So, I think you can get, like I was saying before, sort of yellow infected ones which are not particularly nice, and I think that comes from the sort of the sebum, or the whatever it is, the pus is, I don’t know conglomerates and scales over, and that’s quite horrible, and those obviously look the worst. And then you can also getI do-, obviously I don’t know the medical terms, but I know you get red ones, which are the most uncomfortable I find, and they’re really painful, and they’re sort of more like l-, sort of less of like a pustule, and more of like just a lump. Seems like obviously quite a small like a spot, and those are a lot harder cos you can’t really like break the skin of them or anything like that, and they’re really painful during shaving and stuff like that.

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.

So acne has lots of different types of spots. Some people will have mostly one type, some people will have all different types. All spots come- are focused around something called the pilosebaceous unit and that’s where the hair grows out of a follicle, with a little sebum producing gland which is called the sebaceous unit. The earliest type of spots are mostly comedones and people will know these as whiteheads and blackheads, and those are called open comedones [blackheads] and closed comedones [whiteheads]. That’s really just a build-up of sebum and other stuff within the hair follicle. The more inflammatory type of spots are pustules and that’s when you get a different type of cell, called a white cell. And those are the ones which look like squeezable spots, so they look quite pus-y and they look quite different from comedones most people will be able to tell the difference between a whitehead and a pustule. Then you can get more problematic or larger spots, you can get cysts, abscesses. And then you can get from spots, you can get marks and scarring. And you know some of those scars can be more lumpy, hypertrophic or keloid.

I can’t really remember when I was diagnosed with acne. I think it was in Lower Sixth in secondary school. When I was younger than that, more kind of Year 10/11, beginning of Lower 6th, I also had this very nasty kind of red rash. We, it was variously diagnosed as eczema, dermatitis. We never got a kind of clear idea of what it was or how to treat it. It would be kind of around my eyes and around my neck and just generally looked very red and unsightly and that just disappeared by the time I got into 6th Form. What didn’t disappear was the acne and that just kind of remained throughout 6th Form and also throughout my time at university up to the present. Although it has certainly gotten better than it was while I was an undergraduate when I think it was particularly bad.

So the rash and the acne came at the same sort of time for you?

A similar time and then one disappeared and the other didn’t. If I’d had the choice honestly I’m really glad that the rash disappeared cos the rash was very difficult to cover up and [pause, thump/door closing in corridor] that really upset me, the rash the acne, a lot less.

Would you be able to say a bit more about those differences between sort of teen acne and then adult acne?

Yeah. Yeah, absolutely. I’ve always had oily skin, with my acne. But while I was a teenager it was incredibly oily. My skin’s sort of normalised more from that now. But I’ve found as I’ve become less oily skin, I’ve got larger pores. Which now is my main problem with acne, because the larger pores are more prone to it, rather than it being the oily skin. So now I’m more focused on getting the right moisturisers, getting – staying hydrated, drinking lots of water, things like that. Whereas when I was a teenager it was all just oil control. Which make-ups can I use, which things can I take to sixth form to wash my face with at lunch, or you know, you can buy those little towel bits of paper that soak up all the oil and things. So I think it definitely has changed quite a bit. I mean, even before, when I first got my breakouts – I can’t even remember what my skin was like then. I was 12, you know? I think my skin was just changing so often. I do have quite sensitive skin as well, I’ve always had that. So that’s sort of been an added complexity to all of it, because you can’t just throw lots of chemicals at my skin without it reacting badly. So yeah, it’s definitely different now than how it was before.

I mean I, since I’ve come to university I’ve gone to like a different doctors surgery, I did stick with him for quite a while. And I found him quite useful like one of his things was like he had like a chart and it had like a numbered boxes and different like shots of skin like with varying scales of acne so like eight was the worst, one was the least like, the most mild and he would kind of like point out where you think you are on this scale. So where I pointed out was kind of much more severe than his diagnosis which actually did make me feel a lot better about it because I realised that potentially some of the like how I was conceiving it was maybe a bit worse than it was at that point.

So that was a helpful exercise and it kind of, I think it was useful in terms of like maybe calming me down a bit.

It wasn’t that painful usually, but then sometimes you’d get sort of the big kind of nodal acne where you’d have these big lumps under your skin and that would be painful. You’d like, they’d sort of throb during the day and if you touched them they’d be painful. So that was a kind of uncomfortable pain. But with, with the, sort of when you put certain creams on or, yeah, or oils and things and they have a bit of a burn, it’s not really, sometimes it’s a burn, sometimes it’s more of a tingle. But it’s that, it’s kind of that feeling of, like if you were cleaning the hob or something and it would just, it would kind of like sizzle away all the grime and you’d clean it. It’s sort of, that kind of burning is a sort of a feeling of cleanliness almost, yeah. I don’t know if that makes sense.

I think it does. It’s so hard to convey though, isn’t it, unless you sort of know?

It’s when it, with the burning you feel like it’s doing something useful, cos you, you can sort of feel it almost, you can almost imagine like the acne evaporating from your skin. You’re like Yeah, this, and then you look in the mirror and you expect to be, you know, completely, completely clean skinned. But it does, it definitely feels like it’s working when it burns.

Well personally I don’t really pick my spots that much. The reason why my back got so bad with all the scarring and stuff with that is that it just used to get quite itchy so I just used to scratch and not really care. But I don’t feel much of a temptation for picking spots just because it’s quite painful and it’s not very nice, and I found that they come back worse and you can end with huge ones if you, if you have a cluster of spots and then you pick them all away, and it leads to scarring of course and you get more yellow the pustule ones from picking, cos I think the dirt or whatever infects it. So, actually I think the problems of picking your spots definitely outweighs the enjoyment you get from picking them.

But then like when I was about 14, 15, like I started like picking at my skin as well and became obsessed about like getting rid of everything that I saw was an imperfection. And when my acne had like started to calm down a bit, I was still picking at my skin, even though there was nothing really there. And it developed into dermatillomania, which is what I suffer with now and continue to suffer with, even though the acne isn’t always there any more.

Could you say a bit about what dermatillomania is?

Dermatillomania is like an obsessive condition where you pick at your skin basically. And like I know for me it’s just anything I feel shouldn’t be on my skin, like I just start picking at my skin. And then it just turns into scabs and then I’ll pick my scabs because they’re also imperfections and things that I see on my skin. So-

Could you tell me a bit about that time when you first started picking and when you then got the diagnosis of dermatillomania?

Well, a lot of people that I know didn’t really know what dermatillomania was. And for me I started doing a lot of research because I thought this can’t be normal, like what I’m doing. And in the end I did go to my local Children and Adolescent Mental Health Services to basically say, Look, I’m suffering with this. And to start with, they actually didn’t know what it was. And they decided that they wanted to try and transfer me to see a dermatologist because it weren’t anything that they could deal with. But then I had to basically educate them on what it was because I’d done my research. And then they kind of realised that obviously it’s not just a skin condition, it is something to do with your mind as well.

If you’d, if you’d gone back to me then and said, Look, here’s, here’s make-up product, try it out. I probably would have tried it out. It’s just I’ve never actively seeked out a make-up product like a foundation or anything to sort it out, but now my mum, sort of, recommended me like something called BB Cream.

And that, I mean it might, might be OK for someone with acne, but for me who’s kind of got like a little bit damaged skin and I can still kind be a little bit red and blotchy sometimes it just gives like a nice matte finish to the skin, but when, like I said, when I had acne I didn’t, I didn’t really use anything.

It’s just now after, it’s kind of nice but if I could go back I would have probably used stuff to cover it up.

So do you use BB Cream on like a daily basis now or?

[Sighs] I’d say, out of the seven days of the week, I probably use it maybe three days. Like if I’m going out like – if I’m going to the gym, I’m not going to use it, but if I’m going say around town or, you know, I’m going to, you know, going out on a night out or I’m going to like a meeting somewhere

Yeah

I’d probably use it then. Because you don’t really need to use that much and a, a little tube lasts quite a while so.