Nina

Age at interview: 20

Age at diagnosis: 12

Brief Outline:

(Text only clips) Nina developed acne when she was 12. She has tried different treatments, finding antibiotics which she initially tried when 13 to be more helpful at age 16. Nina would like to see more advice for young people on how to not let acne affect confidence.

Background:

Nina is 20 years old and a university student.

More about me...

Nina was first diagnosed with acne when she was 12. At first she felt like her spots were a normal part of being a teenager. However, as she got older, she felt like most of her peers’ spots had cleared up whilst hers hadn’t. She feels that other people often expect a person with acne to be able to cure their skin condition and she finds this frustrating. Nina experiences some difficulties with her mood and self-esteem. Nina also has a diagnosis of OCD which can interact with her acne; for example, she can feel very unsettled if she doesn’t follow her daily skincare routine.

Nina saw her GP for various different treatments but they didn’t seem to make much of a difference. When she was age 14, she was offered the contraceptive pill but declined it as she felt embarrassed by what people at her school might think. She was also offered some antibiotics but she was worried about taking them as one of the side effects included low mood. As she got older, Nina was referred to a dermatologist and her skin improved at 16 when she began a new antibiotic. 

Nina went to an all-girls secondary school where she felt there was a lot of emphasis on appearance. It seemed that the better you looked, the higher up you were in the social hierarchy. Although Nina had friends at school, she thinks she may have had more if she had not had acne. Nina has recently started at university and although her skin is much better now than when she was younger, she still worries about how people will perceive her when they first meet. She spends quite a bit of time on her appearance before she goes out. She feels comfortable playing sports though as she says people tend to not look their best whilst exercising and so she worries less about her skin. 

Nina would like to see more advice for young people on how to not let having acne affect confidence. She also thinks that it would be helpful to give school students more information about skincare, bearing in mind that many young people cannot afford expensive products. She would like for doctors to take acne seriously and to help young people express their concerns about how they feel, rather than “brushing them aside”. This includes the impact of acne on self-esteem and mental health.

Nina has had spots and ingrown hairs in places where she shaved, such as her armpits and bikini line, in addition to her face and back.

When I stopped taking my antibiotics last year I also developed this weird kind of like oh I forget what it’s called it’s the type where you get like nodule type really horrible really big painful kind of infections in areas that I shave so like armpits and bikini area which is really horrible because it’s painful and also like makes you incredibly self-conscious even more so perhaps than my face. And I also since I had my ears pierced on my earlobes I tend to get sometimes my, the actual earholes get infected or just like around on my earlobes, yeah. That’s pretty much, I mean frankly at least it’s like yeah, and the other thing is that from my back because I did a lot of sport that’s something that really bothers me is that the scars on my back from having had spots there in the summer and my face thankfully, you know, cos the like really big ones I tend to get them either on my neck or in areas that I shave and those do scar a bit. 

Nina felt uncomfortable taking antibiotics for such a long time and worried about resistance.

I think I probably started taking antibiotics when I was about 12 and after about, because I knew they took a while to work, after maybe about two years on one I ended up swapping to another one and then about two years later swapped to another one and took that one for two or three years. But that also made me feel kind of rubbish because I was becoming more aware of the fact that taking antibiotics you almost feel like you don’t really need them when it’s your skin and like you kind of want to save it for when you really need it because I mean obviously that’s [antibiotic-resistant infections] a growing problem and actually like whenever I went to the GP or anyone that had a list of the medication I was on, it’s the first thing they would comment on like ‘Do you really need that like your skin looks alright’ but was my skin looking, you know, I mean like alright, alright or a bit worse than it is now you know, was it okay because I was taking medication, I don’t know. But and I guess it’s their responsibility to do that you know but that also kind of, makes it’s feel less satisfactory. 

Nina hasn’t tried isotretinoin because of links with depression.

But I think it was probably about that time that a lot of, you know, there was that study that came out that was associating it with an increased risk of suicidality in young people and because my mum at the time was aware that I’ve got quite a strong family history of mental health problems she did not want me taking it and it’s just as well because like shortly after that I like sort of realised myself and ended up getting also treatment for mental health problems including depression which it turns I’d probably been depressed for a while and I would say that like obviously it’s ‘referring to skin, not saying depression is a small factor!’ a small factor, that people get depressed, you know, for all sorts or reasons and on their own but like I definitely think that my skin didn’t help and I think that’s probably true for a lot of my friends that had, you know, problems with their mood because you feel really bad about how you look. and, so I mean it’s probably, you know, just as well, and so after that trying to, after, you know, you get diagnosed with that it’s pretty difficult to get anyone to prescribe Roaccutane and also the pill again because, you know, mood tends to fluctuate with the pill. yeah so I guess both of those I was offered by multiple people but, you know, I, you know the pill when I was too young to be like ‘What, no I’d be really embarrassed none of my friends are taking this’ and Roaccutane I guess yeah my mum didn’t want me doing that and I can understand, I was annoyed at the time and then I understood, you know, shortly afterwards it was just as well.

For Nina, physical appearance and image can have a big effect on mood. She was diagnosed with depression at 18 and thinks her acne contributed to this.

If you have trouble with your mood small things tend to have a much larger impact on how you’re feeling and if its’s like the face that you literally face the world with that’s actually significant but I think acne tends to be brushed away [‘in general and in terms of its impact on the acne patient’s self-esteem and mental health’] as something that is maybe, you know, they worry more if its’s like scarring types of acne but they tend to brush it off as like its’s not a particularly threatening to your health and wellbeing or it’s not threatening to your physical health very much well, you know. And, you know, it doesn’t, it doesn’t tend to be seen as a very serious problem but you know, I’d be interested to see, I think it will be interesting to see sort of like, you know, among people that do struggle with, you know, not necessarily like clinical levels of mental health problems or, but particularly those that concern your self-image which is quite a number of them actually I’d, you know, I’d hazard a guess that those people are people that have things that probably affected their appearance in one way or another including acne, other skin conditions things like that. you know, cos I know, you know, it’s very well documented about how obesity can contribute to depression.

…people get depressed, you know, for all sorts or reasons and on their own but like I definitely think that my skin didn’t help and I think that’s probably true for a lot of my friends that had, you know, problems with their mood because you feel really bad about how you look. 

Nina’s mother was the first one to draw Nina’s attention to her acne. Her mother was aware of how having acne was affecting Nina even before she herself was.

I think there’s a lot of pressure on appearance in my family there’s a lot of pressure for general perfection which means often I wouldn’t really, you know, I might, you know, mention how I wasn’t feeling great about my skin particularly when it was like everyone was going to a party I’d like, you know, when I was like younger I’d tell my mum that I was feeling bad. But she was actually the one I think, I know she didn’t mean it she was always trying to look out for me- at first made me aware that my skin was really bad because she, it was obvious to me that she was concerned about it and she was trying to take me to doctors to get resolved but I guess also that was because she could see the effect that it was having on me and like my you know just at school and, you know, social life and stuff like that and I think, so I guess she was probably even more aware than me how it was affecting me.

In Nina’s school, they learnt about the causes of acne and she thinks this helped a lot. She was never bullied at school.

Yeah, I mean I think we had to learn about it in PSHE or like or watch a video in science [lessons] or something, and, like, you know, I guess I think we were basically told ‘Oh it’s a little bit diet, a little bit like, you know, factors that you can’t really control such as how oily your skin naturally is’ and yeah I think that was really frustrating as well for me because if it’s something you could control, you know, it’s like an environmental factor yeah of the, that would have been great, you know, if it was just like ‘Oh, wash your skin more often’ or something. but at least I think it was very much reinforced that it wasn’t because you were an unhygienic person so at least I was never like bullied about that or anything, so that was good yeah. And I guess that was PHSE or science [lessons] to thank for that, I don’t know I can’t remember which we learnt about it in.

Nina thinks it’s good to talk about how acne makes you feel, but you shouldn’t “overestimate” its importance for how others see you.

Feeling, like to have voiced your feelings about stuff feelings, like, talk about specifically like oh, you know, being able to like go up to your mum and be like ‘I’m feeling really rubbish cos my skin makes me feel horrible and it means that I don’t socialise as much do you have any advice like can you help me and stuff.’ 

I think I overestimated the stigma attached to it so and I also underestimated the significance of it and yeah its’s like important to talk about A) if you’re like I’m really not happy with the fact that I’m not happy with how my skin still is I’d like to have more medical help with it and B) it’s making me feel rubbish how do I like resolve that. because it’s an issue partly that you feel like its’s trivialised and partly that, you know, feel a bit ashamed about and like yeah partly that you feel like everybody you already knows you have acne cos it’s everyone that sees you can see it which is actually not true a lot of people don’t notice it anywhere near as much as you do.

Nina suggests doctors read between the lines and listen carefully to how acne is affecting the person who has come to see them.

And it really is like you know, I think because like people at that age they don’t have like mortgages or things like that, you know, what job do I have to worry about so how they look is really important and yeah just recognising you know paying a bit more attention to what the young person is saying if they say ‘Oh it bothers me a bit’ realising that maybe a lot of the time that means it bothers me a lot but I don’t want to say that so taking the time to listen yeah I think and take it more seriously, not as in I don’t think people do an inadequate job but if, if like I mean I think they are all great professionals, you know, I don-it’s not like I’m saying they don’t do a good job treating people for acne but if they, I think the one thing that would be missing would be like the voice of a young person telling them actually it really is a huge issue for some people and you know, also those people tend to probably play it down and like, you know, please listen to them you know cos you never know maybe they might go on to be like really, really depressed or something like that or they might not or they might go on to have like scars on their face or they might not, like who knows but like you don’t know do you so like you know, that’s why yeah it’s important to just try and see things from their point of view and you know maybe going and find out, talk to some more young people about how they’ve experienced it because like that’s what we’re all. Yeah cos again like they don’t have much time with you do they just thinking about young people’s experiences thinking back to when they were young and stuff like yeah so I think just having a little voice in the back of your head of a young person being like yeah.