Most of the people we spoke to talked about the emotional side of having acne. People often worried about how others would react to seeing their acne (spots and scarring) and some were concerned about treatments.
People tended to have good and bad days with their acne – Sarah felt things were fine most of the time but “every so often there are days where I feel a bit blue about it”. Some described how their first thought in the morning was to look in the mirror to see how bad their acne was that day. Feelings about acne changed over time for most people. Even though it could get them down, many felt strongly that it wasn’t something to be embarrassed about or take over their life.
Common emotions about having acne included feeling:
• embarrassed, awkward and self-conscious or having low self-esteem
• frustrated and annoyed
• scared
• nervous
• sad
• stressed and irritated
• confused
Chris describes how having acne wore him down.
Chris describes how having acne wore him down.
Age at interview: 20
Sex: Male
Age at diagnosis: 17
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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.
Age and having acne
People often saw acne as a “quite normal” part of teenage life and, for some, having other friends and siblings with acne made it easier to live with. At the same time, the idea that acne is ‘just part of being a teenager’ stopped some people from getting medical help sooner and could leave them feeling unsupported.
Those who had had acne in their pre-teens often found it a very negative emotional experience, especially when their peers didn’t have any spots at all. It made them feel isolated, lonely and jealous of other people with “perfect” skin.
It was frustrating for Naomi when people trivialised her acne as ‘just some spots”. She had acne from the age of 9.
It was frustrating for Naomi when people trivialised her acne as ‘just some spots”. She had acne from the age of 9.
Age at interview: 22
Sex: Female
Age at diagnosis: 9
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What about the transition from primary school to secondary school for you?
I think, yeah, in some ways like it was more accepted there because like yeah it was more common and you’re at an age where yeah like people just think that that’s quite normal. But in some ways I found that quite frustrating because people would, if anyone ever talked about it they’d be like, “Oh, you know, you’ve just got some spots – like big deal.” whereas for me it, it was like a massive deal and like I just felt like no-one ever understood because you know, I’d had it so long already and it had such a huge impact on me and yeah I just felt like people were dismissive and wouldn't take me seriously and yeah I think that was quite upsetting as well. and I remember like when I, because obviously I was taking this like medication and stuff and, you know, so like my friends knew and you know, I think they just sort of thought, you know, “Why are you making such a big deal of it? Like it’s a phase, like it will go.”
I mean for me like I look at pictures of me then and I just think ‘that looks disgusting’ and I think that, that was part of the problem as well because I thought I looked disgusting so I thought everyone else must have thought that as well. And like I definitely told my, one of my closest friends that one time and she was just like, “Well you know nobody thinks that.” But it didn’t matter that nobody thought that, it was the fact that I felt like that. And like, you know, I see people with bad skin sometimes now and I just feel really sorry for them because I know what that’s like but maybe it doesn’t even affect them as much, maybe they don’t even care but like if for me it was just like a really big deal.
Yi felt depressed and hopeless.
Yi felt depressed and hopeless.
Age at interview: 23
Sex: Female
Age at diagnosis: 14
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I think I’ve become like depressed about myself, is some effect with the acne. And sometimes I just feel hopeless about my face at that time, as I try. So I was like avoid seeing people and like I can only see my fr-, like close friends and family at times.
Oh, I was like inconsolable and so that’s the emotional side, I think.
Yeah. So does that mean that you missed out on seeing people and doing things with them, like days out or evenings out?
Yeah, I mean I had no evenings out at the time and at the time I used to like watch a film like all by myself or like doing something all by myself, like anything [laughs]. I don’t know it’s the best thing or a good thing.
So was that for quite a big period of your life, that it was like that or was it some days, just occasionally?
It’s like for week-, oh for months.
Having acne could knock confidence and self-esteem at a time when the person was going through the physical and emotional changes associated with adolescence. Harriet was “quite shy” and found having acne drew unwanted attention to her. She explained that “when you’re a teenager, you already feel like everyone’s looking at you anyway. And then when you’ve actually got a definitive reason why they might be looking at you, it just makes it so much worse”.
Rachael explains that having acne fundamentally affected how she saw herself and made her less confident.
Rachael explains that having acne fundamentally affected how she saw herself and made her less confident.
Age at interview: 18
Sex: Female
Age at diagnosis: 16
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I think, for quite a long time it sort of defines you and it affects your day to day life. And I think it does affect your identity and how you see yourself because you sort of see yourself through that, as opposed to seeing like who you are. It just gets in the way of that. And for a while, like yeah it does, it makes you feel like less confident and like you do need to like wear make-up to look good, so yeh.
I think some people are just naturally more confident and less bothered about the way they look but, some people aren't so, I think that just plays a role but, I think I try to be quite positive about it but sometimes it was frustrating cos I just, I didn’t want it, I just… it annoyed me, like I just didn’t really understand why I had to have it so, that was quite annoying.
Having acne beyond teenage years and into your 20s could be frustrating, especially when people were often told that their acne would ‘go away’ before then. Marga didn’t have many spots until the end of sixth form/start of university – she felt “frustrated” because “I thought I had passed that [point]”. Some people said they didn’t mind having acne as a teenager and Deborah hoped she would “get it out of the way”, but their feelings about this changed as they got older and their acne continued.
Some felt that it was easier to talk about acne when they were older as they felt less self-conscious. Initially, Harriet had been very worried about others seeing her scarring but was told that eventually she wouldn’t notice it and she has now stopped thinking about it. Devan became more confident about finding a solution to his acne when he left secondary school. Getting older and socialising with other adults could make a big difference.
Now Ish is in his 20’s, he finds it easier to talk about his acne than when he first got it at the age of 12.
Now Ish is in his 20’s, he finds it easier to talk about his acne than when he first got it at the age of 12.
Age at interview: 22
Sex: Male
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I mean to be honest, especially during that age I don’t think anyone’s going to talk to it, talk about it. That’s why it’s so important, as I said like, finding the right doctors who make you feel welcome and open about this subject ’cos you’re not really going to start talking to your friends about these kinds of things during that age. It just makes you feel awkward a little bit and you’re embarrassed about it. I mean later on like, I know it’s a cliché but when you grow up a little bit more you have more experience, you will know that your friends went through it and it’s a little bit easier to talk about it. And it’s like, “Yeah, I used this and I used that and it worked perfectly, you know.” It’s more of an open subject. But when you’re twelve, thirteen, fourteen, it’s like you’re not going to talk about it. You have enough stress on you as it is fitting into a social group at school and everything. You don’t want to be known as the person, “Oh, yeah that’s the kid with the worst acne in the school, you know and he evens talks about it.” So you don’t, you try to avoid that [laughs].
Reflecting back on a summer job, Naomi compares her school environment to her work environment. She thinks teenagers put more emphasis on appearance, whereas adults are more “accepting”.
Reflecting back on a summer job, Naomi compares her school environment to her work environment. She thinks teenagers put more emphasis on appearance, whereas adults are more “accepting”.
Age at interview: 22
Sex: Female
Age at diagnosis: 9
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I worked over the summer between like my years at university for my mum’s architectural practice, I was just like doing some sort of admin and that kind of thing but I felt like, and my skin was never that bad during that time but. Yeah, I mean, well it was last summer because that was when I’d just had the implant put in so that was kind of stressful but in some ways that wasn’t as bad really because they were, well my sort of colleagues but I think that’s less damaging to your self-confidence than your peer group.
I think the worst thing was at school and yeah the work environment was kind of not as bad for me because it didn't really matter what I looked like, that didn’t, well it mattered to me but like I felt like they weren’t really gonna judge me for that because they were older and like I was doing them a favour by going in and doing this work for them. Whereas with your peer group I think it’s just much more traumatic and you feel like it matters a lot more what you look like. and also I think just being around like teenagers who care about that kind of thing was more stressful whereas I feel with adults they’re more accepting and less judgemental. so yeah, yeah I think that’s not as bad.
Acne on different areas of skin
People talked about different parts of the body affected by acne. Having acne on the face and neck tended to make people feel more self-conscious. This could mean using make-up to cover up spots and scars, avoiding photographs being taken of them and, when it was at its worst, missing social events like seeing friends. Acne on the chest and back was usually less visible than facial acne, but could make some people anxious. This included feeling self-conscious when changing for P.E. lessons (especially swimming) or showing more of their skin in the summer. A few people mentioned that they thought it was less socially acceptable to have acne on the body than on the face, but others were less worried about acne on their bodies. Naomi saw acne on other parts of the body as “just a kind of subsidiary to the face thing, like I wasn’t really that bothered”.
Devan had acne on his back and describes how it would bleed and he would have to find ways to clean his bed sheets and t-shirt.
Devan had acne on his back and describes how it would bleed and he would have to find ways to clean his bed sheets and t-shirt.
Age at interview: 18
Sex: Male
Age at diagnosis: 13
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When I sort of started with acne – a lot of them would pop so I’d have, say, tee-shirts that were covered in blood from them. But other than, I don’t really get that much now.
I did obviously have a point where say my bedding, I’d find spots of blood all over that, or they’d be bleached because of the creams but, like I say, now more or less, it’s more or less clear.
Yeah. Yeah. What, what, what was the sort of impact of if there was blood on clothing or, or bedding?
A lot of it, it depended on how it was, was washed. The, I mean, the bleached clothing I just had to get rid of it because it wouldn’t’ come out. But the blood did just seem to wash out, did the blood.
Is it something that bothered you at all, if you did see the blood?
Yeah, purely because sometime, say if it happened the morning, and I wasn’t at home, I was at school, some people might have noticed it. Thankfully I had a black jumper so I’d just wear that all day. And, so if I’d had known people would sort of spot, say, “Oh, you’ve got blood on you back”. So it was that sort of thing, people would notice that.
People didn’t see my other, you know, my back, they didn’t see my back Or they’d only see that if it was during P.E. and you’d have to get changed so they’d only see it then. But I’d sort of found different ways to come around that, to stop people from noticing by, say, wearing my P.E., P.E. clothes underneath my school uniform and different things like that. To just sort of save that hassle …
Yeah.
… of having to deal with people like that.
Scarring
It wasn’t just the acne itself but sometimes the scarring that it left behind on their face or body that can be difficult. People could feel very self-conscious about scarring even if others didn’t notice it, although scars could fade over time. It could get easier to cope with scars as time went on. Abbie said she doesn’t mind her scars now and sees them as a kind of proof that she “succeeded in my acne fight”.
Emma had scarring on her chest and worried about wearing low cut tops for some time.
Emma had scarring on her chest and worried about wearing low cut tops for some time.
Age at interview: 20
Sex: Female
Age at diagnosis: 10
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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.
Gender
A few people talked about how they thought their gender made it more or less difficult to deal with acne. Many of the young women talked about pressure to meet media stereotypes of flawless skin and to wear make-up, and some wouldn’t go out without make-up on. Most people felt that there was more peer pressure for women to hide their acne and any scarring than for men, which made female acne seem more ‘unusual’. At the same time as feeling pressure to cover up spots with make-up, some young women talked about other people’s beliefs that this was a cause of acne.
Fatima thinks acne affects her brother more than it affects her because he is more fashion conscious. Marga thinks boys and young men are at a disadvantage because it seems less socially acceptable for them to cover up their acne with make-up (which for her is a “safety net”).
Eli thinks there’s peer pressure for girls to wear make-up in the UK, which she says wasn’t the case in her home country of Greece.
Eli thinks there’s peer pressure for girls to wear make-up in the UK, which she says wasn’t the case in her home country of Greece.
Age at interview: 13
Sex: Female
Age at diagnosis: 11
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Yeah, in Greece lots of-, well some of the girls have spots, in the girls I used to hang out with so, but like they didn’t really find it weird and none of them wore make-up so it was just like, like everyone-, like no-one would wear make-up so it was alright with me. When I came to England it all changed.
It was weird cos the first day I didn’t wear make-up because I didn’t know how it was. But I saw everyone was wearing it and they were looking at me weirdly and stuff. So I started putting make-up on after a week or so.
Yeah, well cos most of the boys in my school don’t really have acne and most of the girls don’t really-, well some of them do. The people, they just don’t really like it so I just feel awkward when I’m around boys cos I can’t really talk to them cos I just feel awkward.
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.
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.
Age at interview: 20
Sex: Male
Age at diagnosis: 17
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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?
Kosta says he doesn’t “feel insecure” about acne, but knows others do. He thinks his age and gender make a difference to this.
Kosta says he doesn’t “feel insecure” about acne, but knows others do. He thinks his age and gender make a difference to this.
Age at interview: 14
Sex: Male
Age at diagnosis: 13
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Could I ask a bit more about confidence and your experiences with that?
Well, in my opinion you should just accept that you have spots. You can’t change it, you’ll just have to wait, be patient until they leave but certain people seem to make big deals out of it. They can either-, it can actually lead people to being depressed having spots, having to cover, cover them up, but that’s not my case I suppose.
Why do you think that might be, that you’re a bit more sort of okay about it?
Well, in my case I think as-, in my age group and generally boys I wouldn’t say I care that much about my image. It doesn’t bother me I wouldn’t mind if someone commented on me having spots but I suppose for other people it must be quite harmful and it must bother them quite a lot.
Emotions associated with seeking treatment
Talking to a GP or dermatologist could be emotionally positive (“taking back control”, “hopeful whatever they’d give me would sort it out”) or emotionally negative (“embarrassing” “awkward”, “it’s annoying admitting that you’ve like got an actual condition or a problem”). Several people spoke about feeling worried that it was too trivial a condition to see a doctor about. But for most, the doctor’s response was to take it seriously. Some people believed diet, bacteria and stress had an effect on their acne – because of this, a few felt that having acne was partly their fault. Others disagreed and were hurt that some people might see their acne as a sign of poor diet or lack of personal hygiene. You can read more about causes and triggers here.
Everyone we spoke to talked about trying many different remedies and this could be an emotional process (a “rollercoaster of emotions”). People could feel “frustrated”, “annoyed” or even “quite hopeless” when creams or medication didn’t work or made things worse. Marga found a cream that works well but feels concerned about stopping the cream because every time she does the acne comes back.
Using creams, taking oral medication, and trying alternative or home remedies could be stressful. Unwanted advice from family, friends and even strangers could be tiring. Some people worried about side effects. Some treatments can have side effects on mood too, such as isotretinoin and hormonal contraceptives.
But there could be positive emotions associated with finding something that worked, and people spoke about feeling more confident about themselves.
Mental health in the context of acne
A few people described having acne in the context of a diagnosis of depression. Others talked about being “moody” and prone to anxiety. Many found that stress and acne fuelled one another.
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.
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.
Age at interview: 20
Sex: Female
Age at diagnosis: 12
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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.
Rebecca picked and squeezed her spots, which she says later linked to a psychological condition called dermatillomania.
Rebecca picked and squeezed her spots, which she says later linked to a psychological condition called dermatillomania.
Age at interview: 18
Sex: Female
Age at diagnosis: 12
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But then like when I was about 14, 15, like I started like picking at my skin as well and became obsessed about like getting rid of everything that I saw was an imperfection. And when my acne had like started to calm down a bit, I was still picking at my skin, even though there was nothing really there. And it developed into dermatillomania, which is what I suffer with now and continue to suffer with, even though the acne isn’t always there any more.
Could you say a bit about what dermatillomania is?
Dermatillomania is like an obsessive condition where you pick at your skin basically. And like I know for me it’s just anything I feel shouldn’t be on my skin, like I just start picking at my skin. And then it just turns into scabs and then I’ll pick my scabs because they’re also imperfections and things that I see on my skin. So-
Could you tell me a bit about that time when you first started picking and when you then got the diagnosis of dermatillomania?
Well, a lot of people that I know didn’t really know what dermatillomania was. And for me I started doing a lot of research because I thought ‘this can’t be normal, like what I’m doing’. And in the end I did go to my local Children and Adolescent Mental Health Services to basically say, “Look, I’m suffering with this.” And to start with, they actually didn’t know what it was. And they decided that they wanted to try and transfer me to see a dermatologist because it weren’t anything that they could deal with. But then I had to basically educate them on what it was because I’d done my research. And then they kind of realised that obviously it’s not just a skin condition, it is something to do with your mind as well.
Although having acne could be upsetting, most people said they didn’t seek any special emotional support such as through online or face-to-face support groups. Some said the support they had from family and friends was enough, or that they wouldn’t have felt comfortable talking about acne with other people.
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