Pop!

I’m about to tell you something I have rarely said out loud, because if I did, then it might be true.

When I was 12, pustules and pimples began to stipple my back. Before long, the spots spread to my chest, multiplied on my chin, and propagated across my cheeks. For a time, it was manageable as I adapted to adolescent hygiene routines—washing my skin with a gentle yet effective facial cleanser after sweating, swimming, in the morning, and before bed, but it soon spiralled out of control.

Over ten years, I have learned that the most painful pimples wedge themselves along the line of your lip, where your tongue compulsively probes the zit like a reptile moistening its eyeballs. The only way to speed the healing of this variety of pimple is to soften it with lip balm—ideally Vaseline—until the whitehead splits open on its own. This will likely happen mid-laugh, or as you smile, so you are made to watch as the person you’re speaking to muffles their horror while you subtly wipe the pus away with the back of your hand.

After ten years, the pores on my nose are chronically engorged, the skin of my cheeks dappled with scars, and my skin the calibration standard against which I measure my self-worth.

Acne vulgaris (the medical name for the condition) affects roughly 85 per cent of people between 12 and 24 (an age group I am still part of), according to a review in the Journal of the American Medical Association[1]. And yet, I am filled with shame and dread and fear as I whisper to you in my very smallest voice: I have acne.

Though my sister is almost two years older than I am, we hit pubescent milestones at roughly the same time including the mass breaking out of our skin.

Our mum remembers this as a time of trying to help us without making it a “big deal.”

Before I interviewed her about my experience with acne, my mum and I had never really spoken about it beyond arranging appointments at the doctor or dermatologist or talking about treatments. During our chat, she is tender and empathetic, searching for her words as I struggle to contain my emotions.

“Obviously when it first started [I] noticed it, because you go from this beautiful child that you as a mother have made, to suddenly having a blemish and it’s like, ‘oh hang on, what did I do wrong?’” she said.

“You were always a very confident child and outgoing and happy and for a while you were not so confident and became very self-conscious, which is a shame.”

She said she does not think my experience with acne has ultimately shaped who I became as a person.

“I really don’t think it has impacted your personality, but maybe that’s because I’m hoping it hasn’t,” she said.

She thought for a long time when I asked whether clear skin should be the goal.

“I don’t actually think so. I know it’s probably a cliché, but beauty is on the inside. And still – then again, I am your mother – I still think you’re beautiful.”

When I asked my sister, she told me she felt talking about acne at home was taboo, and that this shame she felt manifested as flat denial.

“If someone mentioned my acne I would be like, ‘what the hell? That’s so rude!’,” she said.

I laughed when she said this; at the familiarity of this thought, at the deranged lengths our minds will go to in protecting us from truths incompatible with our sense of self.

Despite struggling with the same issue, at the same time, in the same place – and in hindsight with the same thoughts – our suffering looked very different.

“Part of me thinks that’s why we drifted apart.”

I also hadn’t really spoken with my dad about acne, though in recent memory, when I see him over FaceTime, he’ll sometimes let me know whether he thinks my skin is looking good or not.

“I notice because I look for it, because I know it affects you emotionally,” he told me.

“You do want to look good, and you do want to have clear skin, and I know if you have really bad acne it does get you down, so I’m looking all the time.”

He told me at times when my skin is clearer, I seem happier, but if I had never had acne, I probably would have just been insecure about something else.

While I agree everyone likely has insecurities, acne’s status as a disease makes it feel so curable. And yet, if I’ve tried all the lotions, potions, ointments, antibiotics, contraception, oral isotretinoin – pushing my liver to every extreme – and still have acne, I must consider that there is something deeply, truly, fundamentally wrong with me.

My dad told me that when I first got acne, he left my mum up to making the decisions about courses of action for my acne, a choice he would make again.

He listed off what they thought the causes of my acne might be when I first got it: “You know, if you want to treat acne keep your face clean don't put any makeup on,” he said.

Instantly enraged, I barked, “Well, that’s just not true!”

In a squall of emotion, I begged him to understand that if all it took was good hygiene and not wearing makeup to clear my skin, I would never have a pimple again.

Interview, for most intents and purposes, over.

A few days later he emailed me with the previously cited JAMA review of acne vulgaris treatment efficacies.

In pop-culture, a face covered in zits is oft-used shorthand for being an incel or a loser– a degenerate lacking hygiene – so I forgive your mind’s eye if it sees me as such. But what’s difficult about opening yourself to conversations with people you love about acne, is the looming threat of finding out they also see you that way. 

One of the only people I ever spoke with about my acne was my good friend Lily Lockhart.

We met when we were 15 and both our acne conditions were at their worst. Throughout our friendship we have seen each other’s skin through nightmarish breakouts, moments of clear skin, and the complete devastation of the first few pimples after a few months of reprieve.

She said that she remembers in our first conversations about acne I had very negative thoughts about it.

“Now I feel like you're kind of at the point where you know it comes and goes in cycles, and it's something that you have come to accept about yourself and not be too stressed about and not put as much pressure on yourself, even though obviously it's something that you still have a problem with.

“I feel like your relationship with your skin has definitely improved and your confidence within yourself has also improved, and that's probably tied in together.”

For as long as I’ve known her, Lily accepted “having acne” as part of her identity, while I chafed against the diagnosis to the point of categorical refusal. While we both pined after clear skin in the same way, she found solace in the shared experience of having acne while I felt dread with being lumped with that group.

“I feel like I have a shared identity with [people who have acne] and potentially a shared experience with them,” she told me.

“I think for you, you want to identify with the in-group of people who don’t have acne, and therefore it feels like people with acne are the out-group that you don’t want to be associated with because that’s ugly and you don’t want to be unattractive.

“I think that’s where our experiences vary.”

She tells me that even though she feels acne is unattractive on herself, acne on another person has never made them less attractive to her.

It’s tender to admit that not only have I found others less attractive because of acne, I have also judged romantic partners for finding me attractive when I felt my acne was at its worst.

“It's like a thorn in your side and it sits in your brain. And every time a new pimple pops up, you know, it's sort of feels like the ugly part of yourself both physically and mentally. I guess those scars haven't necessarily healed yet, even though my relationship with my skin has changed,” she said.

Lily also talked about a mutual high-school friend of ours, who had perfectly clear skin while ours was at its worst and often dealt us redundant skincare tips.

“They were always trying to give me advice on what to do with my skin, even though they'd not had that experience of what that problem is like, and that it doesn't just go away from basic cosmetics or a basic skincare routine.

“Like washing your face isn't going to fix it, using a particular moisturizer, or some skincare routine they've seen online isn't going to fix it.”

That friend then struggled with acne after school.

“It's probably not a very nice part of myself that has sort of judged them for that experience after because it's sort of like ‘oh so now you get it,’ I guess,” Lily said.

“This is such a primitive kind of rudimentary way to put it, but I guess I feel scorned by those who haven’t had it.”

When another friend, Jilly Weir, reflected on her experience with acne, I recognised the shame and powerlessness she felt when her acne was at its worst.

“I was eating well, I was not touching sugar at all, I was not touching fast food, I was eating so much fresh food, I exercised a lot, I was washing my face, you know I was doing everything, but it was still sort of there.

“It felt like something so out of my control, but somehow it was still my fault.

“I didn’t want to go out; I didn’t want anyone to see me.

“Even now, it’s made me so self-conscious about other things – not just acne, but maybe acne was the catalyst for it all.”

The complexity of what I have found with acne is that creates a dichotomy of control with which we must learn to wrangle without descending to obsession.

Some specialists argue lifestyle factors contribute to acne[2], but if I gave up crisp pinot grigio in the summer, dark chocolate with hazelnuts on day two of my period, dancing with my friends until the sun comes up, relishing every bite of my Grandma’s sticky date pudding, and popping champagne to celebrate loved ones, then I’m not sure I’d really be living.

I’m not defeatist enough to resign myself to #acne4life. I am experienced enough to understand that there will be no miracle fix. And yet I am obsessed enough to keep looking for the cure.

As a teenager, psychological negotiations with my traitorous skin led me to YouTube in the hallowed days of makeup influencers. Here I learned to colour correct and which concealer to choose and how to make it last all day. But the very existence of these videos and their tips and tricks inferred the existence of blemishes to cover in the first place.

Compare this to the internet of now, where faces fill screens with skin so flawless and dewy it reflects ring lights, and you, humble viewer, are but one holy-grail product away from also having such skin. When there’s always another cream, regimen, product, or treatment to try, your insecurity can also become your hobby.

Acne loiters like a cartoon villain pointing and laughing at my face, daring you to imagine how my pillowcase is stippled with pus and spots of blood when I wake up in the morning, and scrawling onomatopoeic “pop” sounds in bubbles above my head.

It’s one thing for your acne to feature in a monthly Instagram dump post, but the dread I feel when I imagine seeing a zit, or even the scar thereof, in pictures of my wedding day or the birth of my hypothetical child chills my blood.

And I can feel you pining, as you read, to see my face and decide for yourself how bad my acne really is. But this is not a story about my appearance, it is a story about perception.

I think my dad was right when he said I’m happier with clear skin, which over time has become the heaviest shame of all: that my acne has whittled down my sense of self to the point that my interior life and mood and the way I show up in other people’s lives is dictated by my external appearance.

It’s difficult to hate such a fragile organ which tenderly binds my insides in place and protects me as I move through the world. But here I sit, again, in the doctor’s office willing try yet another treatment.

[1] Eichenfield, D. Z., Sprague, J., & Eichenfield, L. F. (2021). Management of Acne Vulgaris. JAMA, 326(20), 2055. doi:10.1001/jama.2021.17633

[2] Wolkenstein, P., Taieb, C.-R., Cazeau, C., Voisard, J. J., Michel, J., Misery, L., & Maghia, R. (2013). Acne and lifestyle: Results of a survey on a representative sample of the French population. Journal of the American Academy of Dermatology, 68(4), AB13–AB13. doi:10.1016/j.jaad.2012.12.056