My cystic acne started in my twenties. With a skin that wasn’t clear during puberty and high school, dark spots started forming almost every day, leaving my face full of red scars along with angry new breakouts. I’ve spent countless evenings in my bathroom poking, treating, or just staring at acne from my cheekbones to my jawline. This continued until my thirties. (Although I was never diagnosed with a metabolic disorder, I probably did; a 2020 study found a high prevalence in people with acne. ) Every morning, I put on makeup. I avoid making eye contact with my colleagues and even my friends.

At that time, I felt lonely, but I am not. According to the American Academy of Dermatology, up to 15% of women experience acne, but it is on the rise in adults, both women and men, and some believe the number is even higher. “Based on surveys and my own experience, I can say that up to 40% of women in their 30s are facing some form of acne,” says New York-based dermatologist Joshua Zeichner. fish eggs.

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Bridging the gap between perception and reality – and helping acne sufferers feel supported – is the goal of the acne activism movement on social media. Influencers with hundreds of thousands of followers post makeup-free, makeup-free selfies of pimples and scars with pride, and acne-care brands like Starface, ZitSticka, and Banish try to normalize the condition they treat, instead of shame.

Even celebrities participate. “To all those struggling with this, please know that you are not alone and you are fine! MY ACNE NEVER Ceases Me,” actress KekePalmer wrote on Instagram about her acne last December, with nearly 1.3 million likes.

MikZazon (aka @mikzazon), an acne and body influencer from Columbus, Ohio, says, “I’ve struggled with acne my whole life and I’ve never been. Now I see people like me in skincare ads. with nearly 900,000 followers. “I thought I was this ugly person with some kind of illness; that people are looking at me and just want to correct me. The active community with acne is to demonstrate normal skin. ”


But there’s a big difference between following beauty standards and having your teeth whitened to overcome the stigma, stress, and even physical pain that can accompany acne. “Many people with severe acne are more prone to depression,” 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 found a significant link between acne and depression and anxiety.

“Almost every day, [an adult patient]Cybele Fishman, MD, a holistic dermatologist in New York City, and my skin has been crying in my office. “When I asked, ‘How does this make you feel?’ The answers I get are: ‘I’m not signed up for projects at work that will have presentations or’ I haven’t had sex in two years because I’m afraid to remove my makeup. ‘ It makes them feel really, really, really bad. ”

Derms typically treat adult acne with prescription topical retinoids, birth control pills, antibiotics, or an off-label oral medication called spironolactone (which blocks the hormones that cause acne in women). Two new topical prescriptions – Winlevi and Aklief – have hit the market in the past two years. But oral isotretinoin (which goes by many brand names but often goes by the now discontinued Accutane name) is considered a potential acne treatment, according to the American College of Dermatology (AOCD), as about one half of the patients can stop. complete treatment after a course of four to six months. “It worked very well,” Lal said. However, rumors of potentially dangerous side effects have kept patients coming back, myself included.



Even when I was already on isotretinoin and it worked, I worried that I would only cure a symptom of an underlying medical problem, rather than the problem itself. My doctors have ruled out polycystic ovary syndrome, a serious condition that can cause acne (and, in fact, it’s what causes Palmer’s acne). In my quest for a solution, I searched for allergy tests, special diets and herbal remedies; I tried hundreds of creams, high-tech gadgets, and even meditation. It seems the answer is always just one more hole away from Google. However, it was never really like that. In the end, it became clear that the stress of my struggle was much worse for my body than any drug I was avoiding.

“People think of Accutane as an aphrodisiac, but it’s just a synthetic drug[derivative of ] vitamin A and every cell in your body has receptors for it. It’s not unusual,” says Fishman, who avoids prescribing oral antibiotics for acne, as they can cause long-term resistance and microbiome imbalance.

According to the AOCD, the most common side effects of isotretinoin include dry skin, lips, nose, and eye irritation. There is also a very high risk of birth defects if the patient becomes pregnant (abstinence or two forms of birth control). But Lal and Fishman say the data around larger concerns like adverse mental health or digestive effects have been controversial and possibly overblown.

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Zazon is one of the few people with positive skin effects who have chosen to take isotretinoin and document their experiences. “What I think a lot of people don’t understand about acne is not only what it looks like, but how painful it really is,” says Zazon, who regularly applies cold compresses to his face for pain and inflammation. She shares her mental health diagnoses with her followers and says she has been taking isotretinoin to support her mental health. “Acceptance doesn’t mean you have to accept what hurts. You can make your own choices and exercise your autonomy.”

That is ultimately the crux of acne positivity. “We want to give women choices they can feel good about, no matter what choice they make,” says Fishman.

While isotretinoin isn’t a cure-all for everyone, my six-month course has cleared me 99.9% and lifted two tons of stress off my shoulders. I think about the hours in front of the mirror and wonder what I could do with that time. Or maybe it makes me stronger and more empathetic. But my real regret is not having a community in the same boat to make me feel good. “The more I talked about it, the more I started accepting myself as I am,” said Zazonsays. And if her growing follower count is any indication, she’s not alone.

This article first appeared in the June/July 2021 issue of ELLE Magazine.

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