Acne

What I Learned in My Desperate Search for a Solution to Severe Acne

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Living with acne involves many uncomfortable moments: waking up and discovering pimples that weren’t there the day before, feeling pain when smiling, or washing your face because it’s full of sores.

For me, however, the worst moment was staring in the mirror when leaving the house on a day when I felt like my face was torn apart.

Acne is an inflammatory skin disease, but in none of these words can I find a clue to understanding the emotional and social experience I have lived over the last almost 10 years.

I suffered from chronic cystic acne —sometimes more severe, sometimes less so—which took me to four dermatologists, expensive treatments, emotional ups and downs, and a reflection on self-image.

Dermatologists know: that acne can have devastating effects on a person’s life, self-esteem, and quality of life.

It can lead people to isolate themselves from their support network, to leave their jobs, and to drop out of college. It is a problem that usually arises at a time of emotional fragility, and physical appearance can often be the difference between social success and failure.

When acne traps you in your mind, it’s hard to think about anything else.

At times when my skin was so inflamed, red, painful, and ugly, going out to dinner with friends or going to a party became almost impossible to enjoy. Anger and shame became a maze.

I remember, for example, the day I was offered my first job, my skin was at one of its worst points. I sat down with my boss to discuss the position, but all I wanted was for the meeting to be over. I didn’t want anyone to see me like that. My mind was not present.

Note

No treatment mentioned in this article should be followed without diagnosis and monitoring by a dermatologist. The American Dermatological Association highlights that each skin is unique and no treatment works for everyone.

Certain over-the-counter medications can help with mild cases of adult acne. When the lesions do not improve, it is recommended to consult a dermatologist.

A case of acne like so many

As for most, my acne started as just one part of the changes that come with the hormonal imbalance of adolescence. At a certain age, it is a kind of equalizer with others.

The first time I went to the dermatologist about acne, I didn’t feel like it was a serious problem yet.

At the first consultation, he prescribed me an antibiotic. One pill a day. He didn’t explain much, but it wasn’t what I wanted either. I wanted a quick fix for the pimples that were starting to accumulate on my forehead, temples, and nose, and pills seemed to be it.

  • ‘I woke up one day and suddenly I had severe acne all over my face’

He also created a multi-step skincare routine that I followed in detail and recommended that I periodically do a facial with blackhead extraction.

In all the years I’ve had active acne, I’ve had at least a dozen of these cleanses, all painful to the point of tears.

In one of them, the beautician told me that she had never seen skin with so many blackheads. Another commented with relief that I was the last patient of the day, because, otherwise, she wouldn’t have time to extract all the pimples. They weren’t malicious comments, but they made me feel deformed, almost monstrous.

Scars from cleanings took longer to disappear than pimples took to reappear.

I followed the treatment for a few months, but it didn’t work, so I stopped going to appointments with this dermatologist.

I thank him for telling me in a consultation that “eating a tablespoon of butter a day was bad for your cholesterol, but not for your skin.”

He freed me from a guilt I had, as my father insisted that the pimples were a consequence of my eating habits.

When I stopped taking the medicine, my skin got worse. It was worse than before the first appointment. At the time, I felt (mistakenly) that I was better off staying away from dermatologists, seeking a solution on my own.

There were months when I forgot about my acne a little. But there were others where my face would break out in pimples, and I would desperately look online for solutions or take unsolicited advice from family and friends.

Regarding acne and skin care, there is an inordinate amount of information. It is the most common skin disease in the world.

Much of this information promises immediate improvement: homemade masks, snail secretion, toothpaste, avoiding dairy products, creams, cosmetic procedures… The offer is extensive and overwhelming.

Today I know that the vast majority of this information is unscientific and counterproductive.

I tried everything: lemon juice with honey, rice water, and oat masks.

No product of this type can help fight acne.

Acne occurs because pores become clogged and accumulate sebum and bacteria. Any substance not indicated could end up making the situation worse.

My skin in ‘pieces’

The second time I saw a dermatologist, several years later, and with a more serious problem with my face and self-esteem, I decided to go to one of my health plans in Colombia, as it was cheaper.

The proposed solution: the same antibiotic, again, now accompanied by two products for topical use that I would have to have made, according to the doctor’s prescription, in a laboratory.

After a week of following this second doctor’s prescription, a low blow.

My skin had an unwanted reaction to one of the products, and it started peeling all over my face. This is normal when using certain chemical peels, but not in my case.

When I listen to my current dermatologist explain how people who suffer from acne start to isolate themselves, I remember this moment when my skin was falling apart.

There were weeks in which I limited my social life.

I did strictly what was necessary at university and returned home.

I often went into the bathroom to check that there were no pieces of dead skin on my clothes. Hugging my friends at university was out of the question.

There were days when I felt like my skin was screaming all the time.

For the second time, an attempt to improve my skin ended badly. The frustration started to accumulate, and I felt like I was carrying something I didn’t deserve.

I went back to the dermatologist to tell him what had happened. He prescribed me a cream to control the reaction (dermatitis) and, of course, stopped the products that were causing the problem.

These were products that had cost me a lot of money and that I had to throw in the trash.

The day I went to the office with my skin in tatters, the appointment lasted five minutes, and I felt no empathy from him.

Not even the adverse reaction made the pimples go away.

At that point, I still knew very little about my acne.

I turned to the internet again in search of information and came across YouTube channels with reviews of skin care products. The content of this type is endless.

After spending many hours watching a Spanish YouTuber with the perfect skin I dreamed of, I bought some products: a serum and a chemical exfoliant that was very popular at the time.

I noticed that the exfoliant was restricted in countries like Canada and Australia. It has such a high concentration of acids that laws in these countries only allow its application by a professional in a dermatological clinic. Leaving a product like this on your skin for more than 15 minutes or using it more than the recommended frequency can cause serious burns.

And yet, it was within the reach of someone like me, a young Colombian man of around 20 years old who, at that moment, didn’t have the most scientific criteria or the most serene attitude to decide what to apply to his skin.

Today I see this purchase as a symptom of desperation and as one of the risks we face when looking for solutions on social media.

But, at that time, I felt that so many warnings about this product were precisely a sign that it would help me.

Isotretinoin

The products helped me for a while, but, to solve my acne problem, topical products alone weren’t enough. I came to isotretinoin (also known as Roaccutane).

It was prescribed by a third dermatologist I consulted. The doctor was an authority. She participated in world dermatology congresses, and applied Botox to famous actresses, and, of course, this restored my hope.

Isotretinoin is a medication used in cases of severe acne that does not improve with other treatments, like mine. The American Academy of Dermatology defines severe acne as “deep, painful cysts and nodules that may be the size of a pencil eraser or larger.”

I had already heard about the medicine and it made me a little scared. The dermatologist explained that, due to my age, the treatments I had already tried without success, and the size and number of the lesions, my problem was not acne vulgaris, that is, the kind that people commonly overcome after adolescence. It wasn’t completely new information to me, but hearing it from her changed my perspective. It was a wake-up call that I was suffering from a health problem that was affecting my life.

She told me to take isotretinoin for three months and come back. The treatment was extremely expensive: a consultation with a dermatologist cost the equivalent in Colombian pesos of around US$100 (around R$500); isotretinoin, approximately US$60 (about R$300) per month. And to that was added the other skin care products I still needed to use and a facial every month and a half.

The minimum wage in Colombia at that time was around US$300 (about R$1500 reais). It was a luxury, impossible for the vast majority to afford. But it was only three months, I thought.

Side effects

During these three months, I experienced many side effects.

As isotretinoin reduces the size and function of the sebaceous glands – as explained by my current dermatologist, Mônica Paredes – it alters the skin’s natural hydration process.

The skin all over my body, especially on my face, became extremely dry; The lips then got worse.

The most uncomfortable thing of all was that, as the medicine also dries out the mucous membranes in the nasal passages, I had nosebleeds almost every day.

I had to throw several sheets in the trash because blood was running out of my nose while I slept. I stained tablecloths from more than one restaurant.

Explaining to someone that you’re having almost daily nosebleeds due to acne treatment is strange: it seems like a cure more serious than the disease itself.

In addition to the real risks of the medicine, there is a long list of myths surrounding it: that it can cause sterility, and that it leaves long-term damage. It has a very bad reputation in general.

However one of the possible side effects mentioned by the dermatologist particularly caught my attention.

“Do you often feel sad?”, she asked me during the appointment in front of my mother. It was her way of warning me that the medication is linked to depression.

My mind went blank.

The effects of isotretinoin on mental health are the subject of much controversy among dermatologists.

My dermatologist, Mônica Paredes, explained to me a different perspective: “The patients who take this medication are those with more severe cases of acne. Some patients have very compromised skin. This patient, without having any mental illness, due to the severity of acne, can experience a very depressive impact.”

She adds, “It is unclear whether patients report depressive affect due to the medication.” The American Dermatological Association (AAD) states that treating acne is associated with reduced symptoms of depression.

However, the organization clarifies that “we do not have enough evidence to know whether isotretinoin is related to or can cause depression and suicidal thoughts.”

Throughout her 20 years of practice as a dermatologist, Mônica told me that she preventively suspended the medication of no more than ten patients due to symptoms of depression.

However, she also mentions having patients who use psychiatric medications for depression and isotretinoin at the same time, “because the psychiatrist won’t get them out of their depression if it doesn’t improve their acne.”

“Isotretinoin has been on the market for more than 30 years and is an established product,” said a spokesperson for Cheplapharm, one of the drug’s manufacturers. “The potential side effects are well known, and it is a reliable product when used as recommended and prescribed,” he added.

As for my case, after three months of use, I returned to the dermatologist at the time. At the first consultation, she forgot to mention the duration of the treatment. Of course, she couldn’t have known initially, but it wouldn’t be the three months I expected. When I saw her, she said the treatment would take at least a year. Another frustration. My parents could no longer afford it, and I felt like the medication was harming my body.

Taking a daily pill of a medication that is causing so many side effects is intimidating. Once again, I abandoned treatment.

The improvement

The pandemic arrived and it was like a relief for me, because no one saw me. However, as normality returned, so did the concern about my skin.

I found a not-so-expensive clinic that specialized in acne treatment.

So, I arrived at Mônica’s office. At the first appointment, he told her he was not willing to go back on isotretinoin.

She responded that we would start by trying to reduce the inflammation in my skin with an antibiotic that I hadn’t tried yet, but if that didn’t work, she would suggest going back to isotretinoin.

I’m not exactly sure why the way she explained the treatment and the decisions she was making about what would be best for me made me feel like she understood what I was going through.

As I asked her questions about acne and we reviewed my history to write this article, she gave me a clue.

“I can’t say to a patient: ‘Ah, relax, there is acne worse than yours’. It’s their skin, it’s their experience, it’s what they’re living.”

I was tired of treatments that didn’t work and, most importantly, tired of acne, so I decided to commit until the end. Furthermore, he had already started working and could pay for the treatment on his own.

The treatment that finally cured my skin lasted two years. We tried the antibiotic for a few months, and I ended up going back to isotretinoin, incorporating several products into my routine that helped with the side effects.

When I saw my skin without any pimples after a year, I couldn’t believe it. My body also got used to it, and the side effects lessened. The reaction of the people around me surprised me. They praised my skin. When I posted a photo on social media, my friends would ask me for advice.

Of course, all this positive feedback, which I appreciate and enjoy, is part of the same logic that for so long made me feel bad about having a face full of acne. I believe that saying that we should accept and normalize acne is sterile speech. We all want to have blemish-free skin.

However, I believe that, as a society, we must try to understand the stigmas that arise when we see acne-prone skin, the implicit associations we make with acne, and the profound effects they can have on those who live with the disease.

Sometimes, when my face was full of pimples, I remembered Elmer, a character from a children’s television show who had huge acne on his cheek. He had the typical appearance of a nerd and was part of the unpopular group at school.

Elmer is not just Elmer. A study from the London School of Economics concluded that acne is statistically significantly correlated with better grades at school and a worse self-image of physical appearance, personality, and social acceptance.

Now, my skin is very healthy, as I wanted so much, but I know that there is a lot of damage that acne has caused to the way I relate to myself and others, and these will take longer to heal.

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