Jun 3, 2009

The Face

I had acne once.

Not spots. I had those through school, a constant irritant around my chin and on my forehead.

But in my second year out of school, it all got worse.

My face became a mass of tiny but angry yellow tips, surrounded by red raw circles, that gradually spread out to join other circles, creating a unstoppable wave of ugliness. The pimples went all over my face - my nose, my cheeks - every conceivable space from my hairline to my jawline was covered.

I used to try creams, potions, fancy washes. I used to scrub at my face with brutal exfoliants and harsh astringents. I cried when nothing worked. When I went out, I attempted to cover the spots with heavy foundation. Of course, I was a student, and couldn't afford good stuff. It would slide off with the grease of the spots, leaving me looking like a clown after a heavy storm. Mind you, I'm not sure expensive make-up would have been much more effective.

I used to work at a supermarket, and the comments came often enough to upset me. Many would say "You must eat too much junk food!". Yes, I did. I always have. But it couldn't be all that. I ate plenty of fruit and vegetables as well. I always had. The worst was the kids. "Mummy, what's wrong with her face?" they would loudly whisper, in that embarrassment-free way native to them. "Shh, don't be rude," their mothers would say, avoiding my gaze as they piled bread and milk onto the conveyor.

I saw doctors, of course. Most would hand me prescriptions for topical creams and send me away again. Eventually I went on the Diane contraceptive pill, one specifically designed to combat adult acne. I was not having sex at the time. With a face like mine, how could I possibly be?

One doctor said the next step would be going to a dermatologist and most likely being treated with Roaccutane, a somewhat controversial treatment for severe acne. I had the referral notice and everything, but thought I would wait and see if the pill had any effect at all.

Then, one day at the checkout, a woman reached over and handed me a Post-It Note. She had an accent, but I can't really remember what it was. "He treated my daughter," she said. "He has very good treatments, and will help you." She went back to loading groceries into her trolley. I looked at the note. It was the handwritten number of a dermatologist, bright blue on the stark yellow paper.

I finished my shift, then drove home in a paroxsym of anger and grief. I was young, it should be my time. I should be pretty, I should be attractive. I should not have a face like a three-day old pizza.

I decided to see the dermatologist my doctor recommended. A weight lifted off me when he said it wasn't due to junk food. Within minutes he'd diagnosed pyoderma faciale, and prescribed Roaccutane.

I was worried. "Doesn't it cause depression? Didn't two kids in America kill themselves while they were on it?"

The dermatologist was kind. He listened to my fears and treated them with respect. He said there was evidence pointing to depression as a possible side effect. But he also said firmly that it was effective, and that perhaps people had suffered depression because they had struggled with bad skin for a long time.

That's a fair point, I thought. I certainly wasn't feeling very great about myself at the time (despite the fact a bout of pnemonia had seen my weight plummet - I've never been that skinny since).

I had to have a blood test to make sure I wasn't pregnant, as Roaccutane certainly can cause birth defects, and cannot be taken by pregnant or breastfeeding women. I laughed bitterly on hearing this. I tried pointing out the obvious. "You honestly think somebody would sleep with this face?" Also, "I'm 18! What the hell do I want kids for?" Still, rules are rules. I had the test.

I was already on the pill, so once the official "negative" response came in, I went on the drug. Two tablets a day, for six months. Roaccutane works by blocking the production of oil in the skin glands, reducing the bacteria responsible for the inflamed skin. It started working within a few weeks. The angry yellowy-white pimple heads started to make their retreat. The redness began to fade.

The side effects were dry lips and dry eyes. The eyes were easily treatable with drops, but the cost to my lips is with me today - the constant peeling blurred the line of my lip in the bottom right-hand corner of my mouth.

Still, after six months, I was almost a completely different person. I could wear make-up without it sliding off. More importantly, I could walk out with my bare face, my natural face, and not be scared of frightening children or drawing helpful but hurtful comments.

To this day, I will never talk to a person with severe acne about my experiences, unless they specifically ask for information, or bring up their condition. People are only trying to be kind, but those who haven't experienced it don't understand how terrible you feel when somebody offers unsolicited advice. Sufferers are well aware of their problem - they see it every day in the mirror, in a reflection in a window, in the computer monitor as it blinks off. I know how much it rocked my self-esteem, and could never do that to others. But I will say if anybody reading this does have bad acne - do see a dermatologist. People suffering exzema or psoriasis aren't censored for eating "too much junk food". You shouldn't be either.

Having said that, I have had too much junk food in the past few days. I get lazy, and have never shaken my appetite for the naughty stuff. Consequently, I've broken out in mild spots across my forehead and chin. I don't like the way I look in the mirror. I think - I'm still young, I should be pretty, I should be attractive. I've got a show on this Sunday night - I want to feel confident and vibrant. Then, even as I rue my spots, I see small creases forming at the corner of my eyes. And I know I will come to loathe wrinkles as well, to battle them with creams, potions, fancy washes. But they are natural, and expected, and mean something.

There are many terrible things humans may have to endure. But my experience with acne taught me that interference with The Face must be one of the worst. People may claim to like big breasts, or slim legs, or pert buttocks. But at the end of the day, people must look most often at your face. It is all of you in a heartbeat. You don't have to be the most beautiful, the most handsome, the most symmetrical, the most smoothed-skin. But your face is the most human part of you. It's what people relate to, what they judge you by. Changes to that canvas - either naturally though a medical condition, or by outside trauma - can drastically affect how people treat you. It's why those children were so disgusted by me. My acne was abnormal, unclean - meaning I must be as well. I can only imagine what burns victims or those injured in car accidents or by physical assault must go through.

Short of adopting a burqa, you can't hide your face. You can't pretend it's not there. And you can't easily change it. Scientists have been transplanting hearts, and livers, and kidneys for decades. But faces? They're only just starting.

Love your face. You will only ever have one. It's probably not perfect. But it's whole, and it's you. Show it to the world.

Oh, but wear sunscreen.


  1. Def yes on the sunscreen, my dad who had an outside based business in his youth now get skincancers cut out of his face twice a year.

  2. Yep. Down there I reckon sunscreen is a must.

    With all due respect, Natalie, since I barely know you-I'm sure you look fine just the way you are-and probably did then. Be kind from the inside-eventually the looks may fade, but the kindness will remain. Or like the man says: 'Beauty is only skin deep. Ugly goes to the bone.'

  3. My wife took the profile pic for girlclumsy and made special note of just how gorgeous her skin is now. She said it makes her very photogenic.

  4. I went on Roaccutane in my teens, too - it was awesome. I would be pitted with acne scars now if I hadn't. My sister had similar acne, but chose not to take it, and still has scarring.

    Have they come up with anything new in the last ten years? You'd think it'd be an area people would be keen to throw money at.

  5. Junk food connection is spurious. Roaccutane FTW, made me the beautiful creation I am today. Just for the interest of Amy - it's a Roche product - they're pretty good at locking up IP and making sure they've patented their favourite drug and any potential variants of, so any other pharma company would probably have very limited 'freedom to operate' - as well as Roche having neatly locked up the market itself by providing a product which works well.

    As for the depression thing... don't mean to be flippant but blaming Roaccutane for teenagers being depressed is massively spurious. As Bart Simpson said making teenagers depressed is like shooting fish in a barrel. It's the default state for teenagers to be in.

  6. Kids are very good at pointing out the 'different from the norm', aren't they? From: "Mummy, that lady's really FAT!" (muffled hushing) "...Well, she IS!"
    to: "Is that a man or a lady?" and the well-informed variation: "Mummy, does that lady have a PENIS or a 'GINA?"

    You've captured the horror of not being able to escape the face-ful of horror. I've had adult-onset acne on and off since I was 19 (still clutching the dermatologist's list, me). Apart from all the 'concerned' parents at work asking what had set it off, the slings and arrows administered by their kids delivered a series of contiguous stings. They varied from asking what "the red dots on my face" are to telling me that they had to stay at home when *they* had chickenpox.
    Thankyou for expressing it so well.

  7. Ahhh I went on Roaccutane last year (I was 19, but well past the hormonal teen stage) and it made me terribly depressed. Not in the mood swing sort of way, in the "didn't leave my bed for days" sort of way. It didn't fix my problem. But I got all the fantastic side effects you mentioned.

    Since then I've tried drinking rivers of water every day, cutting out soft drinks, and naturopathy, none of which has made a difference.

    In fact, I'm getting embarrassed talking about this now :P time to ski-daddle. Great post, I would never have guessed you'd ever had any problems with your skin!