My skin started playing up from around the age of 12. It coincided with a difficult time in my personal life, during which my father died unexpectedly in his early forties, and I moved country and started at a new school—all within a few weeks. What started off as increased oil production quickly deteriorated into marked congestion (blackheads), and then widespread angry and inflamed spots. I remember looking in the mirror and running my fingers over the spots, to try and imagine what my face would look like without them.
It made me feel withdrawn and self-conscious—I didn’t like anyone looking at me. Even if one spot cleared, a dozen others would appear in its place, alongside the pigmentation and scarring I was being left with. I avoided activities like swimming in case my make-up washed away, and tried to blend into the background at school due to fear of people’s reactions towards me. I remember feeling that if my skin got better, life would improve, too. My own self-worth was inextricably tied to my skin.
In the early days, I really abused my skin. I constantly washed it (with the usual ’90s suspects, like Clearasil), in an attempt to remove the oil or grease. But over-washing simply led to irritation—and the spots kept coming. I had nodulocystic acne, which was, in retrospect, never going to respond to the “right” choice of face wash or moisturiser. I was prescribed numerous topical creams and oral antibiotics by my GP, which failed to clear my skin. At this point, the acne was leaving marked scarring on both of my cheeks.
Then I ended up visiting a dermatologist, where isotretinoin (or Roaccutane) was recommended. At the time, my mum felt I was too young and that I could still grow out of my acne—she worried about the side-effects of the medication. [Roaccutane has numerous side-effects and has been linked to mental health issues. Anyone taking it needs to be monitored closely by a doctor.] But after taking another course of antibiotics, which did not help, I returned to the dermatologist and began taking it in my teens—it worked, and I was able to start university with clear skin for the first time in years.
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I wish my acne ended there, but it didn’t. I was later diagnosed with a condition called polycystic ovarian syndrome (or PCOS), which itself is a cause of acne and oily skin, and my acne returned in my twenties. I’m now 40—and a consultant dermatologist—and since then I’ve had intermittent treatment as and when I need it. I now understand that acne is, for me, a chronic condition which waxes and wanes over time, but I don’t dare hope—even doing the job I do—that there will be a permanent “cure”.
That said, when I started my medical training, one of the things I recognised was that skin made sense to me and that I could empathise with patients having problems with their skin. My aim is to catch it before it creates long-term physical damage in the form of scarring, or psychological damage due to deteriorating mental health. I don’t want my clients to do what I did and waste time and hard-earned money on products which won’t work if acne is deep or inflammatory.
What have I learned? I like to keep things simple. I know it has become popular to use multiple products in the morning and evening, but I am really fussy about what I put on my skin. I believe less is more, and it’s important to stick to bland cleansers and moisturisers but to use a prescription acne treatment which is a mixture of vitamin A (retinoid) and benzoyl peroxide every night. There is no doubt that for those with mild acne or congestion, using products containing salicylic acid, as well as the above, can be helpful.
Chemical peels can be excellent at improving skin tone and shifting pigmentation, while laser has been fantastic at removing my own indented or atrophic acne scarring. I still have some on my left cheek, but it no longer bothers me so I’ve stopped treating it further. As I’ve gotten older there are also a number of anti-ageing treatments I like, which includes the occasional injectable—Botox or fillers—as well as skin tightening of the lower face with high-intensity frequency ultrasound. Often in the press we tend to see the horror stories, but when these treatments are done well, no one should be able to tell you have had them done.
Like so many others, I have also tried the standard stuff like cutting out dairy and reducing my sugar intake. It made no difference for me and my acne, and my diet is now fully inclusive and I don’t restrict myself—I simply eat what I want.
I still suffer with break-outs and suspect this will continue to be the case over the coming years. With many chronic conditions, there is a constant threat of things worsening, even when things seem to be going well and are under control. But getting older has been helpful. I simply recognise that my skin is a very small part of who I am and what I can achieve.
My advice to those struggling with acne is to speak directly to your GP, or arrange to see a consultant dermatologist. It can be easy to spend time and money on skincare which may not work and it is better to get professional advice early. No one should have to suffer or despair because of their skin, and it is not up to anyone else to underestimate how you feel or how it affects you.
This article originally appeared in British Vogue.