Deborah

Age at interview: 25

Age at diagnosis: 12

Brief Outline:

Deborah first began to get spots around age 12. Contrary to what Deborah expected initially, her acne has stayed with her into her twenties. She has used over-the-counter products, steroids creams and prescribed tablets but has never felt ‘acne-free’.

Background:

Deborah is 25 years old. Her ethnicity is White British.

More about me...

Deborah started to get spots at the age of 12. At first, she felt glad that her spots would be “out of the way by sixth form”, but acne has remained with her into her twenties. When Deborah was younger, she found that her spots were concentrated on her face around the t-zone. More recently, her acne affects mostly her jawline and across the shoulders, back and chest – parts of the body which she finds harder to treat acne. Deborah says that her skin has changed as she has got older; for example, she used to have oily skin, whereas now thinks that she has larger pores which are open and so clog up easily. Deborah still gets some breakouts, especially in response to certain triggers including as stress and hormonal changes such as around her menstrual period. Deborah also avoids dairy as she thought it might be triggering her acne.

Deborah says that it didn’t occur to her until only a few years ago that a person could see their GP about acne. She has since visited her doctor and tried a number of prescription treatments, including the contraceptive pill, steroid creams and antibiotic tablets. The first treatment she tried was a gel, but it was time-consuming to apply and made her skin itchy. Deborah has also seen a dermatologist in Australia whilst living there. She was given some tablets which worked well, but she couldn’t get the same medication when she returned to the UK. She is not taking any prescription medicines for her acne at the moment as she hasn’t found anything which helped much and she doesn’t like the connotations implied of acne being an ‘illness’. 

Acne began to affect Deborah’s life more seriously around the age of 15 as she began to feel much more self-aware of her skin. She bought make-up and over-the-counter products like vitamin supplements, which made her feel that she had some control over the condition. Deborah has tried many different skincare products, such as tea tree oil, and she takes care to keep her make-up brushes clean. Deborah also tries to find ways to avoid touching her skin, such as by taking the arms off her office chair at work so she can’t rest her head on her hands. Having spots on her back and chest can be especially difficult, as it is extremely painful if she accidentally knocks or catches a spot. Sometimes Deborah also wears clothes with high collars to cover these areas up. Deborah worries about the impression that having spots as an adult can give, for example that her colleagues might perceive her to be less professional because of break-outs. When she was younger, she also felt like people might think she was dirty because of her acne. Deborah says it can be annoying to have to deal with spots when at work or out with friends. She takes a kit out with her that includes different products and make-up removers, so that she can fix her skin whilst away from home. 

Deborah thinks it might be useful for pharmacists and nurses at schools to be able to prescribe acne treatment, rather than for young people to have to go to the doctors for these. Deborah encourages healthcare professionals to take more time in listening to people with acne. Her advice to other people with acne is “to not let it define you,” adding that it’s not the most important part of a person. Deborah says that having acne can feel isolating, but having friends and family who provide emotional support helps. She also finds YouTube tutorials and blogs helpful for make-up tips and advice on acne, and that they can open up dialogue about acne.

Deborah talks about how her acne has changed over time.

Would you be able to say a bit more about those differences between sort of teen acne and then adult acne?

Yeah. Yeah, absolutely. I've always had oily skin, with my acne. But while I was a teenager it was incredibly oily. My skin's sort of normalised more from that now. But I've found as I've become less oily skin, I've got larger pores. Which now is my main problem with acne, because the larger pores are more prone to it, rather than it being the oily skin. So now I'm more focused on getting the right moisturisers, getting - staying hydrated, drinking lots of water, things like that. Whereas when I was a teenager it was all just oil control. Which make-ups can I use, which things can I take to sixth form to wash my face with at lunch, or you know, you can buy those little towel bits of paper that soak up all the oil and things. So I think it definitely has changed quite a bit. I mean, even before, when I first got my breakouts - I can't even remember what my skin was like then. I was 12, you know? I think my skin was just changing so often. I do have quite sensitive skin as well, I've always had that. So that's sort of been an added complexity to all of it, because you can't just throw lots of chemicals at my skin without it reacting badly. So yeah, it's definitely different now than how it was before. 

Deborah’s careful to avoid getting an infection from popped acne spots.

Things like if you do just catch one and it bleeds, you then have to go and sort it out because you don't want it to get more infected and get worse. Which can be quite irritating to have to do if you're, if you're busy, if you're at work, if you're out with friends, if you're doing things like that. And then if you've got one that's popped, or something like that, and then you have to deal with all of those sort of things. And keeping them, them clean while they're open can be really quite challenging, especially if you're then - if you're out, and you're in make-up anyway. Do you then take off the little bit of make-up around that zit? Do you take all of it off? Do you try and reapply over, and hope it doesn't get infected? It can be quite challenging to deal with those. Especially if you're, you weren't expecting it or you weren't prepared for it anyway. You can end up getting quite sort of panicked about it, sometimes. 

I was going to ask you about infections, and your experiences, if you've ever had any skin infections from acne spots?

Nothing that serious, thankfully. There have been a couple that I can tell have got considerably worse for being knocked. And therefore presumably they've got infected a little, but nothing that hasn't healed by itself and by my regime. Some of my friends have had things get quite badly infected, and have needed to go to a doctor's and see things then. 

The main body parts affected by acne have changed for Deborah over time.

When I was younger it tended to be more on my face, across my nose and cheeks and my forehead. Now it tends to be more along my jaw line. I still get them all across the front of my chest, and all the way down my back. The ones on my back tend to be smaller now, which is good. But I don't know, it's still things like when you're washing yourself in the shower and you can feel all of them. Even though I can't necessarily see them as much, you still know they're there. I don't tend to get them anywhere else. So my arms, my legs, the rest of, the rest of my body seems to be okay, but. Yeah it's, it's not pleasant to, to have them everywhere. Especially when you can't get to them, almost. Like the ones on your face you can make sure you're washing and keeping clean, and things like that. But the ones down your back, you can't really help that. Try to wear more natural fabrics and things like that, when I have a breakout, just so they can breathe a bit better. Like I say, I'll wear things that have more of a collar or go higher up, just to cover them up. But that's not, it's not wholly impractical. A little bit when it's summer, because don't want to be covered up, or end with a gazillion tan lines. But it's, it's, it’s been okay.

Deborah sometimes accidentally knocks spots on her jaw and nose.

The soreness definitely is an issue. For example the ones I've got round my jaw line here [points to right jawline] are really quite sore at the moment. So much so that I'll sort of wince if I catch one of them, which I did at work the other day. And you kind of don't want to show that you, you're in pain. Cos then people go, ‘Oh, are you alright?’ And then you have to explain, ‘Oh, I've caught one of my zits.’ And that's embarrassing. So that can be quite difficult. I had one on my nose a couple of days ago that I just caught when I was scratching, and it bled. And I couldn't see that it was bleeding, and someone else had to say, "Oh, did you realise you're bleeding?" And that's quite embarrassing, to have to go and then patch yourself up, and have a scab on your nose for a couple of days. 

Deborah mentioned about acne at the end of her doctor’s appointment, rather than going to talk specifically about it.

It wasn't until I was probably in my twenties that I thought about going to the doctor for it. While I was a teenager, I just sort of considered it was something that was happening to me that I didn't have any control over. Which probably isn't the best mind frame. Maybe if, if more people - maybe if I knew that I could go to the doctor about it, and there were things, medical interventions, that you could have to help, then maybe it wouldn't have bothered me as much because I would have been getting the help earlier.

Could you tell me a bit more about making the decision to go see the GP for the first time?

I don't think it was the main reason for me going to the GP. Are you one of those sort of people that saves up things when you go the GP? I think I'd gone with two or three things. So it was more of a side note, "Oh, while I'm here, my skin's really been painful recently. Is there anything that you can do for that?" So it was a sort of side note at the end, where I hadn't really thought about it, it was just spur of the moment kind of thing.

Deborah put off seeing a doctor about acne because she didn’t want to feel she was ‘sick’ or ‘ill’.

You've said a couple of times about sickness, and sort of the identity as a sick person, you think is something that you don't see yourself, or don't want to be seen as?

No. That is probably one of the things that I have struggled with while seeking help. Because at one side of the spectrum I want to take control, I want to take ownership of it, I want it to be something that I don't let impact my life as much as it could. But at the other end, I don't - I don't like the, a large amount of medical intervention, cos it's not - it's not an illness, it's not a sickness, it's not something that you need to declare on health forms or things like that, so. I do sometimes struggle with that. And again, that's something that I am still working on. But I really don't like the idea of the, the tablets and having to get your prescription filled, and be in line with everyone else that probably is genuinely sick and needs those sort of things. I think maybe that's sometimes why on the odd occasion where I have had a bad experience with a GP, it's maybe what, what they're thinking as well, that it's not - it's definitely not as serious as other things you can go to your GP about, it's not something that's making me sick, making me feel bad physically, sort of thing. So I don't know, it - it would be nice if there was a different channel for it. I mean it's still a medical thing, but it's definitely not an illness. It's, it's a condition but - you know - everyone has a condition, life is a condition, it's a state of being, you know? So I don't, I don't see it as a diagnosis, I guess. And I don't like feeling like it is as a diagnosis. Because it's - it's just a thing, you know? It shouldn't be - it almost makes it feel worse, when you have to go to a doctor about it, because - you know - you see doctors when you're sick, so. I don't, I don't like that connotation. But there's not a lot you can do about that really, it's just something I'll have to make peace with.

Deborah had first taken antibiotics for acne whilst living abroad and found the pills in the UK were much bigger.

So yeah, it wasn't until I'd come back after being in Australia that I knew there were alternatives to the nasty gel or just the over the counter things. I don't think they were able to give me exactly the same thing that I'd been on in Australia, they gave me an alternative. And it was really huge tablets, and I'm not very good with tablets. The ones in Australia were really little. So again, my compliance went down with those, because I didn't enjoy taking them. And so my skin got worse because, you know, if you're on mild antibiotics for things you have to keep your dose up. So yeah, that was why I decided to come off the pills, because I wasn't seeing the benefit, and I was feeling like I was constantly ill because I was always going everywhere taking tablets. And like if I was going to stay with at a friend's I'd put my overnight bag down and it would rattle, so you could obviously tell that I'd got a pot full of tablets in there. And it was just - wasn't overly pleasant. So yeah, that's - that's why I decided to come off the tablets. 

Deborah used the hormonal contraceptive pill to help her acne.

With hormones, is there anything that you've tried before? For example the contraceptive pill? 

Yeah, absolutely. They do, they do get a little better when I'm on the pill. And sometimes I'm just on the pill just because it does mediate my skin a bit better. Rather than I'm needing them for contraception. So I definitely do prefer to be on the pill because it, it helps my skin. Doesn't make it go away entirely, and I still get a monthly fluctuation in my skin. But it's less noticeable. I do try and have a, a couple of months off every, every year or so when I'm on the pill. And I can definitely notice then my skin get considerably worse. I haven't noticed a difference between them, though. Like I've tried quite a few different pills, and I don't, I haven't found one that's miraculously cured everything. So just sort of pick them on the other side of things, rather than acne being my main, main prioritisation. I don't think there's any other medication that's impacted them that much though.

Deborah usually takes a “little kit” with her when she goes out with her friends in case she needs to take her make-up off. She describes one occasion when she forgot her kit.

And I make sure I've got things to, take off make-up if it's bothering me while I'm out. So yeah, I seem to go everywhere with a little kit, almost if my skin decides it doesn't want to be in what it is. I was actually out probably a couple of months ago, and I'd left, I'd left it at home and taken a little bag out. And my skin decided it wasn't happy at all while I was out. And I actually cut the night short and said, "Oh, I want, I want to go home and sort myself out, and then maybe we'll go out afterwards again." Just because I was so uncomfortable. And I was aware that if I just tried to take it off with soap that was in the ladies bathroom there, then that was going to make it so much more worse. And I didn't want to be the girl that was furiously scrubbing her face in the bathroom. I didn't want to be red and blotchy and out, I wanted to be home and I wanted to take it off. And thankfully the friends I was with were completely fine with that. They're well aware of how, how difficult it can be. So they were great. They- we came back, I washed my face, and - I think we did go out again afterwards, I think we went to dinner or something, but. I feel bad that I had to do that. Whereas if I just had some things in my bag, then I would have been fine, I could have sorted myself out and we would have stayed out. But it seems like such a silly thing to have to do, like. You should, you should be able to have your skin not be a problem, like it's there to protect you not - not make things more difficult, so. But that, that's quite a rare event, that doesn't happen that often. But it does happen sometimes.

Deborah felt isolated because friends didn’t understand what it was like to have acne. She thinks getting emotional support from friends, rather than practical advice, is really important.

And there isn't a one size fits all for supporting someone with acne, but. I think it's more recognising the emotional support is needed, rather than the physical support. I guess that's something that some of my friends have fallen into, they've tried to help by suggesting things I can do to make it better. And I get really quite frustrated at that, because I know all the things I can do to make it better. And people will say, "Oh have you tried this, this cream? I found it was really helpful when I had chickenpox." And I'm like, 'that's, that's a nice sentiment but it's not chickenpox, it's - I've tried all the creams that are out there, you can't - there won't be just some offhand general knowledge comment that can help.' But what I need is the emotional support, and I need for people to say, "Oh you're so much more than that, I know this is difficult now but it'll get better." All those sort of more personal support than the practical support is needed. Which sometimes - especially practical people tend to fall into. Perfectly well-meaning, I know they mean to help. But sometimes it's, it's not helpful at all. Cos it just makes you feel more isolated, that they don't understand what you're going through. And fair enough, why should they understand? But until you've been through it, I don't think you can. But you can be supportive through anything. You can make sure that you’re there, make sure you're reminding them that they're there more than that, that they're, that they’re your friends, they're there for you in whatever way. And they want to help, if you show them how to. You can't just expect them to know, know how to off the bat, so. I think that would be my main thing to friends and family, is it's emotional support not the physical support that they need.

Although she thinks it shouldn’t affect her work, Deborah says she’s less likely to interact with others when she has a “bad breakout” of acne.

I think it definitely is more, more the professional side of things that I feel it bothers me socially. And it's a very teenage-associated thing. As an adult with acne, it makes me feel like I should have grown out, out of this by now. And that - I don't know, it just makes you feel slightly less prepared. Slightly less in control, maybe that's what it is. I don't, if I don't even have control over my skin. So I do definitely tend to talk less or interact less when I've got a bad breakout, because I don't want to draw attention to. So I try, I really try not to let it get in the way, but that's because I'm putting the effort in. If I was just left to my own devices it would probably stop me going out and making new business clients, or interacting in a way that would be, be best for me. So yeah, it does bother me quite a lot, even now. Which again makes me feel bad, because I feel like it shouldn't bother me because - you know - it's just skin. But you have to live in your skin every day. So it's still something that I don't know, bothers me because it is there, constantly. There's no, no, no escape from it. And you wouldn't want people to, to judge you for it. So yeah, as well if you're going out on a night out as well, even with your friends, I may swap what side I'm on in a photo, to minimise how much acne you can see, and things like that. So it's not that bad, with my friends. It's more with work that it makes me feel unprofessional for.

Deborah talks about the cost of make-up.

I think there definitely is a financial [laugh] aspect to it, especially when you're going through products or you're having to buy more expensive things. But I think that comes with anything, especially being, being a woman and having make-up all the time, that's quite a big financial aspect as well. So I don't see it being that much of a drain. But I'm lucky enough to be in a position for it not to be. While I was a student I wasn't buying as many of the products because I didn't have the money around for it, but it was - it was less, it was bothering me less if I had acne through university cos you can be more relaxed, and you're not expected to be as, as professional all of the time. So yeah, there definitely is an impact. I found it quite difficult through uni to afford some of them, but it didn't matter as much if I couldn't. Whereas now, it's nice to have them around.

While there is a lot of information about acne for teenage skin, Deborah thinks there is not enough about acne for adult skin.

I think there's a fair smattering of adult acne things out there, but it's definitely less than the teenage acne sort of things that you find. So sometimes they're not appropriate for my skin, sometimes they're things - just repeating things I know. And they're just implying that it's a phase that you'll go through and you'll get rid of it afterwards. Which, you know, this is a really long phase, [laugh] if it is. So I think there needs to be a bit more recognition that there are adults with acne out there. And what, what your GP can do. What your options are. What treatments there are out there. And how best to care for your skin. Cos it's, it's very different to teenage skin. So I think, I think that would be - it's not necessarily a gap, but it's under-represented, I'm sure.

Deborah feels you shouldn’t let acne define you.

I guess if I was talking to myself when I was younger, which is really the only sort of reference point I've got, the key advice would be to not let it define you. That it's a part of you but it's not the most important part. It's not the bit that everyone sees, it's just a small part of you. So you shouldn't let it consume what you think you are. And that there is help out there, go and have a look, go and talk to your doctor, Google it, find other people to talk to about it. You're not on your own with this, but that doesn't mean you have to live with it. Which I think is the trap that I fell into, thinking 'Oh well, it's just something people get, and you just deal with it'. No, there are loads of things out there that you can do to help. I'm still discovering some of them, so they're definitely out there a lot, and I would urge people to find them.

Feeling you are being listened to is important and Deborah says that medical professionals should be aware how even “sighing” can put people off coming for help.

It's sometimes the GPs and the nurses that spend all their time dealing with infections and diseases, and proper - proper medical, medical things that can sometimes make you feel not listened to. Or just some offhand comment. Or even something as simple as just sighing can, can really put you off going and seeking medical help, because you don't feel like you're being listened to. Or that it's not important enough. So just really taking the time to listen. Cos if someone's - it's probably taken them a really long time to get to the GP. So if they've taken the time to get there, make the appointment, then you need to take the time to understand why they're there, and appreciate where they're coming from with it, and that they need help.