I’m so excited to kick off 2020 with this incredible interview. I’ve been a huge fan of P for their incredible work on Instagram: not only do they raise awareness of acne and help their followers feel more seen and accepted, but they write so beautifully and in such a raw way that it’s a pleasure to follow.
If you’re new to my How Do I Look? series – welcome! I have rosacea and have been blogging about it for over 6 years, but last year I decided that I should use this platform to show the many faces of skin positivity. So far I’ve spoken to people with vitiligo, psoriasis, scars, eczema, hair loss, birthmarks and more (links at the bottom of this post for each of them) and I want to keep going. Each interview teaches me something, makes me feel less alone, and shows me that although we may look different, we all have similar experiences.
I hope you enjoy this interview as much as I did.
Please introduce yourself and tell me a little bit about your acne?
My name is P and I’m non binary. I use they/them/their pronouns.
Acne feels as if it’s been with me forever, though I was 12 when it first made an appearance. Relatively mild in form but throwing me into what would be a long battle with a deeply rooted skin insecurity. I guess the classmate who asked ‘why do you have all those spots’ couldn’t have known this, so I swallowed the sting of their words, cast my eyes downwards, and mumbled an ‘I don’t know’. Not even the doctor who reluctantly prescribed a cream could offer insight, only that it was typical of my age and I would grow out of it. I really believed it too. Acne came and went in various forms throughout my teens, never severe, though I know from experience and from talking with many others the severity of a skin condition isn’t necessarily proportionate to the distress it can cause. It was always there. I shied away from cameras. I walked towards the bathroom sink —and mirror— with my head down. And I never spoke about it.
At age 22 I was back at the doctors with what can only be described as nightmare acne. Big, throbbing cysts came out of nowhere, swelling up at an alarming rate and protruding my cheeks like red marbles. It was terrifyingly unlike my usual spots and I had to wonder if it was acne at all. There was no hiding it, it hurt like hell, and a doctor told me they’d never seen it so severe. As far as bad days go, that one was pretty awful.
18 months and a course of Roaccutane later and I have a painless face again. Scars stretch across my cheeks and pimples still pop up but I’m more at peace with my skin than I’ve ever been. And it only took developing a pretty nasty case of Acne Conglobata!
What are the common misconceptions, comments, or questions about acne? What do you wish people knew about acne?
If I had £1 for every comment both on and offline related to diet then paying for the dermatology treatment I needed would have been a breeze. I do not blame them because I once believed acne was caused by food. There is an overemphasis on the role lifestyle factors play in the development of acne. This misinformation is so readily available too. Tap acne into Google and you’ll likely get links telling you which foods to cut out. I think it’s only human for us to want to believe the cause is in our control, because if the cause is in our control then the cure must be too. It never ceases to amaze me that despite being one of the most common skin conditions, it is so poorly understood – by both acne sufferers and genetically-blessed clear skinned folk alike.
I once had somebody walk past the window of my workplace who saw my face and came in to tell me to eat probiotic foods while pointing to his cheeks. I wish I didn’t have to say that the comments were at one point so frequent I had to learn to tune out of them. I know my truth well enough so that these things mostly don’t hurt any more, but the most troubling is what I hear from other sufferers online. Usually young people who are scared to eat chocolate and cheese. People whose relatives think they need to wash more thoroughly. People who spend more money than they can afford on skincare promising to be the cure. Even people who are worried masturbating is the source of their skin struggles. The popular myths have a common thread – something you are doing wrong is giving you acne, and if you could only do the right things, you’d have clear skin.
Besides being unhelpful in treating skin, this generates a huge sense of shame in sufferers. What I would love for people to understand is that nobody causes it and nobody deserves it. The cause is a complex mix of genetics, hormones, sebum production, naturally occurring bacteria, and probably other components we don’t yet understand.
What is an assumption about your acne that you hadn’t anticipated?
As an AFAB (assigned female at birth) genderqueer person who presents relatively masculinely, a lot of people have met me with the assumption HRT (hormone replacement therapy) caused my acne. I hadn’t anticipated just how much hormones would come up. Specifically, how much testosterone I have/take. I’m often torn between feeling as though I shouldn’t have to explain myself and wanting to be transparent. I haven’t undergone HRT and I’m really keen for people to understand a severe case of acne really can just… happen. In fact it’s more usual than not for it to be seemingly out of the blue. I’m becoming increasingly aware that having a space where I talk about skin things and gender things may not be the likeliest of combinations, but they are both big parts of my life offline and so they exist side by side online. I didn’t expect to garner so much interest talking about acne, and my hope is that while most people swing by for a bit of skin positivity, they maybe learn about some other things too.
When did you decide to start talking publicly about your acne? What sparked this decision?
Honestly I felt incredibly lonely. Though I have wonderful and supportive people around me, none of them had been stared at the way you are when you have shocking skin. I found some people talking about acne online but it still wasn’t quite what I needed. There were many self-help type resources: skincare routines, makeup tutorials, medicine updates. All of which are needed among a community of people who likely don’t get to talk about it in real life either. I couldn’t find anyone talking about the hard stuff. About how it felt, about how you’re supposed to get through the day when you want the ground to swallow you whole. (and that’s not to say they didn’t exist, just that I couldn’t find them). While I’d accepted that many people who saw my skin might wrongly assign meaning and judgement to it, I was drawn to the idea of getting a chance to tell my story too. Acne has a way of making you feel hyper visible and yet so simultaneously unseen. So I started writing about it the way I wished it was written about. I knew if I could reach even one person who was feeling as lonely as I was, all of it would have been worth it. It was terrifying, but the support has been overwhelming. People reach out with the most heartfelt messages. They tell me they feel less alone now, and I tell them it very much works both ways.
Something really big happens when you realise other people have not only experienced the things you have experienced but they’ve also felt what you have felt. Sharing our stories, connecting with each other, being vulnerable, that’s how we shake shame.
How does your skin make you feel on a day to day basis?
Teen me would be horrified to learn they will one day have face scars but you adapt, you learn, you grow, and day to day, I feel good. It’s difficult not to when I’ve seen so much improvement. And among the many big things this has taught me is the knowledge I am the same me no matter what my skin looks like. Not everyone will be able to see that, but that’s on them. All I can do is dare to believe wherever I’m at and whatever I look like is enough.
What are your thoughts on the media visibility of acne? How do you think social media has impacted the visibility of different skin conditions?
Acne visibility is practically non-existent in mainstream media, not even skincare ads show spots. Social media has been pretty ground-breaking in that sense – and it’s not exclusive to skin conditions either. All sorts of different people who haven’t been represented now have communities of support and voices fighting their corner. It’s phenomenal actually, how empowering it can be for so many when a group of people are having a public conversation.
We are visual beings and everybody deserves to see parts of themselves reflected back to them. A little while ago a skincare company put a billboard up in Brooklyn full of every day people’s selfies, and every day people’s skin! (including this every day person’s every day skin!!) It felt like a major step towards authentic representation and wouldn’t have happened in the absence of online skin positivity.
How do you deal with bad days?
Recently I found myself in a busy venue full of people my age and all I could see was their non-scarred and smooth skin. I spiralled a little. It happens. That’s the thing I try to explain when asked about confidence or self-love: there’s no point of arrival where the work is done and everything is fine and dandy indefinitely. Bad days are human. Necessary, even. I think we’re taught to want to fix ‘bad’ emotions, as if happy is a default. I try my best to go against this reflex, try to let it be. I get home and cry if I need to. I remind myself all emotions are temporary states and five minutes, five hours, five weeks from now could all feel very differently. Cuddling my cat certainly helps too!
If you have consulted the medical community for your acne, how were those experiences?
I’ve been back and forth to doctors over the years. Most were unhelpful. I get the feeling they don’t fully realise the gravity of the situation. Skin conditions, particularly visible ones, can take a huge toll on your self esteem and even quality of life. Acne isn’t dangerous in the physical sense and is often dismissed as superficial, especially milder manifestations. Though even with severe acne at no point did a medical professional ask about my mental health. Of course, I didn’t speak about it either. I hope in talking about it online it is raising more awareness on how acne effects far more than skin.
People often ask me for help with their acne and I’m certainly not qualified for that, but I would tell anyone that if they are able to, they should get a consultation with a dermatologist. It was the best decision I made and I owe my now healed skin to dermatology treatment. I understand the barriers that stop people from accessing care. From the referral times to the cost of private treatment, even feeling like your skin complaints aren’t ‘bad enough’ to warrant it. But I would tell anyone that if you can make it happen, do.
In the past few years there have been more conversations around the link between skin and mental health, what are your thoughts?
Skin conditions undeniably have a detrimental effect on mental health. At my lowest, I didn’t know how I could carry on. And from speaking about it with so many people it is clear these conversations are long overdue. People are suffering because they feel unworthy, unattractive, unclean, unhealthy. We spend an awful lot of our time online where images are doctored and lives edited to fit the shape of ideal. It is so easy to feel bad about yourself. Throw in a skin condition commonly misunderstood to be a symptom of poor lifestyle choices and there is no wonder acne is associated with depression and anxiety. Scars too can be incredibly difficult to deal with- physically and emotionally. We are often our own worst enemies. We cling onto hurtful comments. We compare ourselves to our peers. We are far less forgiving towards ourselves than we would be to a loved one.
Acne blurs the line between a health issue and a cosmetic one. I don’t believe we’re able to talk about skin conditions and their effect on mental health without looking at image and beauty as a whole. And I don’t believe we’re able to do this without looking at gender norms and roles. I was socialised as a girl and woman which means a lot of things, but in relevance to this, it means I grew up with a sense of self-worth entangled in a willingness to conform to conventional ideals of femininity and an ability to perform celebrated ideas of beauty. In short, I felt that my aesthetic beauty equalled my desirability equalled my worth. People (especially girls, women, and femmes) need to be taught their value is independent of their beauty. No one is immune to the expectations that an ideal demands and everybody feels under pressure to look and be a certain way. More diverse representation must surely be a start. More people saying: ‘Hey, this is me. I don’t look like the world tells me I should and I’m pretty damn great. If I am more than what I look like, then so are you.’ This, I believe, is where the power in social media lies.
Have any positives come out of your acne?
It took dealing with severe acne to accept this skin condition is more than teenage skin. It’s likely chronic and that’s okay. I no longer feel the need to ‘cure’ it because I both understand there is no cure, and refuse to believe I need immaculate skin to be my best self.
There were a few months where I couldn’t walk down a street without turning heads. This was incredibly difficult at the time but has given me a deeper sense of compassion and empathy towards people who live with visible differences. I believe self reflection helps us see others more clearly, and I believe nothing worth going through is easy.
You don’t have active acne so much any more, but you do live with scars. How is that different?
I feel like acne – or any skin condition that is visible, red, inflamed – can be read as a health disorder. The reactions to that are difficult. We are hardwired to avoid things which could be harmful. In some ways scars are easier to live with. They are not painful, they are not so visible, and they are a sign of something having been resolved. My scars don’t look like typical acne scars and so I’ve had questions about having been in an accident or house fire, and received comments about my ‘birth marks’. (It is amazing how many people think this is appropriate small talk!) People meet me with curiosity now where they met me with discomfort before.
Some days I truly love my scars. They remind me of a resilience I never knew I had, they are totally unique, and they are as much a part of me as anything else. Other days I worry about things like first impressions, interviews, employment. On rare days I just want them gone.
Even within the skin community, where acne is accepted, there is an emphasis and celebration on the healed skin at the end – and rightly so. It’s a joy to get acne under control. A flare-up of acne is always temporary. That thought alone saw me through many a bad day. But what about afterwards? The permanence of scars is more difficult to reckon with. Though they do fade, and there are fantastic treatments available, scars can stick around. It’s funny, I go on the internet and talk about self acceptance and being okay with visible scars, and I’m routinely met with (well-meaning) messages on how to fix them. Sometimes I search Google to try to find scars which look like mine and I’m met with ‘how to get rid of scars fast’ and ‘top full-coverage foundations’ and ‘find skin clinics near you now’. There’s so much urgency I start to lose agency. I want scars to exist as something other than the space between the wound and the laser treatment.
Of course, the privileges I hold as a white, thin person means I have an easier time navigating the world based solely on what I happen to look like, and it’s important to stay mindful of this when talking about being judged on appearance.
What are your top tips for living with acne?
- If acne is really bothering you (and you’re certainly not alone if it is), get to see a dermatologist if you can. Equally, if you’re struggling emotionally, (and you’re certainly not alone if you are), get to see a therapist if you can. I love therapy. Life is weird and messy and we need as many tools that help us as we can get.
- Remind yourself who you are because you are not the condition of your skin, or any of the other things we’re conditioned to feel bad about for that matter. If in doubt, consider the people in your life you love and who you deem beautiful. Consider what makes them beautiful. I’m willing to bet it isn’t their complexion but their being. Entertain the thought that other people see you in your entirety the same way you see them.
- Get online. Search the #acnepositivity hashtag on instagram and follow a bunch of wonderful people embracing their skin and sharing their thoughts. Maybe even share your selfie too, it’s incredibly empowering, and we’ll all have your back.
- Do more things that make you forget about your skin and never ever look in a 3x magnified mirror.
An enormous thank you to P for such incredibly honest and thought-provoking answers. If you aren’t following them on Instagram, I cannot recommend it enough. P is such a light in my feed and I’m sure they will be in yours as well.
Want to hear more from P? Follow them on Instagram
Read the other posts in the How Do I Look? series here:
- MICHELLE talking about her scars;
- SOFIA talking about her acne;
- NATALIE talking about vitiligo;
- SUSIE on her Telogen Effluvium (hair loss);
- AMY on her port wine stain birthmark;
- GEMMA on psoriasis;
- AMARA on eczema;
- GRACE on her scars;
- JUDY on her sensitive skin;
- SHANKAR on his Vitiligo
- and SOPHIE on her Trichotillomania.
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