Tom

Age at interview: 15

Age at diagnosis: 15

Brief Outline: Tom has experienced acne since around the age of 13. He tried a number of ‘over the counter’ spot creams and gels before seeing his GP who prescribed oral antibiotics.

Background: Tom is 15 and a secondary school student. He is single and lives at home with his parents and a sibling. His ethnic background is White British.

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Tom has had acne for around 2 years. Before visiting his GP, he tried a number of different products for his acne such as face washes and creams. However, he found that the instructions for using these products were sometimes unhelpful, missing out details such as when to moisturise, and requiring lots of effort. 

Tom’s GP prescribed tablets to help clear up his skin. He takes one antibiotic pill a day and continues to wash his face with soap in the mornings and evenings. At the time of interview, Tom had been taking the medication for just over a month and he felt that it was both improving his skin and that it was easier than applying acne creams. 

Tom does not feel particularly worried about having acne as he saw it as something that most teenagers experience and this had also been the case for his siblings. He felt that his acne was worse than some other peoples’ that he knows but, generally, that he is not “that fussed about it”. His acne does not have a significant impact on his home life, schooling or friendships, and he emphasises that it is important to him that he continue to do things such as eating the foods he enjoys and playing sports.
    

Tom finds it unclear and confusing with working out acne triggers.

I think stress probably doesn’t help, is what I’ve heard. I don’t know exactly because I don’t really make that connection myself. But I know people who say that their spots get worse with stress, or like I know people who say that their spots get better in summer and stuff like that. And I don’t know if it’s just something to do with the summer or it’s something to do with them, or if it’s just something they feel but might not actually be true. I don’t know. But for me personally I just kinda go by it day by day. So I don’t really make those sort of connections. I, I would just sort of, I don’t know. I do think they get worse with stress though. And I personally think they get worse if I eat rubbish food the night, the day before. If I’ve had a whole pizza the night before and then forgot to wash my face, when I wake up I’d probably be more spotty than if I ate. But that could, apparently that’s not actually a thing according to my doctor. But I don’t know, different people.

Tom’s brother had told him to stress to the doctor that he had already tried lots of shop-bought things for his acne.

I knew I had spots anyway. And I kind of figured that it would just be sort of like, you know, “Oh, yeah, you’ve got spots. They’re a bit worse than like average and I feel like you should just take this.” And, and the doctor said he wanted to work with me to get rid of them for ever, like so they wouldn’t come back. Which I was quite happy with. So I wasn’t really surprised, cos I kind of figured it out, but like, and I was kind of expecting it.

When you went to see the doctor, could you tell me a bit about that?

He offered me, he spoke to me about how long I’d been trying it and how long I’d been like trying to get rid of it. And my brother had warned me to sort of, even though it had been like two years of trying to get rid of it and sort of it going away and coming back, my brother had warned me that if I wanted to get treatment from the doctor I had to make it out to be very, quite, really bad. Because it was quite bad but it wasn’t like outrageous. So sort of like I just told them what I’d tried mainly and just I kind of, kind of said I’d tried a bit harder than I had, even though I had tried quite hard. But, and he was like, he said it was good to keep trying for the two years or whatever that I had been trying. And he said that that was good and I hadn’t come straight to the doctor. 

Tom wasn’t sure about the instructions for his topical cream, including about when to moisturise.

And so what about the cream that you said there was quite a lot of complicated instructions for?

Oh, that’s, there’s, that’s most of the creams that I’ve used. There’s always stuff like, so like, I don’t know, the branded ones will always be like, “Put it in your hand, rub it, a thin layer round your face, wash it off with hot water and then pat dry.” Which is really stressful. And then the other one was sort of like, “Rub it in until it disappears.” But the problem with those ones is I don’t know whether I’m supposed to moisturise before or after, or whether I’m supposed to wash my face at all before that. I probably am but like, whether I’m supposed to wash my face before or after in case it comes off. So like you kind of have to work out. So like I stopped using moisturiser when I used the one that you just rub in, because I figured that you wouldn’t like, and [sister’s name] was like, “You probably shouldn’t do both.” But then again that didn’t help because I wasn’t moisturising. So that left like dry skin and stuff. So it was kinda, it wasn’t very well explained on the back basically.

So were some of the instructions more complicated than they needed to be?

Yeah.

But also missed off stuff –

Yeah.

- that you needed to know? 

Yeah.

Okay.

It would be nice if they were like, “Put it on your face, wash it off, apply moisturiser afterwards.” Because then at least it’s just all there and then you know what you need to do and you don’t have to worry about, “Should I be doing this? Should I be doing that?” Which is quite annoying. Because it’s already stressful enough having spots without having to worry about what sort of treatment you have to do and how you have to do the treatment.

Tom chose antibiotic tablets over a topical treatment offered by his GP.

And then he offered me like a face, a face cream or a tablet. And I went for the tablet because I’ve tried a lot of face creams. I didn’t really like them and I didn’t really see them doing much. So I tried that. And I’ve been on, I’ve been taking that for about a month now. And it seems to be, well, my face feels a lot better and I think it looks better [laughs] Yeah.

So is that like a face wash or is it like a gel that you put on?

It was a, he described it as topical, so I guess it is a gel sort of thing. I think it’s sort of, not a wa-, it’s more of a rub it in. Kind of, I think it’s one of the ones where you have to, cos I tried one of them before where you have to like put it behind your ear to check if you’re allergic to it and stuff like that. So quite like, you know, it tingles a bit when you put it on sort of thing, yeah.

Was that first one like over the counter or was that prescription as well?

That one was over the counter. Because in the summer I’d asked mum about the doctor’s and she said, “I’ll go to the pharmacy first and ask what they recommend.” And we tried that and it did work a bit to start with. But then over time it just kind of didn’t work anymore. And I don’t know if I was using it wrong or whatever, but we just decided that it would probably be easier to go for like a tablet, because you can’t really do wrong with a tablet. You can’t like, cos the ones, on the back of the face ones it’s a lot of like, “You’ve got to do this, this and this.” It’s just like you’ve got to swallow this after breakfast. It’s quite easy.

Tom finds it hassle-free taking antibiotics for acne.

And then now I’ve got like, I don’t know what it’s called, well, I can’t, I can’t pronounce it. But it’s like this tablet that you take every morning with water and it’s just, seems to be doing all right. I don’t know. I’ve got like a month, three months’ worth. And it’s once a morning. It was going to be two a morning, two a day, but he was like, “Actually, no, once a morning.” So, yeah, it seems to be working all right though.

How far through are you on the course?

I don’t know. I got two boxes of them for the whole three months, and if each box has the same amount in then I’ve nearly finished the first box. I’ve got like two more days on the first box. So I’m nearly halfway, yeah.

Were there any sort of side effects to the medications and the creams that you’ve tried?

One of them hurt on my face, like not hurt, hurt but sort of burned a bit. Which was the one my mum got from the pharmacy. The pills have side effects, but I haven’t got any of them. Like they can turn your tongue sort of white, not white as in the whole colour but like the top bit gets like a white thing on it. And I think there’s something else but I don’t really know.

Tom tries to eat things that are better for his skin, but isn’t too strict about his diet.

I don’t drink or smoke. Just, not anything to do with spots, I just wouldn’t smoke myself, cos I think it’s silly. And then drinking, I’m kinda young, so I don’t really, I haven’t really got into that yet. 

Diet. I might avoid the occasional thing. So I might be like in the Co-op with my friends like, “Oh, I’m going to get a Crunchie. I’m going to get a Mars bar.” And I’ll be like, “I’m going to get a Fruit Shoot today.” Which is still really sugary, but it’s not as bad as like whatever I was thinking about getting. So it’s not like a big change. I’m not like, I know friends who have just gone, “I’m not gonna to eat this because I know it’ll be bad for my skin.” 

So about, about the diet. Before that, had you been sort of cutting certain foods out?

Not really ‘cos I just kind of figured that, I’m not really that age where I want to have a diet and I’m quite happy how I am. And I was like if I’m going to have spots, I’m going to have spots but I also want to enjoy pizza and stuff. So I just kind of got on with it.

Tom sometimes feels nervous about going to parties or big gatherings if his acne is bad because he wants to look his best.

I feel like if I’m having a bad day it’s bad in the morning but by the time I get home and I look in the mirror I’m sort of like, “Oh, yeah, it’s died down.” So I kind of feel like I’ve kind of learnt that. So when, there were times when I’d probably, you know, be quite worried. I’d hang out with my friends but necessarily I wouldn’t go to like, if there was like loads of people, or like a party. I wouldn’t avoid a party but, you know, like if there were loads of people I might think like, “Oh, I don’t know if I wanna go” and get nervous, but still go. But now I’ve learnt that by the time I get home it’s fine. So that means probably for most part of where I am it’s probably died down, it’s probably all right. So, yeah, I don’t really avoid stuff.

When you, when you were sort of getting nervous about parties, was it, what was it about that?

I don’t know. You just don’t wanna be like looking not your best. You gotta be looking fly. But if you’re not looking fly, it’s not good. So I don’t, I don’t know. You just, you just get nervous, you just get self-conscious about the fact that your face is covered in like red things, but you don’t really know why they’re there. But, you know, just I know that it dies down over time, so I don’t really worry about it any more.

Tom used to have a complicated routine using creams and moisturisers but now just washes his face with soap each morning and night and takes medication.

At the moment it’s just wash my face every morning with like warm water, soap. Eat breakfast. Straight after breakfast swallow a pill with water. And that’s pretty much it. And then in the evening wash my face. Oh, and moisturise in the morning and moisturise in the evening but after washing my face with soap and water. But before that it would be a lot more like stressful because it would be a lot more like wash my face with soap and water. Apply cream stuff. Apply moisturiser, Go on with my day and do that at the end of the day. Which made it kind of like less me wanting to do it in a way. Because at least with the pill it’s really quick and easy. Because I just take that and I’m, hopefully that gets to work hopefully. But unlike the topical where it’s a lot more, like you get, if you miss it and you get into bed you’re a lot more like, “Oh, I don’t really want to get up.” Because that takes a good five, ten minutes to do all that. Unlike this tablet which is just like, if I forget to do it and I’m about to go out to school I’m just quickly like, “Oh, yeah” quickly and just take it. So it’s not the end of the world. So I don’t know. At the moment it’s a lot quicker than it used to be.

Tom had advice from his older siblings, who had acne, as well as from his parents. His siblings told him what had worked for them. It made it easier for Tom to talk about his acne.

How long after noticing that you were getting spots did you talk to somebody about it?

I don’t know. Probably quite quickly because it was kind of like I wasn’t really self-conscious in the way where I wouldn’t talk to my family about it, because I’d, I’d seen like my brothers get it. And some of them had it at that point because they were still like, when I was 12 they, one of them would have been like 16, 17, still having them. So it wasn’t like a subject where I was afraid to talk to people because I was embarrassed. So I was quite confident, I was just, not confident but I was just kind of like, “Oh, I’m starting to get it” And then like my siblings were kind of not teasing but like, you know, “Oh, Tom’s growing up” that sort of thing. So they, everyone sort of noticed it. So it was quite an easy thing to talk to people about. So probably quite quickly. I don’t know exactly.

I spoke to like most people in my family because all, most of my brothers and sisters have had it. And they would tell me what they thought that you should do. Friends would say what they’ve done. And then my mum and dad would tell me what they thought I should do as well. ‘Cos I think we saw the doctors as like not necessarily like the thing we should do first, because we figured we should try all the other stuff first. So yeah.

Did you find their advice helpful?

Yeah, it was all right, it was good, it was good. It was like, just stuff like make sure you use hot water when you wash, not hot, hot but like, you know, like slightly warm water. Put, make sure you don’t use certain types of moisturiser that aren’t actually gonna, like that are gonna include stuff that isn’t as helpful. Use like just simple moisturisers. Use like actual, don’t, like [sister’s name] kept telling me to avoid the sort of branded stuff. Because that tended to be a lot more like not as effective because they want you to keep buying it sort of thing. Kinda, I don’t know if that’s true but, yeah, that’s sort of the advice. So it was all helpful because it kind of made me decide what I wanted to do and how I wanted to go about getting rid of it.

Tom finds that branded creams only work for a bit so you have to keep buying more.

I don’t know if this is just me and my theory. But I seem to find that the branded ones work really well to start with but then they start, your spots start to coming back a lot. As in, I figure it’s so that you keep buying it. But that’s just my theory and that’s just probably me being paranoid about it. But I always like, when I first got like the branded ones it had been a lot more like, “Oh, my skin’s looking really good. Oh, I should keep using this.” Then the spots would start coming back a lot more. And then it would be like, “Oh, I need to keep buying this.” And I was like, “Oh, it seems a bit suspicious” sort of thing.

So yeah I don’t know. So in patches they get really good and in patches they go bad. So today’s like quite good I think, not bad. And at the moment it’s just getting better, it’s not really getting worse, because of the GP and stuff. So that’s good.