To take it seriously and to know that the person that’s come in to you might actually not really realise that what they have is, is serious, or that it will be taken seriously. That they’re probably going to be quite embarrassed to be seeking medical advice for something like that. They probably think that they should really just be buying, you know, face washes and stuff like that. And they probably are going to feel a bit embarrassed to be asking for help. And yeah, just to be, yeah, positive. And to offer them something quickly and to say, You did the right thing in coming to a doctor. And I think putting people at ease as well that a lot of the young people who have acne will be, you know, they’re young so they’re not like necessarily as confident, especially in a medical environment where as like, you know, medical professionals and you’re kind of sitting there as a young person, having not really had much experience with doctors and professional environments. And feeling a bit out of place. But also, as someone who has acne, you’re naturally going to have very low self-confidence. So I think knowing that most people that walk into that room are, are going to be really lacking in confidence in general. And yeah, are usually, are usually used to trying to keep their head down, so [laugh]. They’re not used to like being kind of assertive and saying, Arr, I want treatment for this. So, trying to put people at ease is quite important and making them feel quite relaxed in that environment so they can have like a open discussion about what they might want and they can ask lots of questions as well cos they might not be that knowledgeable. And so they can ask questions and maybe just even explain to people what acne is. And yeah, just really breaking it down, what you, yeah, what you can do for them.

I had quite a lot of support because my twin sister also had acne so it was quite easy to talk to her about it and we could have good chats about, you know, it being difficult. And practically as well, like we’d try different things. And, and I think we’d understand what each other were going through. And I think we also, you can understand what’s going to help as well. So it’s not just a case of, of telling someone, Oh no, you look fine. Like it’s actually like listening to them, and letting, like I’d let her talk about how she felt. And not just try and say, Oh, you look pretty, we’ll just move it on. But actually say, you know, How does this make you feel? And listening to her was really good. And I don’t think it was really until I came to uni that I found other people who’d also had quite severe acne and talking to them about it was really helpful. And really good. And part of like the emotional healing process, and not just the physical healing process. In South Africa I found it quite hard because I was very much the only one that was having really difficult, yeah, really problematic skin. A lot of the other girls had very, very clear skin. And because they were a little bit older as well I think that a lot of them had gone through the phases of having spots and then had really good skin. And I think there was probably a lack of understanding in how it was making me feel. I think a lot of people think that they can just say, Oh, you look fine. And then they can-. Because they move on from that conversation, I think they assume that you’ve moved on from feeling that way [laugh]. Which obviously you don’t. And I think just with how it was really difficult with the children as well, and working with them. Just feeling like very exposed. I think people just didn’t really appreciate that that was the case, and I felt a bit- I felt kind of bad saying that I felt that way cos a lot of people might have thought that was a bit selfish and that I should just kind of get on with things. But I had one, I had one friend who was really good and just really lovely, and always had something to say that was really positive. And kind of helped my confidence. And when I used to say to her that I wasn’t sure that I could kind of keep doing things, and I’d say, I don’t really feel like strong enough to face the world. And she’d be like, No, you’re, you know you’re strong anyway. And that was really good. She was really a support.

So I think I just learned to just go without it, and it was almost like a kind of, a stubborn thing in me, that I was like I’m just refusing to wear make-up’, because I was. Yeah. I just, I kind of was almost like daring people to have a look at my face, and… And I’ve still tried to keep that where I’ve tried not to wear too much make-up and to be kind of comfortable with the way that I do look. And I think at uni it was hard because I think the first term I would wear, mostly wear make-up if I was like leaving my room because, just a little bit of like foundation just to kinda cover the, so you couldn’t really tell there was scar tissue there. And I think it was quite a scary moment the first time I was like ‘I’m going to go to the canteen and have breakfast like without make-up on. Because people can sort of tell that it’s a bit discoloured and… But now I’m much more relaxed. I think it took a while, because like- because it’s new people at uni, you don’t know anyone before, and you want people to think that your skin’s better than it is. And then eventually you get, when you get comfortable with people, you’re like oh, I don’t really mind if they, they know. So I’m not really a big, a big one for wearing lots of make-up.

I’ve had really good conversations with a lot of friends who also suffered from acne. But I think anyone who didn’t suffer from it, I didn’t really speak to about it because it’s not really worth it. Like the worst people are people who have like a spot and they, they’ll want to talk to you about how awful it is to be spotty. And yeah, I don’t think you understand what it’s like when it’s genuinely really painful and like scarring. I think if you just never have clear skin at all, it’s a bit different to them having like one spot. But I think people who also suffer from it were the only people I really would have spoken to about it and still do speak to. And I always find that really, really helpful.

Because the alcohol was the only thing that really interfered with it. Although, you know, I had to be careful about drinking a lot more fluids because my throat was very dry. And it meant that if I went out, I had to take eye drops with me and like I used to make sure that I didn’t wear too much like eye make-up that was going to get smudged because I, just because obviously I was staying up-, I kept my contacts in longer, I would need to like go to the toilets and like put eye drops in. Just because they’d start to get dry by ten, 11 at night. I think alcohol was, it was a bit difficult because I was still in fresher’s. Or my first year at uni. But luckily, my friends were quite cool about it, and going out and getting really, really drunk was not something that I had to do to enjoy myself with my friends and on socials. It was, it was awkward at times because especially with kind of socials where, you know, it was like drinking games and things like that. And having to be like, I can have one glass but I can’t have more. It’s sometimes, it sometimes meant I had to sort of say that I’m not going to drink anything because it’s simpler for people to understand than, I can’t drink more than one unit a week [laughs]. I didn’t always like keep to the exact guidelines, but I, yeah. I spoke to my dermatologist about that, and was quite honest with him and be like, Look, I had like this many units last week, do you think that’s okay? And he was good about it and said, Yeah, no actually it’s not that bad, it’s just we’d like you to keep it down, you know, keep it as low as possible. It saved me a lot of money, [laughs] in my first year, so there were some positive side effects. But yeah, I think it was, it was frustrating, I think. A few of my friends were like, Awr, are you sure you don’t want to kind of delay the treatment? But it was more important to me to have my acne sorted out than it was to drink a lot. And I didn’t mind, didn’t mind it in the long term because I knew that it was going to have, yeah, like a positive effect. And I would have chosen to be sober, and to have my acne sorted like any time. So I didn’t mind that, I just- it just meant that I’m kind of glad that I’d researched it quite a lot and I knew what I was going for, and I was quite sure that I wanted it because I think it’s quite a, a big ask. You know, it sounds silly to say it’s a big ask to not drink, but I think you are in your first year in uni and there’s a lot of social things on. It is something that you have to be quite sure that you want to not drink.

Getting quite frustrated because I think a lot of people- especially in South Africa where it’s culturally less , they don’t mind people kind of being more confrontational, a lot of people came up to me in like the shops and like Boots, or the equivalent of Boots, and tried to sell me a lot of things. And like a lot of the, they have like a lot of sort of herbal traditional healers, and they’d like follow me down the street, like [laughs], I’ve got this product to give you, like it’ll really sort out you skin, and this kind of thing. Which was really humiliating, because people in the street would be looking at us. And I’d just be trying to tell them, I don’t, I don’t want it. And they’d be like, Well, how can you not want this? Like, look at your skin, it’s really bad. But this will sort you out. And I just [laugh]. It’s like, Leave me alone [laugh].

It must have been really difficult to cope with, to sort of respond to emotionally, or-?

Yeah. I think- cos there’s part of me that’s really, really angry. But I think at the time like you’re just really, really embarrassed. You’re just like ‘just go way, just go away, like I don’t want everyone to stare at me. Because they’re already looking at , already having a look anyway, because it’s quite an obvious like rash over the face. And people are like sort of glancing over and think-, you can tell they’re looking at your skin anyway. So I don’t need the attention. But I also just felt like, it just made me feel like really vulnerable, I think, as well. Because I couldn’t really tell them to go away. And I could tell they were picking on me because of something that was, you know, wrong with me. And I just, yeah, just feeling like really vulnerable and just really exposed. But yeah, I think-. And then I’d be angry afterwards. But I did sort of thing like I was within my rights to tell them [laughs] just to I don’t know, be a bit rude to them [laugh]. But [sigh], but then I just, I think you never are because you’d rather not cause a scene, but I think technically if someone thinks they can say that about your appearance, then you’re kind of within your rights to just tell them to go away.

You mentioned about migraine, would that have been the contraceptive pill that you couldn’t take?

Yeah. I think it’s, I think it’s the combined that you can’t take. And I don’t think my GP had realised, to be honest, that that- he’d never asked me. But I think when I came to uni, because they’re so much more on it with, they just, obviously the doctors prescribe a lot of contraceptives , she did-. She just checked the list with me. And I said, That’s something that no one’s ever asked me before. And she was like, I’m quite surprised, because yeah, you’re not, you’re not supposed to give it to people with that. So then I went on the progesterone-only, when I was on my Roaccutane (isotretinoin). And yeah. That was, it kind of surprised me that if it was a big deal, that I hadn’t been asked. But I don’t know if it’s that my GP didn’t prescribe many contraceptives, or I’ve, he just assumed it wasn’t a problem. Because I think at that point I’d definitely, I’d had- and it was only one migraine. So probably it never would have occurred to me to have checked. But, yeah. I think, yeah. But it was a bit surprising for me, but. I guess it’s just kind of taught me that I probably do need to check, when I get prescribed things, or like to have a look at the list of it and just check for yourself. Cos I guess GPs are human and they probably do, they might just forget or, but. Obviously it’s your health, so it’s quite, it might have quite significant repercussions for you.

So I took antibiotics for quite a while. I think that’s because I was a bit younger, and they didn’t want to give me the pill. Because a lot of my friends who have bad skin often get given the pill now and I think that’s because, because we’re a bit older. And it wouldn’t be unusual for like a 20 year old woman to be on the pill, whereas I think if you’re 15 it’s a bit-. So they started me on antibiotics, I was on them for quite a while. Tried a lot of different topical things, so. Can’t remember exactly. I think basically most of them that the NHS offers. So like gels and creams and lotions, and probably changed, changed to different ones quite often. But, yeah. And then I switched to the pill, cos the antibiotics weren’t really working. Also the- I think after, because it was so long term, I think it started to affect my sort of, my tummy quite a bit. And, yeah, I wasn’t very happy. It kind of gave me like almost IBS-like symptoms. And my Mum was like, Maybe it’s a good idea to get off antibiotics, because you’ve actually been on them for two and a half years, [laugh] which isn’t, isn’t good. So then I changed to the pill and I found that wasn’t massively effective. Cos I think, yeah. And then I tried, I tried different pills as well. And then at one point, and I was always on, always on the medicine with a topical thing. And then at one point I was on all three together, when it got really bad. And I think, I’ve also tried, I tried moments where I’d just go off all medicines, see what happened. And it would get really bad.

I think I got a bit frustrated because after a year or so it was like ‘surely it has to clear up at some point?’ And I think I was-, I didn’t really think it was something you could see the doctor about, because I thought ‘yeah, I’m quite spotty but… When I went to the see the GP for the first time it was like, What’s wrong with you? And I was like, I’ve got spots [laughs]. It felt like the most like menial thing to say, but I think I also had it quite badly on my back at that point, and yeah the doctor was like, You should have come a lot, lot sooner. Because it left like a bit of scarring. Yeah. And I think I didn’t really realise that it was something that the doctors could do anything about until a friend of mine at school- this must have been when I was, yeah, about 16. Or a little bit before then. She, she’d been to see the doctor about acne on her back and he’d given her cream which works wonders. But until then I didn’t know it was a thing that the doctors could do anything for.

A lot of people, I think they think that it’s caused by a lot of things which it’s only exacerbated by. And I didnt really realise that until I started doing my research. And I think a lot of things that are really unhelpful are often adverts for like cleansing products and stuff like that, which are just not that scientific. And a lot of them are like oh, you just cleanse the dirt out your face. And I think I found that the most frustrating one, that people would assume that you just didnt wash enough or your skin wasnt clean. Or that it was just because you’re really oily. Whereas Ive found that I actually have very, very dry skin, which was made worse by a lot of the topical creams. Because obviously they dry your skin out a lot. So I was having to use like really heavy moisturisers, and my skin would still be quite dry. It was only really when I was a teenager for a brief bit that I had oily skin. But other than that, my skin is very, very dry. I would have actually to be using like Bio Oil and things like that. And that doesnt, yeah it wouldn’t make my skin oily, so. I think a lot of people think that you just need to wash regularly and it would be okay. A lot of people think it’s because you eat a lot of bad food. But I know that can exacerbate it, but none of those things cause acne, it is a medical condition. And I think a lot of people-, everyone wants to give you a suggestion and advice but a lot of it’s really unscientific. And I know Ive. Yeah [laughs]. This one woman in South Africa sort of suggested that I should try honey and cinnamon. And I think that was the only time I turned round to her and said, Oh, Ill have to, Ill have to go and tell my dermatologist cos hell be so pleased that youve found a cure for acne But, yeah. I think there’s a lot of bad science out there. And people think that spots and having acne are kind of just the same thing, and they are actually quite different.

With the creams it was just – I think they’re very aggressive. And different ones would be worse than others. So I think with a lot of the gel or the lotion, they dry my skin out really badly and I’d have like sort of cracked skin around my mouth. And obviously you couldn’t really get them like near sensitive areas but if you accidentally did, and I’d have like kind of almost eczema-like sort of bits on the sensitive eye areas and around the mouth in particular. And that, and so that’s not that pleasant. But then I think my doctor did eventually give me one that was a bit more moisturising. And I also learnt to use like slightly less [laugh]. I think there’s always a temptation and most of it is that you use a lot of the product, when actually the recommendation is to use like a pea-sized amount and I was probably using like a handful [laughs]. So it was probably exacerbated by that.

Before you’d been to the doctors for the first time, had you been trying like sort of treatments you’d bought in the shops, or?

Yeah [laugh]. I think there’s generally nothing I haven’t tried. And even just the sort of stuff people put on online. Like homemade treatments and stuff like that, like we used a lot of those. And I think I’ve tried some really odd things. Like we tried like aloe vera juice. Like some, someone online was like, This works really well for skin. So I remember my Mum buying like from a health, a website online just like this jug of aloe vera juice, and it was really grim. But we used to have this like syrup, and did like the typical kind of washing in salt water. Tried toothpaste, which actually burnt my skin really badly. So that was, I would not recommend that. And I tried like Sudocrem, which actually works quite well. And then just a lot of face washes and all those kind of Clearasil like gels and stuff like that, so I think I probably went through most product ranges.

For most of my history of acne it was just kind of suffering from cystic acne, so just like big lumps under the skin. Which is quite difficult because they can take weeks and weeks to fade, and they’ll leave you like a lump of scar tissue underneath. And yeah, so and you tend to get like a couple of big ones of those. And when I got them on my jaw, they sort of all joined up, so it was like just really like a big solid like lump of, of kind of infected tissue. And I, so I wasn’t really sure what to do about that. And then I just left it, but. Yeah. So I’d get like those big lumps. And then because of that there’d be like-, and obviously my skin was quite bumpy even when it was fading. And then just having like quite a lot of fade marks. So I guess especially if I scratched them, I think- I don’t know if my skin just lost its ability to recover as well, maybe over just the long period that I had acne. So it tended to be that at the beginning they would fade within a couple of days. And then towards the end like I’d be left with kind of fade marks for weeks, for, you know, maybe even months.