Chris

Age at interview: 20

Age at diagnosis: 17

Brief Outline:

Chris has had acne since he was around 15/16 years old, becoming more severe in later years whilst he was studying in college. He tried a number of medications prescribed by his GP before being referred to a dermatologist for Roaccutane (isotretinoin).

Background:

Chris is 20 and an undergraduate university student. He is single and lives in shared accommodation. His ethnic background is White British.

More about me...

Chris has had facial acne since he was 15/16 years old. Chris and his parents had anticipated that he would develop the condition owing to a family history in which his Dad had also had relatively severe acne. Chris initially felt that acne was "just something you experience when you're in your early teens"; however, it continued for him and proved difficult to treat. He tried a number of face washes and over-the-counter spot creams before visiting a GP. Chris then tried various oral tablets and topical creams but felt that these only stabilised his acne rather than curing it completely. He was eventually referred on to see a dermatologist by a GP he saw during his first term at university.

Chris’ acne was most severe whilst he was studying at college. Despite the impact it had on his confidence, there had been only one occasion whereby the impact of his acne stopped him from going into classes. Because his acne was on his face, he felt it was very visible, for example, when he looked in a mirror and to other people. He feels that his family and friends have been supportive throughout but that the biggest impact of acne emotionally was to knock his self-confidence and body image. 

Chris’ acne has now cleared after a several month course of Roaccutane (isotretinoin). He had heard warnings about this treatment from other people but felt that minor side effects, such as dry lips, would be worth the end result. He has been left with some acne scarring for which he sometimes uses BB (Blemish Balm) to cover up the redness. Overall though he feels that, for men in their 20s/30s, looking “a bit rugged” is not a big problem. He was pleased with the outcome of taking Roaccutane and felt confident that the treatment would work well again for him if the acne returned in the future.

Chris sometimes uses Blemish Balm (similar to tinted moisturiser).

If you’d, if you’d gone back to me then and said, “Look, here’s, here’s make-up product, try it out”. I probably would have tried it out. It’s just I’ve never actively seeked out a make-up product like a foundation or anything to sort it out, but now my mum, sort of, recommended me like something called BB Cream.

And that, I mean it might, might be OK for someone with acne, but for me who’s kind of got like a little bit damaged skin and I can still kind be a little bit red and blotchy sometimes it just gives like a nice matte finish to the skin, but when, like I said, when I had acne I didn’t, I didn’t really use anything. 

It’s just now after, it’s kind of nice but if I could go back I would have probably used stuff to cover it up.

So do you use BB Cream on like a daily basis now or? 

[Sighs] I’d say, out of the seven days of the week, I probably use it maybe three days. Like if I’m going out like - if I’m going to the gym, I’m not going to use it, but if I’m going say around town or, you know, I’m going to, you know, going out on a night out or I’m going to like a meeting somewhere…

Yeah

I’d probably use it then. Because you don’t really need to use that much and a, a little tube lasts quite a while so.

Chris was self-conscious about people noticing acne on his face.

When it’s on your face it’s just like every time you look in the mirror like you see it, like, if you, if you’re looking at someone in the, you know, you usually make eye contact, but if you see their eyes move - like even if it’s just down to like, say, this side of your face, you know, that they’re kind of, they’re kind of looking and you, it just makes you feel really self-conscious. 

And, and, yeah, like every time you look in a mirror, I don’t know, even from a distance you can see like it’s, when it’s flaring up and it’s just really difficult to deal with. 

Chris felt differently about his acne treatments as time went on.

So what do you remember about that first appointment that you had with the GP? 

I was kind of hopeful, like I was hopeful whatever they’d, they’d give me would sort it out, but it’s such a difficult thing to sort because there’s so many different treatments you have to do before they like consider putting you on like Roaccutane (isotretinoin) or anything. So I was hopeful, and, you know, like just, it’s just a matter of patience really and when, when one thing doesn’t work for you just have to keep going back really. 

So, I mean, the feeling when I first went in wasn’t too bad. I just sort of, you know, it’s just something I have to get over. And just deal with.

But you sort of became quite frustrated towards the end of that? 

Yeah. Oh definitely, yeah, like when, when you go on one treatment and you go sort of you think you’re getting better and then you don’t and it just takes up months and months and, nothing’s working for you. It’s very frustrating. And, you know, it’s not like you’re just doing that, you’re trying other things, you’re using new face scrubs. It is something where you do everything you can. And, yeah, I suppose frustration is like probably one of the most sort of common emotions that I experienced. Whilst having it, I guess. 

Chris had a follow-up appointment with his dermatologist after finishing his course of isotretinoin tablets.

So after the full course, you have, I had a follow up appointment. It’s quite, they, they’ll ask you how you think it’s gone and things like that. They’ll, they’ll give you the option if you want to continue on it. So, I was on it for five months and they’re like, “Do you want it for another month”? And I was like “Yes, if like, if you’re sort of letting me have another month. I’ll go on another month”. And they’re like, “Yeah, that’s totally fine”. So they gave me another month and that was sort of. I was happy with that so.

It is like it, they are quite they’ll take your sort of perspective into it. Obviously, to a certain extent they’ll consider how long you’ve been on it for and whether it’s worth doing another month, but if you, if they feel like, you know, you might benefit from another month or even if it just sort of, sort of benefits your sort of, I don’t know how you feel about - like you might think in your head, ”Oh another month is what I need”, it might not do anything, but if, if you feel that way then they’re probably more likely to, to prescribe it to you. 

Just for your own peace of mind. 

Chris thinks doctors should tell acne patients about isotretinoin so they’re aware of it.

I’d advise GPs to sort of bring up Roaccutane (isotretinoin) a lot sooner. Like sort of maybe not offer it to them, but maybe offer them a course of action. So you say, say they’ve tried one or two treatments, say, “All right, what do you feel about Roaccutane Talk to them about it then, and then say, “OK, well, we’ll put you on this prescription now, if this doesn’t work, are you happy to go on to Roaccutane?”. So then, as a sort of patient you’re, you’re sort of more confident, you think, “All right, I’ll do this, if this doesn’t work I’ve got Roaccutane and that’s like 90% effective or whatever”. So you then feel less frustrated if you’ve got to go back and, then they give you another sort of drug. So, yeah, I’d just say like, bring up Roaccutane like don’t sort of, I mean, yeah, it’s got bad side effects and things, but you can talk through them when you’re with the patient. So I’d say, yeah, just bring it up a lot more with people who have it have it quite badly. 

Chris started to see a difference in his skin after five or six weeks of the treatment.

Well they, they inform you that you won’t see a difference within the first five weeks. It’s not, it might, they tell you it can potentially get a little bit worse before it starts getting better. But mine didn’t, mine didn’t get worse, mine kind of just sort of, I don’t know, plateaued – just kind of stayed gradual. And then after sort of five six weeks yeah, I started to notice a diff-, notice a difference and then sort of four to five weeks on from that, that’s when you sort of really start to see it kick in and it’s kind of onwards and upwards from there really. 

Chris describes how having acne wore him down.

I suppose at the start, it’s kind of like, you kind of sort of learn to cope with it and then eventually it just sort of wears you down, and like you wake up and the first thing you do is like, look in the mirror, and like, you know, see what the sort of damage is. And then obviously if like, with, with bad acne - a lot of people they think, “Oh yeah, no, acne like, oh I get bad spots and stuff like that”, but when you have really bad acne it’s like under the skin.

And of course like you end up like trying to pick it, trying to like, do anything you can about it and it’s like, kind of like a downward spiral. And then, sort of the weeks goes on and you sort of go often it’s like you have good weeks, you have bad weeks, but when you do have bad weeks, it’s, it’s sort of I don’t know just a bit depressing really. 

Just gets you down because obviously the skin on your face is such like every day you, your obviously always conscious about people like noticing it and it’s, you definitely, it’s definitely a case of you notice it a lot more than other people because people will be like, “Oh yeah, you got bad spots”, but…You in yourself think, “Well, yeah, it’s, its horrendous”, and yeah, it just gets you down really, but yeah. It’s, overall I think, you can deal with it. If you’re, if you’ve got the right mind set, but it’s just tough.

While Chris feels that eating healthily and keeping hydrated aren’t enough on their own to clear up acne, once the acne has gone these practices can help keep skin clear.

I think diet is quite a key one. That was another sort of factor that, you eventually realise do, does or can affect it. But, yeah, diet, I suppose the main one. Maybe stress to a certain extent. You might have certain bad weeks, but because you fluctuate quite a lot it’s difficult to sort of pin point what’s the cause, like if there’s a cause effect relationship of like stress or diet you can only kind of guess. So, yes, I suppose I didn’t really understand like all the main causes. But, you kind of just, you kind of just do your best to get on with it and try and eat well and try and hydration. I knew can affect it as well. But, like I say, because you fluctuate so much you kind of, you are sceptical whether like, you know, keeping hydrated and keeping a good diet, it does actually work or not. So, I think it’s kind of like an individual sort of level. 

Was it raised ever by any of the GPs or dermatologists about sort of things like diet and stress? 

No, not really. Not at all. They didn’t really go into like how your lifestyle can affect it, or at least I don’t remember them going into that sort of thing. That was more like me looking up on the internet like how to sort of prevent sort of acne and things like that. 

But obviously to a certain extent that doesn’t, that will work, to a certain extent for like certain individuals, but when you’ve got acne, like, just keeping hydrated and a general, general good diet is not going to do a great deal. I mean, it might help, but it’s not going to like clear it.

I think my skin will be fine from now on. Touch wood. I think with Roaccutane (isotretinoin) when, when you’ve been on it, you’ve got a lot less chance of getting acne again. So I’m quite confident I won’t get it again and as long as I like, I am like sort of doing the stuff like keeping hydrated and having a good diet and like doing a little bit exercise that’s going to help.

Chris talks about starting university with acne.

You come to university, you’re meeting new people like you, it, when you’ve got sort of flared up skin you are consciously aware of it. And, you know, the social life at uni is a lot, it’s something you experience new, I mean, before going out, you know, you want to look your best like you want to be like, you know, if you’re out to meet new girls or whatever like, you don’t want to be, you’ll always feel self-conscious if you’ve got like loads and loads of spots on your face.

So, I guess, the only difference at uni is that you’ve just got more social opportunities and that’s probably the hardest thing about it. 

Do you think that sort of feeling and in these situations ever change your behaviour like would you ever avoid certain situations? 

No, I can’t remember a time when I’ve ever avoided like a situation at uni Maybe because it like it got bad, but it never got terrible at uni So, I mean, if it’d gotten a lot worse potentially I might have done but, yeah, no, I always felt kind of confident in myself that, you know, I’ve got acne, but, you know, I can get, get along, get by with it.

Chris thinks a man with spots doesn’t stand out as much as a woman with spots. However, he likes to use a product to cover up his acne scars.

If a guy gets a spot, people think oh, it’s normal, like guys get spots. But like if there’s a girl, like usually girls because they wear make-up, their skin always looks good. So, you get a girl who’s got acne or something all of a sudden she doesn’t have good skin and she will stand out a lot more. Whereas, a guy who’s got bad skin - there is probably sort of maybe two or three other guys that have got bad skin as well. So it’s just a case of, it’s less common in girls, but, well as far as I know it is, but if it does occur in a girl, obviously she can only do so much to cover it up. So it’s, yeah, and if you do, if you do try and cover it up you can still kind of see, see through it. 

And it’s obviously there’s that, I think with girls obviously they care about the way they look a little bit more obviously to a certain extent guys do as well, but yeah, girls are a lot more image conscious. 

Whereas, I think there should be more focus on that guys putting on make-up - maybe. Like, it’s, if you, I think, if you, because obviously the, the make-up thing you think if, if you said to me ‘make-up’ I’d think, “Oh yeah, girls, like use it to, before they go out sort of thing”, or whatever. You don’t really think of guy make-up or guys using make-up. But if you give me some of the products that are out there now, which match my skin tone and cover up things quite nicely, as well as being like, as well as like letting your skin breathe and things like that, not like a thick foundation

I’d probably use it like because you can’t notice it often and if it makes you feel more confident in yourself of like, like why not? 

Chris was concerned about the potential side effects of depression if he took isotretinoin and found it helpful to discuss this with his mother.

And what about family members? 

Yeah, I mean, like mum, I suppose my mum was the main person I spoke to about it. And she was like, “Yeah, it’s, it’s a good idea just to go on it. See how you find it, if you get depressed, or if like, if you need to talk to anyone, just give me a call and we can like, see how your feeling and then you can just come off it if you feel like you’re deteriorating or, or something like that”.

Do you think there was any sort of impact on your parents or other family members of sort of having acne in terms of…? 

No. Maybe, I mean, maybe my mum, obviously my mum had to see me go through it. And she might feel sort of a little bit bad for me when like it flared up and she’d be like, “Oh, it’s looking quite bad today”. Like she wouldn’t shy away from saying, it looks bad, like she’d tell me, “Yeah, it’s looking bad, what have you been doing to try and prevent it?” So, I mean, she felt sort of, maybe a little bit, sort of sad for me at some times, but, you know, she knew I was sort of I’m quite a like, I don’t know, an emotionally strong person. It’s not I’m going to sort of cry about it or anything like that, I just get on with it. 

Chris thinks it’s normal to feel self-conscious about your acne when meeting romantic interests.

Oh yeah, definitely. If you’re looking for a girlfriend or like even just meeting girls you wanna be good mates with, like obviously they’re, like if they’re a nice girl they’re not going to judge you at all, but in your, in your own mind you’re always going to be like, “Oh, I don’t look good today”, and it’s just going to play on your mind and you will feel self-conscious. Well, I mean, it’s, some people might not, but in most cases you’re probably likely to. 

I mean, it always, it’s always worse in your own head than it is in theirs - like they’ll probably not notice it, but you’ll notice it a lot more. 

Chris describes a day when he didn’t feel like going into college because of his acne.

Yeah like the worst experience I’d say, in sixth form it was getting quite bad. Obviously, like in sixth form and school in general really like you’re such a sort of, you was conscious about how you looking, like your image, like people sort of, sort of just like just talking about - you, you, you might think people are talking about your skin or something like that. Like, oh, yeah it’s, and like I say, like people looking at you like looking at your cheeks or whatever like, you know, they’re, you know, they’re looking at how bad your skin is.

And making it like an opinion from that. But yeah, One, there was one day I got out of bed, looked in the mirror and it was like, I mean, I went, I went to like college at the worst of days, but this day was particularly bad and I just thought, “No, I’m going back to bed”, and I put some cream on, went back to bed. I just couldn’t like deal with, with just going in that day. 

I suppose that was like the worst case, but at, in terms of at uni it never got back to that sort of level of severity. I mean, there were bad days and, and you’d try to just cope with it as best you can. 

Chris had “bad days” with his acne when he worked in a department store but doesn’t think his acne affected his work.

Potentially, like I worked at [department store] for a year and like it kind of fluctuated bad days, like good days, but in general I don’t think that affected, like my acne affected my work or anything like that. 

Yeah, I, obviously a company like [department store] they’re not going to sort of send you home for having bad skin. It’s just, you just, and you know that, and it’s you work within a team which is, which is it’s sort of quite well, well organised and, you know, everyone’s friendly so, yeah, you can get by quite easily I think…

Yeah.

…with work.

Chris was “quite independent” and didn’t need support in going to the doctors from his parents, but he did appreciate support from his mother when he was considering taking isotretinoin.

And up until that point when you’d been going to GP appointments, had your parents been coming with you or? 

No, I was quite independent in that sense. I mean, my mum would sort of support my thoughts in saying, “Oh, yeah, I think you should sort of go to the GP”, but in terms of coming with me they just, I just did all that sort of stuff on my own. 

Yeah, yeah.

But, yeah, I didn’t really feel like I needed support for it. It wasn’t like I was like, “Oh, can you come with me mum?” Or anything like that. And then she was like, “No”. It was more like, it’s like, it’s my skin condition, like, I’m old enough to book a doctor’s appointment and go get this sorted out, so it’s just what I did really. 

Was acne or any of the treatments something you spoke to your friends about at any point generally? 

Yeah. Like I kind of sort of like spoke to them about some of my thought process You know, like risks and stuff involved and they were like, “Oh yeah, just, like, if you are just, you, you’ll be able to come off it”. They was kind of supporting my thoughts originally. So, yeah, they were sort of helpful or quite helpful to a certain extent. 

And what about family members? 

Yeah, I mean, like mum, I suppose my mum was the main person I spoke to about it. And she was like, “Yeah, it’s, it’s a good idea just to go on it. See how you find it, if you get depressed, or if like, if you need to talk to anyone, just give me a call and we can like, see how your feeling and then you can just come off it if you feel like you’re deteriorating or something like that”.