I was showing someone a photograph of my cat when I realised just how bad things had become. “Whoa, that’s a lot of selfies,” they said, prompting sweat to start trickling out of every orifice in my body. It was a lot of selfies: 106, to be precise. They weren’t the pretty kind that you’d post on Instagram in exchange for some flame emojis, either. They were close-up, brightly lit shots of different parts of my face, tracking the progress of various skin issues I’d been experiencing. “It’s for an article,” I snapped back, quickly grabbing my phone out of this poor person’s hands.
My skin wasn’t something I ever had any intention of writing about; the plan was simply to smother myself in concealer and whatever fancy product I could afford until it improved. But then I started speaking to friends, and it transpired that skin anxiety was something many of us were experiencing. For all of us, it was also taking its toll.
Before last summer, I’d never had any problems with my skin. In fact, it was often something people complimented me on. “You must drink a lot of water!” they’d say, rather vexingly. “What products do you use?” The truth is that while I did drink a lot of water and use a fair amount of products, I never paid particular attention to my skin because I didn’t need to. I’d watched, over the years, as friends would go on roaccutane, or other acne treatments, and complain about having dry lips and not being able to drink. It always made me feel grateful that my skin wasn’t something I had to think about.
Then I went through a break-up and suddenly something changed. I noticed a red cluster of spots gathering on the lower left side of my cheek; it was subtle at first, only visible to those who knew it was there. To me, though, it was all I could see when I looked in the mirror. Don’t get me wrong, I’d had spots before. But this was different; it looked like an allergic reaction. Easy to fix, I thought. I put it down to a new moisturiser I’d started using, and went to the pharmacy to collect some antihistamines.
But after two weeks, the cluster was still there – and it was getting worse. Soon, my entire left cheek was covered in tiny red bumps and spots. Anyone you speak to about skin problems will tell you the worst thing you can do is to touch your face, or “pick your skin” and try to pop the spots. I resisted for a while, until I returned home one Friday evening after a few too many glasses of wine. I started to hack away. The next morning, I woke up with a very red face.
It was at this point that I started seeking professional help, reaching out to various dermatologists and skin care clinics. One person suggested I try chemical peels – so I did. Six of them, actually. The problem got worse, as did my bank balance. Another suggested hydrotherapy facials; I had two, and while they brightened my complexion, my left cheek remained covered in spots. I tried more expensive products, too – like those from 111 Skin and Dr Barbara Sturm. While they certainly helped even out my skin tone, the spots didn’t go. I was told by one dermatologist that this was a form of cystic acne, and that it was common for women in their late twenties. Fine, but now what?
Having to deal with the reality of acne is hard enough, but such catastrophising can lead to anxiety and depression
After a few months, my confidence was at an all-time low. I felt frustrated, angry and insecure, none of which was helped by the fact that I’d spent a lot of time and money trying to fix my face to no avail. I now know that this only made matters worse, which is a common side effect of having any kind of skin issue. According to one study, there is a 63 per cent increased risk of depression in a person with acne compared to someone without, while another study found that 90 per cent of people with the skin condition rosacea reported lower self-esteem.
“Imperfections on the skin are easily conflated with ideas of being imperfect in yourself in some way,” explains Dr Marc Hekster, a clinical psychologist at The Summit Clinic. “Our skin is the largest organ in the human body; it’s what other people see and associate with who you are.” In short, the stakes are high for our skin. With this in mind, it’s no wonder that it can have such an impact on us when something appears to be going wrong. The trouble is that worrying about it can actually make it worse.
“Our skin is incredibly sensitive, but so is our psychosocial response to our skin,” says Dr Sally Austen, a consultant clinical psychologist. “The impact of our own perception of our skin can be so significant that in 2021, the National Institute for Health and Care Excellence recommended that some people with severe acne would require mental health support alongside any physical treatment options.”
This made a lot of sense. I was caught in a terrible cycle of stress that was making my skin issues worse. My problems were also exacerbated by social media. Having liked a few skincare posts by beauty bloggers, I witnessed my Instagram explore page transform into a panoply of dermatology and plastic surgery. Trends like “donut skin” – or impossibly dewy, clear skin smothered in either oil or sweat, though it’s usually the former – were everywhere, alongside photographs of Hailey Bieber’s impossibly smooth complexion. I saw before and after photographs of people who’d had ludicrously expensive laser treatments on their face. Then came the posts about botox. Buccal fat. Nose jobs.
Suddenly, I couldn’t look in the mirror without thinking about how much work my face needed. I wanted my nose reduced. My buccal fat removed. My lips plumped. Nothing was good enough on its own. “Having to deal with the reality of acne is hard enough, but such catastrophising can lead to anxiety and depression,” explains Dr Austen. “[So] we need to tease out what is within our own control; what thoughts we will allow to populate our minds and what thoughts need to be challenged.” If you allow yourself to spiral, she suggests, matters will only get worse. “Breaking this cycle by questioning the validity of our own negative automatic thoughts is crucial. It’s not easy to do at first, but the more you practice, the easier it will be.”
The problems I was experiencing were now two-fold, though. Not only did I need to try and fix my skin, I needed to rewire my brain to help me accept it if I couldn’t. This is no mean feat. As women, we’re constantly bombarded with messaging about how we can and should improve the way we look. The result is that we’re encouraged to strive for perfection in all aspects of our appearance, incorporating whatever trends and treatments we have access to in order to meet a set of societal standards that are increasingly impossible to achieve unless you’re Kendall Jenner. In Trick Mirror, her 2019 collection of essays, journalist Jia Tolentino terms this “self-optimisation”.
It wasn’t until I met the wonderful Liz at the Dr Tatiana Clinic in central London that I finally got some answers about my skin issues. She took me through a series of scans and examinations and concluded the possible causes of my acne cluster: stress, diet, sun damage, and using too many products on my skin. She prescribed me with a vitamin C serum to use, before applying SPF (to give me better protection from the sun) and Tretinoin 0.025 per cent cream, which is a retinoid.
Anyone who knows anything about skincare will already be familiar with retinol – it’s often hailed by beauty bloggers for its anti-ageing properties. My only experience with it, though, left me with completely dried-out skin, so I stopped using it. Liz assured me that this one, which was of a much lower percentage than what I’d used before, would work well for me – and it really has. Within a few weeks, my cluster of acne cleared up completely. I also improved my diet and cut back on coffee and, erm, cigarettes. That helped enormously, too.
I still have skin issues, like redness, spots, and blackheads all across my nose. But I’ve taken a more holistic approach to it. Gone are all the endless products I was applying to my face. Instead, I’m sticking to a fairly straightforward cleansing, toning and moisturising routine, with the odd serum (Dr Sturm’s hyaluronic acid is truly worth every penny, as is Sunday Riley’s vitamin C serum) and an SPF 50 moisturiser. I’ve also started taking supplements: omega-3, mainly, in the hope that this will boost my skin health further.
Most importantly, though, I’ve started to turn down the noise in my head. This hasn’t been easy, and has only been achievable through a combination of self-reflection, therapy, and learning to shift my understanding of what makes me valuable. I know that the skin issues I had weren’t anywhere near as bad as what some people go through. But having seen a glimpse of what skin concerns can do to our mental health, I know this is something we need to take seriously.
Beyond reaching self-acceptance, there are other things we can do. And not just for ourselves. “I think it’s important to think carefully about the impact our own views have on others,” says Hekster. Having been through my own skin saga, I noticed I became more aware of – and judgemental about – other people’s complexions. I’ve had to actively try to stop doing it. After all, I’d hate to think about people using my skin issues as fodder for gossip, or use it to make sweeping assumptions about my lifestyle – that I must be somehow dirty, or not take good care of myself.
Ultimately, it would benefit all of us to place less importance on the way others look. And while that might seem like an impossible task in a world fixated on appearance, we have to start somewhere.
