was all quite stressful as well. So I think the acne didn’t help with that either.

Abbie found lots of interesting blogs and videos online about covering up acne and treating it.

Yeah, I, like whenever you google ‘how to get rid of acne’ or whatever then lots of things like that come up. And I, there was lots of YouTube videos as well that I, I’d watched before. And there was oh like, do you know Tumblr, the website?

Yes.

There was like lots of blogs on there of like, and it had lots of links to different kind of ways of coping with acne. Like ways you can cover it up like with make-up and stuff. And ways you can like make it not so red and things like that. So that was really helpful.

Could you tell me like an example of something that you found online that you found useful?

Yeah, so I found, like there was a way to make your skin not look so greasy, like. Cos with acne it kind of, it sometimes makes you look really shiny and really red. And there was this blog on Tumblr that basically told, explained that if you used this make-up that was like tinted, I think it was tinted green or something, then it would like cancel out the red. So that was really helpful cos I got some of that. And, yeah, that was a good thing.

And I also looked at these like, people had done like blogs about their like, their like journey of trying to get rid of their acne. And especially this one girl. I can’t remember what the blog was called. But she’d like started it when she started Accutane (isotretinoin). And she’d posted like loads of photos of her like face and how it had got better. And I think hers lasted about six months as well. And it was really good to see the, like the difference and how it worked on someone else. And that made me more like hopeful that it could work on me.

Abbie thinks people can be too quick to see isotretinoin as the solution for their acne but there are other options.

And I would also say that lots of people say when they get acne they would automatically google ‘what’s, what’s best for acne?’ And then lots of people immediately see ‘ah, Accutane (isotretinoin). I want Accutane.’ And so they’ll go to their doctor and be like, “I wanna go on Accutane.” But that’s only for like really, when it gets really bad. And I think people need to, need to know that there’s other options before Accutane, because of all the side effects and things. And I think if, and if anyone’s ever feeling like sad about their acne or upset, then they, they must tell someone. Because it’s hard like, cos your self-esteem just like completely drops. And you need to have someone like a, your mum or a friend that you can talk to about it, because it sucks. And someone else needs to know that it sucks. So they can kind of help you through it.