Naomi

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Naomi’s experiences with seeking acne treatment have been very frustrating and involved a lot of waiting: for appointments, referrals and trying out so many different products. She feels that this prolonged the length of time that having acne damaged her confidence and impacted on her social life. The treatments themselves could also be upsetting. For example, Naomi found taking Roaccutane quite stressful because it involved a lot of trips to doctors for blood tests, compulsory pregnancy tests and to collect the next month’s supply. She also experienced side effects such as very dry skin and she found that her acne would become worse on the treatment before it started to get better.
Naomi thinks it can be difficult to have acne as a young person because this is a formative time when appearances matter a lot. Acne affected her self-esteem and it knocked her confidence further when various treatments didn’t work. She found it hard to open up to people about how badly her skin was affecting her, including to doctors. Naomi didn’t feel confident telling the doctors that she would like stronger or different medications, and they did not tend to offer other options. A turning point was when the dermatologist for the third course of Roaccutane described acne as a “disease” and reassured Naomi that it could be treated. Previously, Naomi had felt that many of the doctors had dismissed her acne as “just a teenage thing”, despite the fact that it had started for her at an early age, lasted for many years and returned again in her early 20’s. Naomi encourages other young people with acne to feel more confident and be insistent when talking to doctors.
Naomi didn’t like to do hobbies (like swimming) which got her face wet because her make-up would come off.

Naomi didn’t like to do hobbies (like swimming) which got her face wet because her make-up would come off.
If you go swimming, like if you’re wearing make-up obviously it’s going to come off. So I think that did kind of bother me like I never really wanted to get my face wet because like I’d be kind of exposed as it were. But like but we didn’t really often do that kind of thing. But yeah it was definitely something I thought about. And like on holidays as well like we, we sometimes went on like ‘cos I really like horse riding so like sometimes we’d go like riding or something and then like, you know, you want to like splash your face ‘cos its really hot, like you’re in holiday, but like I’d never really want to and then [laughs]. So yeah I think, I think yeah it did kind of affect my behaviour but probably not my clothing so much because there was nothing I could do.
Naomi was upset by others giving incorrect and unwanted advice about acne causes and triggers.
Naomi was upset by others giving incorrect and unwanted advice about acne causes and triggers.
And then one person one time said to my mum, you know, “Oh, it’s the fruit and vegetables, she’s obviously just not having enough fruit and veg.” And so I’d just eat so much fruit because I thought it might help and like nothing made any difference. So, yeah it was crazy. And like you know, one, one person said, “Dairy products are really bad,” so then I just had this massive thing about cheese and like I couldn’t eat cheese because I thought it would make it worse and like it didn’t make any difference, so [laughs].
So yeah, I think it really kind of like took over my mind. I mean it was just horrible.
Naomi’s acne returned when she tried the implant (hormonal contraceptive). She had recently stopped taking isotretinoin (Roaccutane) and so didn’t want the contraceptive pill.
Naomi’s acne returned when she tried the implant (hormonal contraceptive). She had recently stopped taking isotretinoin (Roaccutane) and so didn’t want the contraceptive pill.
And what about when sort of before you went on the third treatment of Roaccutane (isotretinoin), when it resurfaced, when you had the implant?
Yeah, yeah that was really awful because I’d only sort of a few months before I finished the previous one and I didn’t want to be taking a pill anymore every day because having taken so much medication all my life I just, I thought, you know, I want to be able to get up in the morning and not have to remember to take a pill, not that I forgot but I just, for me it was just another form of medication and I didn’t want that anymore. And so, you know, I went to the GP and they said, you know, “Try this implant” and initially I thought ‘oh well, I’d rather have a coil because they don’t have hormones in’ and like . But when I went to the like sexual health clinic place they were like, “Oh, don’t worry, like we can, we can just put this implant in, it’s really easy and it’s like much less painful than a coil.” and, you know, “If you have any problems, we can just take it out and it’ll be fine” and I think I should have stuck to my guns and said, “No,” but I was like, “Yeah, you know, I might as well.” And so they put it in and within a couple of weeks my skin was just ruined and so I, I was like well maybe I should just wait a bit ‘cos it might improve but it just didn’t get better. So I went back to the clinic place and said, “Please just take this out, I don’t want it here.” and obviously that whole process like took time as well because I had to wait to see if it improved then I had to phone and make an appointment and they didn’t have one for like four weeks. And yeah so then I had that taken out and then I was hoping that that would make things better but it just never really, like I waited for a few months and nothing happened and that was when I was just, I was so upset I just thought like ‘I just want to go private because I can’t face waiting again’.
Naomi thinks there are several factors which might explain why her acne clears up whilst on holiday.
Naomi thinks there are several factors which might explain why her acne clears up whilst on holiday.
Naomi wishes her doctors had used the term ‘acne’ earlier.
Naomi wishes her doctors had used the term ‘acne’ earlier.
I don’t really remember [laughs] I mean I, I think, I think they didn’t even really call it acne then because I was so young and they were just like, “Oh, you know, this cream will just help with your skin.” and actually yeah I mean I think, I think like yeah, I mean I knew it was acne I guess but like I think because, I think part of the problem was because everyone was like, “Oh it’s just a teenage thing, you just have bad skin,” and so I remember actually when I went to the dermatologist the most recent time and he said, you know, “This is a disease and we’re going to treat it,” and I just remember that being such a turning point because I’d always just kind of it had always just been like ‘bad skin, a teenage thing’ and then suddenly it was someone who was like really taking it seriously as a disease that was treatable. and I think yeah, so I think like the way people talked about it did really have an impact and I didn’t really realise that until suddenly this dermatologist was saying, you know, speaking about it in that way. and that made me feel like so much better in some ways because even though it was like ‘oh my God, I've got a disease’ it kind of, it made me feel like I was justified in being as upset as I was and that you know, this was a serious problem. But someone was taking it seriously and was going to fix it for me.
Yeah.
So yeah I kind of wished that someone had said that earlier on really [laughs] because it took a while.
Naomi saw GPs about her acne for many years.

Naomi saw GPs about her acne for many years.
Naomi didn’t feel confident enough to ask her GP to try something else, even though the treatments didn’t seem to be working.
Naomi didn’t feel confident enough to ask her GP to try something else, even though the treatments didn’t seem to be working.
Usually the decision was ‘do I carry on with what I'm doing now or do I kind of go up to the next level?’ And I think usually I would be the one pushing to try something stronger because nothing was working and I was frustrated but I think often I think my, my lack of confidence in going to all these appointments kind of meant that when I, particularly with the GP ‘cos I’d be going because I’d run out of whatever I was taking and so then they’d say, “Okay well shall I just prescribe some more?” And I’d kind of be wanting to try something else because it wasn’t working but like didn’t have the confidence to say, “No, I don't want more of this. I want something that’s gonna work” and so I’d just say, “Yeah, okay, I’ll have more.” and I think, yeah that was part of the problem because I guess I did have a choice and I could have said, “No, this isn’t working for me. Can you give me something else?” but yeah. Also I just wanted to, I always wanted to leave so I’d just be like, “Yep, fine, I’ll take a prescription and go.” yeah but that meant that there were times when I was just on the same thing for so long and it wasn’t working and I’d go and get more and it still wasn’t working so that’s quite frustrating.
Naomi saw a dermatologist privately when her acne returned, having previously had a long treatment process through the NHS route.
Naomi saw a dermatologist privately when her acne returned, having previously had a long treatment process through the NHS route.
Naomi felt anxious about her medical appointments and didn’t feel her doctors were interested in hearing about the emotional impacts of acne.
Naomi felt anxious about her medical appointments and didn’t feel her doctors were interested in hearing about the emotional impacts of acne.
Naomi talks about dry skin as a side effect.
Naomi talks about dry skin as a side effect.
It was frustrating for Naomi when people trivialised her acne as ‘just some spots”. She had acne from the age of 9.

It was frustrating for Naomi when people trivialised her acne as ‘just some spots”. She had acne from the age of 9.
I think, yeah, in some ways like it was more accepted there because like yeah it was more common and you’re at an age where yeah like people just think that that’s quite normal. But in some ways I found that quite frustrating because people would, if anyone ever talked about it they’d be like, “Oh, you know, you’ve just got some spots – like big deal.” whereas for me it, it was like a massive deal and like I just felt like no-one ever understood because you know, I’d had it so long already and it had such a huge impact on me and yeah I just felt like people were dismissive and wouldn't take me seriously and yeah I think that was quite upsetting as well. and I remember like when I, because obviously I was taking this like medication and stuff and, you know, so like my friends knew and you know, I think they just sort of thought, you know, “Why are you making such a big deal of it? Like it’s a phase, like it will go.”
I mean for me like I look at pictures of me then and I just think ‘that looks disgusting’ and I think that, that was part of the problem as well because I thought I looked disgusting so I thought everyone else must have thought that as well. And like I definitely told my, one of my closest friends that one time and she was just like, “Well you know nobody thinks that.” But it didn’t matter that nobody thought that, it was the fact that I felt like that. And like, you know, I see people with bad skin sometimes now and I just feel really sorry for them because I know what that’s like but maybe it doesn’t even affect them as much, maybe they don’t even care but like if for me it was just like a really big deal.
Reflecting back on a summer job, Naomi compares her school environment to her work environment. She thinks teenagers put more emphasis on appearance, whereas adults are more “accepting”.
Reflecting back on a summer job, Naomi compares her school environment to her work environment. She thinks teenagers put more emphasis on appearance, whereas adults are more “accepting”.
I think the worst thing was at school and yeah the work environment was kind of not as bad for me because it didn't really matter what I looked like, that didn’t, well it mattered to me but like I felt like they weren’t really gonna judge me for that because they were older and like I was doing them a favour by going in and doing this work for them. Whereas with your peer group I think it’s just much more traumatic and you feel like it matters a lot more what you look like. and also I think just being around like teenagers who care about that kind of thing was more stressful whereas I feel with adults they’re more accepting and less judgemental. so yeah, yeah I think that’s not as bad.
For Naomi the stress of not knowing how best to deal with her acne kept her awake at night.

For Naomi the stress of not knowing how best to deal with her acne kept her awake at night.
Well yeah, I think so actually because obviously when I was like going to sleep that would be when I would be like thinking about it. And like I’d often get quite upset. So yeah I think so. I think like stopping me getting to sleep – yeah not, not staying asleep that was, that would be fine but yeah often like I’d just be lying awake thinking about it, feeling miserable. And particularly [clears throat] particularly when I had the implant and then that made it worse and like that let me up a lot because I felt like it was my fault. Because I felt like I'd been kind of talked into having it and I'd kind of been, I felt a bit misled because obviously they’d said, “Oh, like don’t worry, like if it’s a problem we’ll just take it out and it will go back to normal.” But I felt like I should have said, “No,” that it wasn’t worth the risk and so I, yeah that was particularly kind of yeah, frustrating for me because I felt responsible. And like the whole time before I’d never really felt like I had any control over like what made it better or worse and then suddenly it was like, it had become a lot worse and it was sort of my fault. And yeah so that was quite frustrating.
And that definitely kept me up [laughs]. And then also all the times that I kind of lay awake wondering what to do about it and like yeah. So yeah, yeah I think it did affect my sleep [laughs].
It was “liberating” for Naomi when she wore make-up during sixth form.
It was “liberating” for Naomi when she wore make-up during sixth form.
Naomi was “a bit upset” that her mother didn’t come with her to follow-up appointments.

Naomi was “a bit upset” that her mother didn’t come with her to follow-up appointments.
Would you tend to go to appointments with the GP and the dermatologist just on your own or would you take a family member or friend?
Well when I think, yeah so initially I went with my mum when I was like really young and then and yeah she came with me to the dermatologist like the first time round and then the second time round, she came for the first appointment and then was like, “Oh, well you don’t need me,” and I was like a bit upset about that because I felt like I did, but never mind. and then this time in [university city], my boyfriend came with me and he’s a medical student so that was just kind of reassuring as well because you know, he was there but.
Naomi wasn’t looking for a relationship when she was in school. Now she is in university she does have a boyfriend who is very supportive.

Naomi wasn’t looking for a relationship when she was in school. Now she is in university she does have a boyfriend who is very supportive.
I don’t know, I mean I, I wasn't in a relationship or even looking for one at school and then by the time I got to university I had I’d been through the first lot of Roaccutane (isotretinoin) and my skin was sort of like pretty good to start with and then I met my boyfriend and then it wasn’t until a little later that I had the second and third course of Roaccutane and he was very supportive throughout the whole way. So yeah I do, I don’t think it would really, I mean I don’t know maybe at school if I’d been more confident about myself I would have, I don’t know [laughs]. But I don’t think I was really in the right like frame of mind and I wasn’t really interested so I don’t, I don’t think so, but I don’t know it’s hard to tell.
Yeah. Was that, when you say not in the frame of mind for potential relationships - was that generally or do you think that was related to acne?
I mean I think generally because my, I, yeah I wasn’t really looking. But like also I think if I'd thought about it I didn’t really think that anyone would be interested… I don’t know [laughs]. It was probably part of that but , you know I was also busy with like all my academic stuff and like my friends. So I don’t think it would have been like the only factor but it probably did have some-, well it certainly had an effect on what I thought other people would think when they saw me so I just thought that no-one would find me attractive anyway so it didn't really matter but yeah.
When Naomi was in primary school, no one else had acne. A cream she was prescribed didn’t work and she couldn’t cover her acne up.

When Naomi was in primary school, no one else had acne. A cream she was prescribed didn’t work and she couldn’t cover her acne up.
And because you said you were in primary school when you first started to get acne.
Yeah.
Could you tell me a bit about what it was like for you at that age, being amongst peers you said also didn’t have acne?
Yeah I think I think that was, that was one of the like, yeah I mean it was, not, I wouldn’t say the worst time but it was quite a hard time to have it because, yeah, no-one else, well I mean maybe people, people did have it a bit but like I wasn’t aware of it ‘cos I was just so consumed by how bad mine was. and you know, one time my mum gave me like some like, you know, cover-up stuff to put on it and I just remember like someone in school being like, “What’s that orange stuff on your face?” Because like children don’t understand that you can’t ask questions about things like that and so then I just like never used it again.
Reflecting back on a summer job, Naomi compares her school environment to her work environment. She thinks teenagers put more emphasis on appearance, whereas adults are more “accepting”.
Reflecting back on a summer job, Naomi compares her school environment to her work environment. She thinks teenagers put more emphasis on appearance, whereas adults are more “accepting”.
Naomi used her savings and money she inherited to pay to see a dermatologist privately and thinks it was worth it.
Naomi used her savings and money she inherited to pay to see a dermatologist privately and thinks it was worth it.
Naomi wishes she had been more “insistent” with her GP on finding a product that suited her instead of continuing with products that weren’t working.
Naomi wishes she had been more “insistent” with her GP on finding a product that suited her instead of continuing with products that weren’t working.
Naomi thinks doctors should have checked to see if her medications were working.
Naomi thinks doctors should have checked to see if her medications were working.
Naomi thinks medical professionals should take the emotional side of acne more seriously. Her dermatologist never took time to talk through the emotional impact her acne was having.

Naomi thinks medical professionals should take the emotional side of acne more seriously. Her dermatologist never took time to talk through the emotional impact her acne was having.
And you just, you’d be seen so quickly and they’d just ask, “Is this working? Have you had any side effects? Go and do a pregnancy test. Pick up the prescription.” and yeah so there was never any time to explore the emotional side of the of the condition or, or really like talk about the impact it had on my life because they were always just interested in the medical perspective and I guess like that was what I was looking for from them, I just wanted then to fix it. But like yeah I could never really have explained how much it meant to me and yeah I think that was quite, quite kind of almost hurtful just because, for them, I was just like five minutes of their time just writing out a prescription and yet for me that appointment meant so much and like I’d be worrying about it for days beforehand. And like I’d usually be crying before I even got to the appointment because just like going into the dermatology unit of a hospital was just like so emotional for me and like and then like having to wait for so long. And yeah at one time it was like an hour and a half but usually it wasn’t as bad as that.