Most people’s acne included a mix of different kinds of spots, such as:
- blackheads: small blocked pores that often look black or brown in colour
- whiteheads: small blocked pores that look white or yellow in colour
- papules: inflamed (red) lumps, slightly raised from the skin and small (less than 5mm in size)
- pustules: like papules, but with a tip of pus
- nodules and cysts: deeply inflamed spots (more than 5mm in size)
Sometimes the young people we talked to knew they had a particular kind of acne, based on the main spot type they got. Devan’s GP worked this out by examining his skin to see and touch the spots.
Having visible acne was a concern, especially on parts of the body like the face. Some people had times when their acne suddenly became more severe, which they described as a “breakout” or “flare-up”.
Acne spots are often red because the skin is inflamed. They can look ‘swollen’, ‘raw’ and ‘angry’. People would ask Rachael questions because her acne “looks really painful”, even when it didn’t hurt. Tom felt his skin was “covered in red things.” Becky and Ollie avoided wearing white or brightly coloured clothing because they worried it would make the redness of their acne stand out more.
Doing sports and getting sunburnt were mentioned as examples when the skin could become redder, but others found exercise and sunlight helped their skins. A few people said their acne sometimes looked like a bruise or a rash when the spots clustered together.
Many found their spots were raised (sticking out from the skin). Sometimes people could see that the spots contained pus. This made the skin “uneven” or “lumpy”, because spots were “protruding” from the skin. Shu En’s spots weren’t always visible but felt “under the skin.” Different kinds of acne spots meant it was sometimes still visible with makeup on, even if the redness was covered up.
Some people said their skin became oilier with acne, but others struggled with dry and flaking skin on some parts of their face and body. Alexandra said her skin was “greasy” when she had acne and others, like Abbie and Eli, found theirs more shiny than usual.
‘Combination skin’ means that the person has both oily and dry areas of skin. This was a problem for Nina, who “struggled” because her skin was “very oily” but cleansing products would “dry up the skin” and cause “flaking off.” As spots dried up, many noticed that their skin would peel and flake as well.
Acne severity is often measured medically in four main categories:
- moderately severe
Some people were told by their doctors which category their acne was in, based on how many spots they had and whether they’re painful or inflamed. Rachael was upset hearing she had “moderately severe” acne, but others found it useful to know. Marga found it good seeing where she was “on the scale” because it made the “logic” behind trying different treatments “more easily understandable.”
Pain and when spots are popped or burst
Acne spots can be painful, especially deep and inflamed spots, but this is not always the case. Sarah’s acne was mostly small spots without pain. Most people said their acne was ‘uncomfortable’ at times. Fatima described hers as feeling “like an insect bite.” Kosta finds his skin sometimes “aches”. For others, their acne was excruciating nearly all the time. Hester had to take painkillers to get to sleep at night because of the pain. She couldn’t put on makeup because removing it felt “like taking a layer of my skin off.”
Some people found their acne itchy, which made them want to scratch. Eli’s skin is itchy after she takes off her makeup. Sometimes they scratched their skin without realising they were doing it.
Lots of people said they knew that they shouldn’t scratch or pick at their acne. Kosta has heard it causes scarring. Many people found it was difficult not to pick or squeeze spots, and most had done this at some point. Sometimes they hoped that squeezing a spot would make it ‘die down’ and give relief, which some found it could, but it can also cause it to become more sore and visible (inflamed, bleed, scab over). Bleeding and oozing spots could then stain clothes, bedding and towels.
Knocks to the skin could make spots burst accidentally. Popped or burst spots can be painful and people often felt embarrassed about it. Deborah will “wince” when she accidentally catches a spot. Some found that topical treatments stung when applied, but this was sometimes seen as a good sign that they were ‘working’.
Scars and lasting changes to the skin
Many people had scars from their acne. Scars come in different forms – some are:
- a different colour to the normal skin (red, dark),
- stick out from the skin (raised, thickened), or
- pitted (like dents, gouges or ‘craters’ in the skin).
Most people with acne scarring had a range of scars. Alexandra’s skin is thicker from the scar tissue and she also has some “like a crater.” Deborah has enlarged pores and describes her skin as “blotchy.” Emma had chickenpox which she thinks interacted with her acne and may have caused her more scarring. She had some keloid scarring on her chest from acne for which she’s had steroid injection treatment to make them flatter.
Some people used makeup to cover their acne scarring (see also the section on skincare practices and styling). Many found it was easier to cover the scarring than it had been with acne.
Although people sometimes felt embarrassed about their acne scarring, Emma, Nina and Hester all thought it was better than having active and painful acne.