A-Z

Acne (young people)

Where on the body? Acne and different areas of skin

For the young people we spoke to, most typically had acne on the face. Alexandra didn’t have many spots on her face and her acne tended to be on her back. Acne can affect other parts of the body too, such as the chest. Sometimes doctors examined the skin of the young person at their appointments to see where the acne was and what kind of spots they had. Devan didn’t mind his doctors doing this, but said he wouldn’t want other people to see the acne on his back.

There can be different concerns and difficulties depending on the location of the acne. This can impact on things such as: confidence/emotions, clothes and make-up, sleeping and hobbies (e.g. swimming). Some concerns were held about acne regardless of where it was on the body – such as it being difficult to find a sunscreen that didn’t cause breakouts.
 

Harriet felt more self-conscious about spots on her chest than on her face.

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Age at interview: 21
Sex: Female
Age at diagnosis: 12
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It was mostly just my face. I got a, like a little bit sort of just here [points to chest/collar], and occasionally on my back, but not very badly at all. So that was quite lucky, yeah.

And were there any differences that you felt about the sort of facial acne versus like the sporadic bits on your back and chest?

In a way I was I think more self-conscious when it was not on my face. So it’s kind of more socially acceptable to have acne on your face rather than anywhere on your body. So I wouldn’t sort of, even now if I, I’ll occasionally get sort of a little spot here [points to chest/collar], I wouldn’t wear anything that shows it cos I feel like that has more of an implication of, you know, “She’s not clean” rather than anything else, yeah.

Okay. So would you hide that acne like with clothing or anything?

I’d cover, I’d cover up with clothing. I wouldn’t, I wouldn’t put anything on it though I don’t think, yeah.
 

Ollie found that some medical treatments were easy to use on the face, but not for areas such as the back and shoulders.

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Age at interview: 16
Sex: Male
Age at diagnosis: 13
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I think with the back and the chest acne it's sort of, it's harder to have topical stuff, cos if you have to put it on yourself it's quite hard. I mean it's not too hard but it's, it’s different to having it on your face, and as well sort of topical stuff's a bit harder to put on cos it's over a…especially on my back it was pretty much my shoulders completely, all the way along there, which is a lot a…a bigger area. So, topical stuff isn't, isn’t as good I don’t think, so it's better to take pills and stuff like th- for that. But because I only had a bit on my chest and not, I mean not too much on my face at that point, then it was fine to just put loads on my back. But it's a lot better to, I found anyway, to take Roaccutane (isotretinoin) as the pill because that just, it basically just clears up, it up everywhere, and you don’t even need to focus on specific parts of your body or anything like that.
 

The main body parts affected by acne have changed for Deborah over time.

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Age at interview: 25
Sex: Female
Age at diagnosis: 12
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When I was younger it tended to be more on my face, across my nose and cheeks and my forehead. Now it tends to be more along my jaw line. I still get them all across the front of my chest, and all the way down my back. The ones on my back tend to be smaller now, which is good. But I don't know, it's still things like when you're washing yourself in the shower and you can feel all of them. Even though I can't necessarily see them as much, you still know they're there. I don't tend to get them anywhere else. So my arms, my legs, the rest of, the rest of my body seems to be okay, but. Yeah it's, it's not pleasant to, to have them everywhere. Especially when you can't get to them, almost. Like the ones on your face you can make sure you're washing and keeping clean, and things like that. But the ones down your back, you can't really help that. Try to wear more natural fabrics and things like that, when I have a breakout, just so they can breathe a bit better. Like I say, I'll wear things that have more of a collar or go higher up, just to cover them up. But that's not, it's not wholly impractical. A little bit when it's summer, because don't want to be covered up, or end with a gazillion tan lines. But it's, it's, it’s been okay.
Acne on the face

The face was the main location where most young people had acne. They thought this was a difficult place because it’s often visible. Harriet said this visibility meant acne was “an outward struggle”. Molly found it embarrassing when spots bleed and other people could see.
 

Chris was self-conscious about people noticing acne on his face.

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Age at interview: 20
Sex: Male
Age at diagnosis: 17
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When it’s on your face it’s just like every time you look in the mirror like you see it, like, if you, if you’re looking at someone in the, you know, you usually make eye contact, but if you see their eyes move - like even if it’s just down to like, say, this side of your face, you know, that they’re kind of, they’re kind of looking and you, it just makes you feel really self-conscious. 

And, and, yeah, like every time you look in a mirror, I don’t know, even from a distance you can see like it’s, when it’s flaring up and it’s just really difficult to deal with. 
 
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Naomi didn’t like to do hobbies (like swimming) which got her face wet because her make-up would come off.

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Age at interview: 22
Sex: Female
Age at diagnosis: 9
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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.

Acne often affects the face because there are a lot of sebaceous glands there (see causes). Some people found their acne affected all parts of their face, for others there were specific bits. This included:

•    T zone (forehead and/or nose)
•    cheeks
•    jawline
•    chin
•    ears/earlobes
•    hairline and scalp. 

Deborah gets large spots on her jawline, which were painful if she touched or knocked them. Harriet waited till her acne had mostly cleared up before getting her ears pierced as she sometimes got pimples there. Ish said the parts of his face affected by acne could change on a day-by-day basis. Ollie and Abbie had both changed their hairstyles to keep their hair off their foreheads (see also: skincare and self-styling).
 

Deborah sometimes accidentally knocks spots on her jaw and nose.

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Age at interview: 25
Sex: Female
Age at diagnosis: 12
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The soreness definitely is an issue. For example the ones I've got round my jaw line here [points to right jawline] are really quite sore at the moment. So much so that I'll sort of wince if I catch one of them, which I did at work the other day. And you kind of don't want to show that you, you're in pain. Cos then people go, ‘Oh, are you alright?’ And then you have to explain, ‘Oh, I've caught one of my zits.’ And that's embarrassing. So that can be quite difficult. I had one on my nose a couple of days ago that I just caught when I was scratching, and it bled. And I couldn't see that it was bleeding, and someone else had to say, "Oh, did you realise you're bleeding?" And that's quite embarrassing, to have to go and then patch yourself up, and have a scab on your nose for a couple of days. 
Some people talked about having spots on their neck. Alexandra used to get a few spots there and kept her hair long, rather than getting it cut short, to cover them up. Deborah tended to wear high-collar tops/dresses when she had a spot on her neck.

Having spots on sensitive parts of the face, such as near the eyes and lips, could have extra concerns too. Hester once had a large and inflamed spot which “ended up tugging on my mouth” when she turned her head. This was uncomfortable and knocked her confidence.
 

Hester found some topical acne treatments were too strong to put on spots near sensitive facial features.

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Age at interview: 21
Sex: Female
Age at diagnosis: 15
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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.
Some people (mostly women but sometimes men) used make-up to cover up their spots. Marga described make-up as a “safety net” and Chris found blemish balm gave “a nice matte finish to the skin”. Some people said make-up didn’t always cover spots very well and could even highlight the acne even more than wearing none. Yi thinks she used “the wrong shade” of foundation and found it wore off after a few hours.

Shaving facial hair was an issue for some men with acne on their faces. Will described it as a “catch 22” because growing hairs irritated his spots but shaving was painful.
 

Ish found shaving difficult with facial acne.

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Age at interview: 22
Sex: Male
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I mean, yeah, especially if you have shave and you have acne, that’s probably the worst combination you could ever have, because your skin, that alone, you know, just when you’re shaving there’s a blade close to your skin which is already taking that hair off, then you’re probably going to end up slicing acne into little pieces and you’re going to bleed more. It does sound disgusting but it’s like, how it is. So, no matter how you look at it, if you shave or something like that, it’s just going to make it worse. 

Was that a concern for you when you sort of first started shaving, if you had acne at that time?

Yeah, I just wouldn’t shave. 

Yeah. 

To be honest like, it comes to that point where you experience it once or twice and you know, you’re using an aftershave but you’re still using prescribed creams on your face that just like combines, and it’s either one or the other basically. So you shouldn’t really combine chemicals to begin with. So that’s just going to make it worse. 
Acne on the back and shoulders

Some people had acne on their back and shoulders as well as their face. This had extra difficulties, like:

•    reaching to apply topical creams
•    pain whilst lying down – Hester took painkillers to get to sleep at night
•    blood on clothes (e.g. t-shirts) and bedding from popped spots
•    pain when clothes pressed on back spots (tight tops, bra straps)
•    embarrassment wearing some clothes (like summer/beach clothes, backless dresses)
•    others seeing the back acne (e.g. when changing for PE classes at school)

Eli, Deborah, Hester and Naomi found that their back acne cleared up quicker than that on their faces. The acne on Devan’s back though has cleared up slower and he thinks this is because it’s tricky to put on topical medicines. Some found that spots on the back, where the skin is thicker than the face, were more painful and prone to scarring. Naomi’s parents sometimes helped her to put the treatments on the spots she had on her back. 

Clothes and make-up were sometimes used to hide back acne, as for Alexandra. Hester didn’t feel comfortable dressing up whilst she had spots on her back. Deborah’s thrown away white t-shirts as well as bedding that have been stained with blood when back spots have popped.
 

Alexandra researched about different bra fastenings which she hoped might be less painful with back acne.

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Age at interview: 22
Sex: Female
Age at diagnosis: 13
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With the bra fastenings…

Yeah.

… is that something that you did research on, when you looked up about…

Oh, yeah. I did look up some stuff about that. Like, for instance, you have bras that can do a clip in the middle so you get the bra straps instead of being like that you get them to cross. But it’s, as I say, it’s quite difficult for my size at the moment, I’m quite small but my cup size is quite big so it’s kind of difficult to get the good bra straps for that. And I would like to feel comfortable in that department as well, that you don’t walk around feeling like, OK you can, everyone can see, so I’m quite comf-, used to looking at clothing that fits every part of the body that I have now and how it also interacts with my skin. So I still feel comfortable, more comfortable with various clothes that kind of cover my spots up a little bit, even if I have tiny little spots, then I would still want to cover them up as much as… I feel comfortable in, yeah.
 
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Alexandra wore a bandage under her bra to help with pain and reduce spots popping on her back.

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Age at interview: 22
Sex: Female
Age at diagnosis: 13
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I do know that from my, my peers and my friends none of them had acne on their back, so I did feel a bit like, “OK, am I the only one here?” Now some of them sometimes had a little bit of, like a spot or something. But that was one [laughs].

And I didn’t have that, I had lots of them and very severe ones as well, and painful ones, and I my mom used to help me as well, so she would sometimes with the bigger ones, if they were under my bra strap and they would hurt she would get a bandage on it. So my mom used to help me as well, so she would sometimes with the bigger ones, if they were under my bra strap and they would hurt she would get a bandage on it. So I sometimes had four bandages on my back during a day. And that did help a little bit, you know, it released some of the pain.

And then if it would erupt, yeah, it’s not like I could really clearly feel them popping or something, that would sound very weird, but you do sometimes when I went to the loos in in my secondary school building I would check sometimes if something had happened, yeah. Because it would, you know, you don’t want to get it, to be on your shirt or something and people could see that. So I used to never wear anything white for instance. 
Many people saw back acne as more embarrassing than having it on the face. They thought it was less socially accepted. Tom said it had been difficult to know how severe your back acne was because it’s hard to see in the mirror. He asked family members to check his back and was relieved not to have any. Naomi thought it was a better location than the face though, as it’s less frequently seen by others.
 

Sarah remembers a time when spots on her back affected her choice of clothing, but she’s unsure why this was the case.

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Age at interview: 22
Sex: Female
Age at diagnosis: 16
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Every so often I’ve had a few spots on my back and a few on my chest but nowhere near as many as I’ve had on my face. And right now I’m not actually sure but I think I’m, I probably don’t have any on my chest and my back.

Do the different locations have any sort of significance for you in terms of the way you feel about it?

Now that is an interesting question because I do remember once considering wearing a backless dress and deciding not to because of acne I had on my back which is interesting because why would that be more of a problem? Is it that it’s a lot harder to cover it up with makeup? I mean I guess I could have had a friend to help me but it’s not really to ask, you want to ask of your friend. It could also be because I’ve got a kind of a faint birth mark on my back but I definitely remember it being the acne that was the problem. Is it because it somehow seems acceptable to have acne on your face and not on your back? That could be it. I remember my housemate last year, she had had acne and had taken a course of I think it was a steroid cream that had cleared it up. And kind of going on and on about how she had ‘bacne’ and how much she hated it. I think that kind of created a bit of a stigma about back acne that for some reason I don’t feel about face acne.

And was the occasion with the dress was that since you had that housemate or was that a previous experience?

I think it was since I had that housemate, I think she was a bad influence on me [laughs]. It’s not something I think of very much but this is primarily I guess because I don’t expose my back that often.
 

Devan didn’t want his peers to see his back acne when changing clothes for PE.

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Age at interview: 18
Sex: Male
Age at diagnosis: 13
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Could you tell me a bit about what you first noticed and where you first noticed acne coming up?

It was, I sort of first noticed it on my face itself. And that was one of more places, one of the places which was sort of the worst. It was predominantly my face through secondary school… as well purely because people didn’t see my other, you know, my back, they didn’t see my back. Or they’d only see that if it was during P.E. and you’d have to get changed so they’d only see it then. But I’d sort of found different ways to come around that, to stop people from noticing by, say, wearing my P.E., P.E. clothes underneath my school uniform and different things like that. To just sort of save that hassle …

Yeah.

… of having to deal with people like that.
Acne on the chest

Some people experienced acne on their chests. Often they used clothes to cover this area of the body up. Tom didn’t have acne on his chest, but he thought it could be a difficult body part and would’ve rubbed on his judo robe. 

Emma had some chest acne and used to feel self-conscious when getting changed for PE classes. She avoided going swimming and would wear clothes to cover the area when with friends. She had keloid (raised) scarring on her chest which she had steroid injections for. The treatment helped flatten Emma’s scars, which made her feel more confident.
 

Emma chose her clothes carefully to cover spots on her chest.

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Age at interview: 20
Sex: Female
Age at diagnosis: 10
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Sort of being quite conscious of having sort of spots, particularly on my chest, meant I didn't go swimming for a very long time, because it was on display sort of then and it sort of affected anything from sort of the clothes that I bought and things like that. So it was more me being self-conscious about it and not wanting to show it that had an impact on the things that I did.

Could you say a bit more about the clothes that you bought and how it had an impact?

Yeah, so because my scarring is in this sort of area [points to chest] I’ve got a high neck thing on now, but I didn't buy any clothes that could possibly show it for quite a long time. Because I didn't want anybody to see the sort of the scarring and the scabs and things. which was always a bit of a shame, because when I’d go shopping with my friends and it would be like, ‘arr this is really nice’ and I’d be like well, I’d sort of pretended I didn't like it so much, because I didn't want it to show. Yeah and that sort of, that didn't change until I was about sort of 16 and my mum went and did some shopping and she bought me some tops which I really liked and I wanted to wear despite them showing it, so. 

Do you remember what it was like when you did do that, when you started wearing tops which maybe showed a little bit more of the skin?

I guess the very first time that I ever wore one that my mum had bought me that showed it, I was a little bit self-conscious. But sort of, I think after I realised that no-one was sort of saying anything or looking then I started to sort of mind less having it on show. 
Other body parts and acne

Rebecca also had some spots on her arms as well as her back and face. She sometimes picked at these spots, a behaviour which later developed into a psychological condition (called dermatillomania) after her acne had cleared up. This included Rebecca picking the skin on areas of her body where she had never had acne, such as the legs.
 
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Nina has had spots and ingrown hairs in places where she shaved, such as her armpits and bikini line, in addition to her face and back.

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Age at interview: 20
Sex: Female
Age at diagnosis: 12
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When I stopped taking my antibiotics last year I also developed this weird kind of like oh I forget what it’s called it’s the type where you get like nodule type really horrible really big painful kind of infections in areas that I shave so like armpits and bikini area which is really horrible because it’s painful and also like makes you incredibly self-conscious even more so perhaps than my face. And I also since I had my ears pierced on my earlobes I tend to get sometimes my, the actual earholes get infected or just like around on my earlobes, yeah. That’s pretty much, I mean frankly at least it’s like yeah, and the other thing is that from my back because I did a lot of sport that’s something that really bothers me is that the scars on my back from having had spots there in the summer and my face thankfully, you know, cos the like really big ones I tend to get them either on my neck or in areas that I shave and those do scar a bit. 
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