I remember asking like, “What is causing this?” as well. And they’re like I was like, “Can I wear make-up?” And they were like, “It’s not caused by the make-up; like you might think it is but it just, it is the hormones and it is like bacteria and stuff.” I don’t really know the exact causes but they were like, “It doesn’t matter if you wear foundation or not; like you’ve either got it or you haven’t got it,” and that made me feel a lot better about it I think cos I knew it wasn’t anything I was doing, so yeh.

So, up until that point did you sort of feel like it might have been because you’ve been wearing foundations and?

Yeah, I felt likeI felt like I was wearing the foundation because I had like bad skin but that it was making it worse, but I felt like it was a bit of a cycle that I couldn’t break. But, they like assured me that like that could be a contributing factor but, you do have a skin condition, it’s not it’s not your diet; it’s not your like what make-up you wear. Cos I was quite active as well, so I did a lot of sport and stuff and but, no they assured me that it was that, and that made me feel a lot better knowing that it wasn’t my fault yeh.

I think it’s always difficult to talk about the difference between causes and triggers. Most people, the cause of their acne is a normal part of puberty and adolescence, and it’s to do with a, you know, complex mix of hormones. Particularly androgens, testosterone, which are higher during puberty. So we’re not normally looking for kind of an underlying cause, because mostly it’s quite well recognised that being in puberty you’re kind of acne-prone. And that’s partly because of the- mostly because of the hormones. And obviously because of those, the way those hormones will then increase sebum production, which in turn will make it a more favourable state for certain bugs. Particularly p. acnes to live on the skin and cause sort of more problems with acne. There are some other kind of rare causes. So you can have other reasons why you might have increased testosterone. For instance, taking anabolic steroids, or something like that. So very, very unusually there can be other causes. But mostly it’s, you know, you’re more likely to have bad acne if you’ve got genetics or bad- family history, family history of bad acne, and then you’re going through puberty. We know that boys tend to have more inflammatory acne in puberty, but girls can have more chronic acne as they get older. So, hormones are the main kind of cause. In terms of triggers, that’s a bit more difficult to kind of untangle. Like any inflammatory state, stress can play a role. Which I think, you know, obviously when people find they’ve got a spot at an important point in their life, and you know, we know that stress can play a role in all of these processes. Other triggers are not so sort of clearly worked out. So people are often interested in diet. And it’s a kind of area of increasing research. Probably some places, some places where they have very low dairy diets have very low acne, even in adolescence. So there may be some role for particularly high dairy diets, and that might have some role on the types of hormones and inflammation they have on their skin. Other triggers. So, smoking doesn’t seem to make acne- so it doesn’t make it better. It’s not clear whether it makes it much worse. But mostly people will get acne, you know, even if they have clean skin, if they don’t have kind of bad skin habits. It’s just unfortunately a part of the way their genetics are and being a teenager.

Can I ask you a bit more about what you knew about acne before you had your first appointment with the GP?

I’d, like I’d looked some things up on the Internet around, cos I used to like think that eating unhealthily made you have acne, or like that, that you were dirty that you had acne. So I used to like look things up on the computer. And there was loads of things like no, it’s not that. It’s just like puberty and it’s like all your hormones and things. And all the GPs kept saying that as well. They were like, You’re young. You’re, you’re going through, like your hormones are all playing up. So it might just sort itself out. But obviously that wasn’t what I wanted to hear. I wanted it to be gone. But, yeah, so I looked up that it was like something to do with like blocking like your pores or something like that. I can’t really remember. But I just, I wanted to see if there was anything like I was doing wrong, like to see if I’d got the acne. Because I was one of, I was, obviously wasn’t one of the only people that I knew with acne. But I’d got it like the worst out of some of my friends. And I was kind of like oh, why have I got it this bad and they haven’t?’ and stuff like that. And, because there used to be like girls in my year who’d wear like loads of make-up and like wouldn’t getting it. And I’d be oh, why do I get it? I don’t wear any make-up. And I used to kind of, that’s why I started searching up things. And it was helpful cos it, it showed me that it was just kind of luck of the draw whether you got it or not.

I think I never really had a lot of faith in what just stuff from the shop would do because, you know even pills and creams weren’t doing anything so I mean like what was a face wash going to do. But I think I think like I kind of, because I was so desperate to do something that might help you know, I was so rigorous and I’d be like washing my face like two or three times a day just trying to do something that would make it better and like people used to say, Oh, you know, you know, you should, you need to drink more water, like that will obviously help. So I was drinking so much water and like [laughs] I’d be at school with like a bottle of water and just like emptying it and then going and refilling it because I was just so desperate to like kind of, I don’t know, I think I thought like maybe it would just wash it out of me or something.

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.

Or things like, for example, they’ll be like, Oh if you do this that’ll be fine, or, you know, It’ll be fine in the summer when you get in the sun. And obviously the sun has-, does make spots better but it doesn’t make them go away. So, I guess it’s also that sort of blaséness being like, Oh if you do this it’ll be fine, and like no, it won’t be, [laughs] like if I do that it they’ll still be there. So I guess for other people who don’t actually-, aren’t actually experiencing or aren’t in that situation at the time, having the spots I guess it’s not-, it’s easier for them to make the blasé comments about it. And as if, I guess it makes you think as if it’s like you’re doing something wrong and that’s the reason you have spots. I guess it’s that sort of blaming in a way.

And it’s not, it’s not that easy, it’s not, it’s not as simple as that, you know, if I stop touching my face then my spots will go away [laughs].

Doesn’t really work like that I don’t think, so yeah.

A lot of people, I think they think that it’s caused by a lot of things which it’s only exacerbated by. And I didnt really realise that until I started doing my research. And I think a lot of things that are really unhelpful are often adverts for like cleansing products and stuff like that, which are just not that scientific. And a lot of them are like oh, you just cleanse the dirt out your face. And I think I found that the most frustrating one, that people would assume that you just didnt wash enough or your skin wasnt clean. Or that it was just because you’re really oily. Whereas Ive found that I actually have very, very dry skin, which was made worse by a lot of the topical creams. Because obviously they dry your skin out a lot. So I was having to use like really heavy moisturisers, and my skin would still be quite dry. It was only really when I was a teenager for a brief bit that I had oily skin. But other than that, my skin is very, very dry. I would have actually to be using like Bio Oil and things like that. And that doesnt, yeah it wouldn’t make my skin oily, so. I think a lot of people think that you just need to wash regularly and it would be okay. A lot of people think it’s because you eat a lot of bad food. But I know that can exacerbate it, but none of those things cause acne, it is a medical condition. And I think a lot of people-, everyone wants to give you a suggestion and advice but a lot of it’s really unscientific. And I know Ive. Yeah [laughs]. This one woman in South Africa sort of suggested that I should try honey and cinnamon. And I think that was the only time I turned round to her and said, Oh, Ill have to, Ill have to go and tell my dermatologist cos hell be so pleased that youve found a cure for acne But, yeah. I think there’s a lot of bad science out there. And people think that spots and having acne are kind of just the same thing, and they are actually quite different.