Facing skin health issues
- Lauren Hellicar
- Mar 5
- 6 min read
“You don’t mind if a few medical students sit in on our consultation, do you?” This seemingly innocuous question came from a consultant dermatologist at a major teaching hospital in Scotland in the late 90s. I was there because I had severe cystic acne. At 17 years old and with next to no confidence, I didn’t really feel like I had much choice. So low was my general mood that I wasn’t even sure what a personal boundary looked like.
I was a lab rat – a specimen for observation by a group of about a dozen (I can’t be exactly sure, as I couldn’t look them in the eye) medical students. They couldn’t have been more than two or three years older than me. These were essentially my peers, staring at my make-up-free, inflamed face, while their teacher – my dermatologist – explained to them using hand-drawn diagrams the mechanisms behind my dis-eased skin.
“Next year will be different… I’m getting older so this can’t last forever… It’s a teenage problem, after all…” Hopes along these lines regularly cycled through my mind during the more severe of the skin flare ups that blighted almost two decades of my teenage and younger adult years.
“You need to lower your expectations. Lots of people live with skin issues. It’s normal.” This is real “advice” I received from a GP. He wasn’t looking at a patient with an immediately life-threatening condition, so he couldn’t see why I was so disturbed by my skin.
He couldn’t get his head around the fact that I would have done just about anything to make it go away. It affected my face and neck mostly, with some hidden in my hair. I even used to wish it would move to a part of my body that I could hide with clothes. My hair was never tied back. If I could use this veil to hide just a few of the bright red beacons flashing furiously around my temples and cheeks, I’d grab that chance with both hands.
I felt disgusting, worried that people would think I was unclean. But on the other hand, I was hearing, “The problem is that you wash too often.” This was one unsolicited explanation that was helpfully doled out for my unfathomable outbreaks. Those explaining most likely had good, or at least neutral, intentions with their words of wisdom. But the message I was receiving was that it was within my control to fix the problem. I tried. I couldn’t fix it. So I felt like a failure on top of feeling like a hideous mess. I’ve no doubt people with health issues besides those that affect the skin can relate to these feelings.
Acne isn’t a life-threatening condition, is it? What people like the aforementioned GP, who have never had a visible skin condition, probably can’t fully appreciate is that it has a huge impact on your self-esteem. And if that self-esteem was already on shaky ground, as it most likely is for a great many teenagers, and others, it can make matters a million times worse.
Highlighting the potentially serious mental health consequences, a 2021 meta-analysis in the journal Medicine found that, “... acne may significantly increase suicide risk. Clinicians should actively treat acne and consider suicide screening.”
While there were undoubtedly other factors at play in my teenage mental state, my skin problems were there with me all the time, from when I woke to when I went to sleep, and sometimes during dreams. Occasionally, it improved – I had such high hopes during these “good skin phases” – but it would eventually flare up again, and I’d be back to shattered hopes and rock-bottom self-esteem.
Every antibiotics prescription (and there were many) presented itself as the next little slip of hope, and every time I was left hugely disappointed. I wasn’t aware of the devastating effect that antibiotics, especially when doled out on repeat, can have on the microbiome until much later. But surely, all those bug killing capsules did the bacterial balance in my gut – and on my skin – no good whatsoever. With a compromised microbiome, I was unwittingly supporting a vicious cycle of inflammation.
To make matters even worse, I took isotretinoin (brand name: Roaccutane), a seriously heavy duty acne drug with a side effects list to make your eyes water, not once but twice.
For those unfamiliar with the medication, the British National Formulary entry on the NICE website lists the following side effects for Roaccutane. Note the inclusion of “skin reactions”.
“Common or very common
Anaemia; arthralgia; back pain; cheilitis; dry eye; eye discomfort; eye inflammation; haemorrhage; headache; increased risk of infection; myalgia; nasal dryness; neutropenia; proteinuria; skin fragility (trauma may cause blistering); skin reactions; thrombocytopenia; thrombocytosis”
Some side-effects are listed under rare, which is all well and good until they happen to you or a loved one. Potential pitfalls on the “rare or very rare” list include a range of serious physical health complaints alongside:
Anxiety and depression
Psychotic disorder
Suicidal behaviour
Additionally, due to the drug’s potential to cause foetal malformations, “The MHRA advises that women and girls of childbearing potential being treated with the oral retinoids acitretin, alitretinoin, or isotretinoin must be supported on a Pregnancy Prevention Programme with regular follow-up and pregnancy testing.”
I also took another acne treatment that affects the reproductive system when I was about 17. I went on a combined pill called Dianette, which isn’t prescribed solely as contraception, probably because there are other options with less serious potential side-effects. According to the government website, there is “sufficient evidence that co-cyprindiol [Dianette is a brand name] has a 1.5–2 times statistically significant increase in VTE risk (deep vein thrombosis, DVT, or pulmonary embolism, PE) compared with levonorgestrel-containing pills.”
My quest for the holy grail of good skin also went beyond pharmaceuticals. When beautiful cosmetics sales women with immaculate complexions told me they could help, I took whatever they were punting, at any cost I could afford. I tried products to dry my skin out and medicate the life out of it. I took their chemical peels that left big flaky chunks of skin falling off my raw, stinging face, thinking it was definitely going to work this time.
The key point I was missing in this constant fight against the spots was that I was also fighting against my poor skin – the part of me that was telling me, visibly, that my body was struggling to cope with something. And here I was, giving it even more to cope with.
These kind saleswomen (which they were – they didn’t know any better) also said I could have the privilege of an appointment with a highly regarded private dermatologist with whom they had some kind of partnership. “Sold! Where do I empty my bank account?”
I saw this dermatologist at his private practice, where he looked at my “severe acne vulgaris” and asked if I’d tried isotretinoin. Yes, I said, and I didn’t have a great experience with side effects. He assured me it had improved in that decade or so and asked if I wanted to try it again. I agreed. Maybe this time it would be different…
With hindsight, I would have gone nowhere near any of the lotions, potions, and pills I took for my skin. These things are designed to “fight” a problem, when what my body really needed was support.
So, what would I have done differently?
I’d live by the simple health rules that I live by now, which work well, for my skin and for my general health. It comes down to:
Supporting your body rather than fighting symptoms. It’s telling you it’s struggling and needs help. Think of how you’d treat someone you care about, and adopt that way of thinking about your own body.
Nourishing your body from the inside out. Beauty is not only skin deep. The skin is our first defence against environmental stressors. It needs nourishment to stay healthy and provide us with protection.
Only applying to your skin substances that don’t toxify the system. Our skin has pores that let in the substances we apply. It might only be a tiny amount of a toxic substance but lots of tiny amounts of toxic substances add up to a large amount for the liver to deal with.
Always read the labels on anything you put on or in your body, including food, cosmetics, and medications. If you don’t know what an ingredient is or what it does, find out.
These days, it feels like we’re constantly bombarded with attempts to convince us that our health is not within our power and that we can’t possibly be healthy, natural humans without external “experts”, lotions, and potions to keep us well. Of course, seeking help and guidance to achieve optimal health can be a positive step to take, but my advice is not to let anyone take the power out of your hands. You know best for you. Always ask questions about what you’re taking into or putting onto your body. It’s incredibly important to understand the full picture.
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