Emma

Age at interview: 20

Age at diagnosis: 10

Brief Outline:

Emma was 10 when she first started getting acne on her face and chest. She tried topical creams and antibiotics before taking two courses of Roaccutane (isotretinoin). Her acne and subsequent scarring have made her feel very self-conscious in the past.

Background:

Emma is 20 years old and an undergraduate university student. She is single and lives in shared accommodation. Her ethnic background is White British.

More about me...

Emma first noticed acne on her face and chest when she was 10 years old. She was the only girl in her year at school with acne and this made her feel “a bit isolated”. Emma struggled to understand why she was affected when others her age were not. The move to secondary school and meeting new peers was particularly difficult. Her acne worsened and she visited the GP with her mum when she was aged 13. The GP asked about the emotional impact of acne; however, being asked so directly whether others were bullying or being unkind about her acne made Emma even more worried about this occurring. 

Emma was prescribed some antibiotics by her GP but one initial problem was that she found it difficult to swallow tablets. After also trying various topical treatments and other antibiotics which did not clear her acne, she was referred on to a dermatologist where she was prescribed a six month course of Roaccutane (isotretinoin). Emma found that her acne gradually began to return after the treatment had finished and so she then took a second course. This cleared her skin and gave her a big confidence boost but she still worried about what others might think of her acne scarring. Her dermatologist offered her treatment for the keloid scarring on her chest and this meant having steroid injections. She found that her confidence continued to improve and she felt less self-conscious about wearing clothes which might show the skin as the acne scars became less noticeable. 

Emma began looking online for information whilst she was taking Roaccutane. She wanted to know more about possible side effects as well as improvements for others who had taken the medication. Her dermatologist asked at every appointment in case she had any ‘moderate’ or ‘severe’ side effects from Roaccutane, such as depression; however, Emma only ever experienced those classed as ‘mild’: muscle aches, chapped lips and dry hair. Emma was still required to do compulsory pregnancy tests which she found “quite embarrassing” because she felt that these were not necessary for her at age 14. She also had to remember to take the tablets at the right times and around meals.  

Having a good skincare routine is very important to Emma. She uses one brand of anti-blemish foundation and face wash because she has found that other products can cause breakouts. She is also very careful to ensure that all traces of make-up are removed before bed; this means that Emma prefers to come home, rather than stay over at friends, after nights-out. She does still sometimes get some spots but this is usually about a week before her period is due and is something which she considers normal for young women. 

Emma thinks that it might have been good for her to have met some other people with acne when she was younger, perhaps at a local support group meeting. She also thinks that ‘Personal, Social and Health Education’ (PHSE) classes in schools should address acne, its causes and the impact it can have socially and emotionally for young people.  However, she doubts that she would have felt comfortable talking about acne in either of these settings at the time when her skin was most severe. Emma thinks that looking online to find out about other peoples’ experiences of having and recovering from acne can be helpful, although this is not something she did herself at the time.

Emma talks about having acne from age 11 onwards.

I suppose I sort of my first experiences, with acne started when I was quite young, when just started secondary school, so since I was about 11. I had sort of some mild acne and spots that were appearing and I suddenly noticed I was sort of the only person with this, the only girl in my year. and so it was quite sort of noticeable. It sort of went on being the only being the only person with it. And until I was about 14 or 15 and it got a lot worse. And I went to I had an older brother with the same condition and we went, my mum took me to the GP and then I was referred to a dermatologist Where I was eventually prescribed with Roaccutane (isotretinoin). 

Yeah. I think at the time I felt a bit isolated because of it. I wasn’t sure why I was getting it and no-one else was. And sort of at age 11, like children can be a bit sort of mean about it. And yeah so it made me quite shy, going to a new school and having that. So, yeah.

‘Cos that would have been the transition from primary to secondary?

Secondary, yeah, yeah.

Emma chose her clothes carefully to cover spots on her chest.

Sort of being quite conscious of having sort of spots, particularly on my chest, meant I didn't go swimming for a very long time, because it was on display sort of then and it sort of affected anything from sort of the clothes that I bought and things like that. So it was more me being self-conscious about it and not wanting to show it that had an impact on the things that I did.

Could you say a bit more about the clothes that you bought and how it had an impact?

Yeah, so because my scarring is in this sort of area [points to chest] I’ve got a high neck thing on now, but I didn't buy any clothes that could possibly show it for quite a long time. Because I didn't want anybody to see the sort of the scarring and the scabs and things. which was always a bit of a shame, because when I’d go shopping with my friends and it would be like, ‘arr this is really nice’ and I’d be like well, I’d sort of pretended I didn't like it so much, because I didn't want it to show. Yeah and that sort of, that didn't change until I was about sort of 16 and my mum went and did some shopping and she bought me some tops which I really liked and I wanted to wear despite them showing it, so. 

Do you remember what it was like when you did do that, when you started wearing tops which maybe showed a little bit more of the skin?

I guess the very first time that I ever wore one that my mum had bought me that showed it, I was a little bit self-conscious. But sort of, I think after I realised that no-one was sort of saying anything or looking then I started to sort of mind less having it on show. 

Emma prefers to remove her make-up before going to sleep, which can impact on her social life and hobbies.

Because I like to try and get any products that I have on my skin off in the evening. if I am going out now or staying over with friends now - that can be a bit of a pain, because if I can’t take it off, I feel quite like, ‘oh no, I am going to end up with really bad skin tomorrow’. So I do always try and come back and take it off, but. I ‘spose that’s a bit annoying. And also when I go on things like the Duke of Edinburgh Award and my assessor was like, “Why do you have all these products in your bag?” I was like, “Well, I don’t want my skin to be really bad after four days” [laughs] of hiking. So he thought that was a bit strange but I wanted to take them with me [laughs].

So he didn't quite understand that it was quite important for you?

Yeah, I don’t think he understood quite how important I thought it was to make sure that I had the right products and how much I cared about yeah making sure that my skin was okay. 

Being asked by her GP whether acne made her feel upset made Emma feel more self-conscious.

I think you said it was your GP that did ask how it was affecting you and like the more emotional side of it?

Yeah. They did, I remember my first, I think one of the first GP appointments I went to they sort of said, you know, ‘are people sort of talking, saying stuff about you?’ And I’d never actually really thought about what other people were saying to that extent and how that was affecting me. I hadn’t really thought about it until that point. So, in some ways, that was quite a changing moment and I, it sort of made me worry a little bit more about what people were saying. but, yeah, it was, I suppose [clears throat] I suppose at that age it’s sort of, I ‘spose it is a concern how it affects like socialising and especially when I’d just started a new school and things so. 

Emma learnt to take tablets when she started on antibiotics for acne.

And with those treatments, what were they sort of like to take?

They were fine to take. I have to say, the antibiotics were a bit difficult because I couldn't swallow tablets at that point [laughs] so I had to learn to swallow tablets. But they were fine to take. Timing, like you have to take them at like specific times of the day and that was always a bit of a pain [laughs]. But yeah I never found them too difficult to take and never had any sort of negative side effects. So it was okay. 

With the difficulty of swallowing tablets, was that something that you’d had as a child as well and then it continued?

Yeah it had, I hadn’t had any paracetamol or anything. My parents had to try and persuade me to take them [laughs]. I was just was really bad, [laughs] I was afraid I was going to choke on them or something. It was a bit silly [laughs]. 

Did it take you a little while to get into the habit of it when you were doing the antibiotics with acne?

It did take a while to get into the habit of taking them at the right times. But since I was taking them then for a couple of years, I soon got into the [laughs] soon got into the habit.

Emma had scarring on her chest and worried about wearing low cut tops for some time.

I think one of the main sort of things that I really worried when I had the condition, I also got acne on my chest and I got a run of scarring. So I had eventually I had treatment for that. I had steroid injections because I had keloid scarring and I think once I’d had that and they’d flattened out a lot, I felt a lot more confident then and so things started to improve at that point. So I think that’s the big sort of, for me [laughs].

Yeah, so because my scarring is in this sort of area [points to chest] I’ve got a high neck thing on now, but I didn't buy any clothes that could possibly show it for quite a long time. Because I didn't want anybody to see the sort of the scarring and the scabs and things. which was always a bit of a shame, because when I’d go shopping with my friends and it would be like, ‘arr this is really nice’ and I’d be like well, I’d sort of pretended I didn't like it so much, because I didn't want it to show. Yeah and that sort of, that didn't change until I was about sort of 16 and my mum went and did some shopping and she bought me some tops which I really liked and I wanted to wear despite them showing it, so. 

Emma was “quite shy” and talks about avoiding certain clothes that would reveal acne scars on her body.

So in terms of going out when I had acne, again it sort of affected what I could wear and how comfortable I felt in situations particularly when there was people that I didn't know and so they didn't, they hadn’t seen that I had acne before and so that might be something that they would notice about me and sort of associate me with, whereas my friends sort of knew me as a person. So, I was quite shy, it always made me quite shy at social events.

Yeah, so because my scarring is in this sort of area [points to chest] I’ve got a high neck thing on now, but I didn't buy any clothes that could possibly show it for quite a long time. Because I didn't want anybody to see the sort of the scarring and the scabs and things. which was always a bit of a shame, because when I’d go shopping with my friends and it would be like, ‘arr this is really nice’ and I’d be like well, I’d sort of pretended I didn't like it so much, because I didn't want it to show. Yeah and that sort of, that didn't change until I was about sort of 16 and my mum went and did some shopping and she bought me some tops which I really liked and I wanted to wear despite them showing it, so. 

Emma is a lot more confident about meeting people since her skin cleared up after a second round of isotretinoin (Roaccutane). She is in a relationship now and says she still feel self-conscious about her skin.

Could I ask about relationships and potential relationships and any impact it’s had on those?

Yeah. I guess because of the self-confidence issue, until I was sort of 16, I just assumed that sort of people like weren’t interested and in sort of liking me. And quite, I always think quite interestingly it was after my second course of Roaccutane (isotretinoin) when my skin sort of cleared up a lot, I don’t know if it had more to do with me being more self-confident and noticing but, like, guys seemed to be more interested then [laughs]. Shallow [laughs]. 

[Laughs]

But, yeah, I guess sometimes now I am still a bit self-conscious around sort of people, even like people I’m in a relationship with – I feel like, ‘Oh no, my skin looks really bad today. Like, what are they going to think?’ So it does still affect me a little bit. But, yeah, I guess I wouldn't want to be with someone who is that shallow.

If my boyfriend is staying over and I’ve got to like take my make-up off, I’m like, ‘ahhh, it’s going to look, I’ve got bad skin today and I’m a bit concerned about it’. Actually when I first met my boyfriend, I’d just keep make-up on like all the time when I was around him which is a bit stupid really, in retrospect and he said it was really daft of me. ‘Cos, see I was like, ‘I really want to take this off, because I am going to make my skin worse but I don’t want to take it off because my skin will look bad’. So, yeah, it is, I suppose still an issue [laughs].

Because young children often think acne is related to poor hygiene, Emma suggests that information about the causes of acne should be part of the PSHE classes.

Yeah, I guess, I suppose even before I had acne, even I thought it was fully caused by what people ate or what people put on their skin or not washing enough. And I think that’s probably the preconception that a lot of younger children have about acne whereas actually it’s, you know, a condition that you can eat really well and you can wash your skin really well but you will still get it. So that’s quite difficult because I was always worried that people wouldn't understand the causes. I think it would be good, I always thought it would be good if like during sort of PSHE classes and something, it was an issue talked about more, because they talk about a lot of other things that teenagers go through. But I think that’s quite an important one that they don’t really say much about, so.

What do you think would be helpful for a PSHE teacher to cover in relation to acne?

I suppose like the causes of it, sort of the, maybe the sort of impact that it has sort of socially on people and ‘cos people before they have acne or if they don’t have acne they can say quite mean things and not mean to. Yeah, I remember actually, I was on holiday somewhere and someone mistook it for chicken pox and it was only a very tiny child. But that made me quite self-conscious. 

Emma did “browse” online support groups and thinks it would have been good to have had people to talk to in person.

I suppose it was more just browsing. I was sort of looking at, particularly when I was looking at online support groups in the time that I was taking Roaccutane (isotretinoin) to try and understand sort of the process of how long it took to make improvements and how to spot side-effects and things like that. And also with the scarring to try and find out what other people were sort of suffering the same sort of things. And, you know, how they felt about sort of having it on show and the interactions they’d have with other people. 

And did you ever sort of post anything about yourself or was it mostly sort of reading the comments?

I think mainly it was just reading the comments. I don’t think I was ever really sure about posting about myself. Yeah, it would probably be something like, with this now, that I would do, looking back on it but at the time, I didn't really feel like it. I didn’t feel.

Was there anything that you felt was missing or lacking or could have been better in some way?

I don’t know really. I’m not sure about the online websites because I can’t entirely remember. I guess in terms of the treatment that the dermatologist and the GP perhaps they could have maybe suggested some more sort of support sites or groups. I don’t know if they, like support groups, particularly exist but I remember sitting in like waiting rooms and for a lot of other skin conditions, they were like, you know, ‘you can talk to these people and that sort of person’ and there wasn’t really that for acne. So, yeah.

If that had of been available, what sort of kind of things do you think it might have been beneficial for you?

I think just for maybe just more about confidence and speaking to other people about their sort of social experiences. Because I was always worried what people might think about me and, you know, if someone else had sort of had the conversation with those people and, you know, then I might have felt more sort of that people actually didn't notice or they accepted it more.

One of Emma’s neighbours who was a beautician gave her advice about what products would help her skin and which ones to avoid, and gave her a skin care routine which she still uses.

Yeah, well I was quite fortunate that a neighbour of mine was a beautician and so she knew quite a bit about what products were quite good to use on my skin and what would possibly cause breakouts and she was very nice to me. Like when I was about 17, she sort of like, we had a day and she sort of gave me the skin care routine I use now and she sort of recommended those products. I use the same brand for some anti-blemish like foundation if I put make-up on. and also very careful to get it all off in the evenings and things. It makes the make-up quite expensive [laughs] but it’d definitely be worth it. 

Emma suggests if you are feeling self-conscious to look at forums and talk to people who’ve had it and “come out the other side”.

I suppose if you’re worried about what other people think well, it’s easy to say in retrospect not to so much but, looking at sort of online forums about other people’s experiences, it was always nice to be able to see that it did get better. I didn't believe it for a long time and when I had acne I thought ‘arr, I’m going to have this forever’. But, obviously it’s got a lot better and I’m a lot happier now so it does go away. And so, being able to see that online and if I’d of been able to speak to people that have gone through it and sort of come out the other side, that would have been good. Sort of encouraging people to get in touch with people who suffered from it.

Being given different options was important to Emma.

I guess looking back to what you said earlier about how much input and sort of decisions I got to make about my treatment. I think that’s a good thing like being, like them suggesting to me, “These are two topical treatments and which one do you think you would sort of prefer?” I think that was quite a sort of important thing to like make me feel like I had some control over like improving, in trying to make, you know, sort of improve the condition of my skin rather than just being sort of given sort of different things and feeling like ‘arr, it’s not working. You know, I want what I wanted’ so I think that was important. Yeah, particularly. But also being understanding, like having the treatment after, being treated for the acne then having the scar treatment. The fact that my dermatologist recognised that it was something that was bothering me. I think that was really good because I really did want something done and I didn't feel I could necessarily ask for it. But she sort of said, you know, “These treatments are available and other people have had them after the acne. Is that something you’d like?” That was really important.