What adult acne and social media can create more transparency in 2021
My cystic acne started in my early twenties. On what had been an incredibly fair complexion throughout puberty and high school, deep pimples began to form almost every day, leaving my face riddled with red scars next to new, angry bumps. I have spent countless evenings in my bathroom pricking, healing, or just watching the rashes from my cheekbones to my jaw. This continued until my thirties. (Although I was never diagnosed with a Body Dysmorphic Disorder, I may have suffered from it; a 2020 study showed a high prevalence in people with acne.) Every morning I put on makeup. I avoided eye contact with my colleagues and even my friends.
At the time, I felt lonely, but I wasn’t. According to the American Academy of Dermatology, up to 15% of women have acne, but it is on the increase in adults, women and men, and some believe the numbers are higher. “Based on surveys and my own experience, I would say that up to 40% of women in their 30s suffer from some form of acne,” says New York dermatologist Joshua Zeichner.
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Bridging this gap between perception and reality – and helping acne sufferers feel supported – is the goal of the social media acne positivity movement. Influencers with hundreds of thousands of followers proudly post unfiltered, makeup-free selfies of pimples and scars, and acne care brands like Starface, ZitSticka and Banish are trying to normalize the disease they treat , rather than shame her.
Even celebrities are joining us. “To all those struggling with this, know that you are not alone and that you are still doing great! MY ACNE NEVER STOPPED ME, ”actress KekePalmer wrote of her acne reveal on Instagram last December, to nearly 1.3 million likes.
“I’ve struggled with acne my whole life and have never seen people like me in skin care ads,” says MikZazon, 25 (aka @mikzazon), a positive influencer for the body and acne in Columbus, Ohio, with nearly 900,000 subscribers. “I thought I was that ugly person with some kind of illness; that people were looking at me and just wanted to fix me. The acne community wants to show off normal skin. ”
But there’s a big difference between conforming to beauty standards and battling the stigma, stress, and even physical pain that can accompany acne. “Many people with severe acne are more likely to be depressed,” says Karan Lal, DO, MS, a dermatologist in Worcester, Massachusetts, who specializes in pediatric and adult acne. A 2020 review of 42 studies in the Journal of the American Academy of Dermatology showed a significant link between acne and depression and anxiety.
“Almost every day, [an adult patient]cries in my office about their acne, ”says Cybele Fishman, MD, a holistic dermatologist in New York City and my dermatologist. “When I ask, ‘How does that make you feel? the responses I get are, “I’m not signing up for projects at work that will have a presentation or” I haven’t had sex in two years because I’m terrified of taking my makeup off. It makes them feel really, really, really bad.
Dermatologists often treat adult acne with prescription topical retinoids, birth control pills, antibiotics, or an off-label oral medication called spironolactone (which blocks hormones that cause acne in women). Two new topical prescriptions, Winlevi and Aklief, have entered the market in the past two years. But oral isotretinoin (which goes by many brand names but is commonly referred to by the now-discontinued name of Accutane) is considered a potential remedy for acne, according to the American Osteopathic College of Dermatology (AOCD), because about half of the patients can stop treatment after a course of four to six months. “It’s very effective,” says Lal. However, rumors of potentially dangerous side effects have held back patients, including me.
Even though I was taking isotretinoin and it worked, I was worried that I would only cure a symptom of an underlying medical problem, instead of the problem itself. My doctors ruled out polycystic ovary syndrome, a serious condition that can trigger acne (and which was, in fact, the cause of Palmer’s flare-ups). In my quest to find a solution, I researched allergy testing, special diets, and herbal remedies; I have tried hundreds of creams, high tech tools, and even meditation. The answer, it seemed, was still just another Google rabbit hole. Yet it never really was. Eventually, it was clear that the stress of my struggle was much worse on my body than any pill I avoided.
“People think Accutane is an aggressive drug, but it’s just a[derivative of ] vitamin A, and every cell in your body has receptors for it. It’s no stranger, ”says Fishman, who avoids prescribing oral antibiotics for acne because they can cause long-term resistance and microbiome imbalances.
According to the AOCD, the most common side effects of isotretinoin are very dry skin, lips and nose, and itchy eyes. There is also an extremely high risk of birth defects if a patient becomes pregnant (abstinence or two forms of birth control are needed). But Lal and Fishman say the data regarding bigger concerns such as adverse effects on mental health or digestion have been controversial and may be overstated.
Zazon is one of a handful of positive skin influencers who have chosen to take isotretinoin and share their experience. “What I think a lot of people don’t understand about acne is that it’s not just what it looks like, it’s really, really painful,” says Zazon, who often froze on face because of pain and inflammation. She shares her mental health diagnoses with her followers and says she took isotretinoin with mental health support. “Acceptance doesn’t mean you have to accept what is painful. You can make your own choices and exercise your autonomy.
This is ultimately the crux of acne positivity. “We want to provide women with choices that they can feel good about no matter what they make,” says Fishman.
While isotretinoin isn’t the cure-all for everyone, my six-month course gave me a 99.9% gap and lifted a two-ton stress block from my shoulders. I think of the hours spent in front of a mirror and wonder what I could have done with that time. Or maybe it made me stronger and more empathetic. But my real regret is that I don’t have a community in exactly the same boat to help me feel good. “The more I talked about it, the more I started to accept myself as I am,” Zazon says. And if its growing number of subscribers is any indication, it is far from the only one.
This article originally appeared in the June / July 2021 issue of ELLE magazine.
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