Dr. Anjali Mahto, the Consultant Dermatologist at Skin55, has suffered from acne since she was a teenager. She told us her story - and everything she learned from it.
Acne - the disease usually begins during puberty
My skin started developing acne when I was about twelve. This process coincided with a difficult time in my private life: my father died unexpectedly in his early 40s, I moved to the country and started a new school - all within a few weeks. What only began as increased oil production quickly developed into pronounced blackheads and then very many inflamed pimples. I remember exactly how I looked in the mirror and ran my fingers over the pimples to imagine what my face would look like without them.
It made me feel uncomfortable, withdrew more and more, and my confidence faded - I didn't like people looking at me. Even if one pimple went away, a dozen others would appear in its place, along with the pigmentation and scars I'd gotten. I avoided activities like swimming in case my makeup was washed off and tried to stay in the background at school for fear of how others would react to me. I remember feeling that as my skin got better, my life would get better too. My own self-esteem was inextricably linked to my skin.
In the beginning, I really abused my skin. I kept washing them (with the usual 90s suspects like Clearasil) to remove the excess fat. But excessive washing only caused irritation - and the pimples kept coming back. I had nodulocystic acne that, in retrospect, would never respond to the "right" choice of facial cleanser or moisturizer. My GP prescribed numerous topical creams and oral antibiotics that did not improve my skin. At this point, the acne was already leaving significant scars on my cheeks.
Eventually, I went to a dermatologist who recommended isotretinoin (or roaccutane) to me. At the time, my mom thought I was too young and that I could outgrow my acne - she was worried about the side effects of the drug. Roaccutane has numerous side effects and has been linked to mental health problems. Anyone who ingests it must be closely monitored by a doctor. But after taking another course of antibiotics that didn't help, I went back to the dermatologist and started taking it in my teenage years - it worked and I was able to go to university with beautiful skin for the first time in years.
I wish my acne had stopped, but it didn't. I was later diagnosed with Polycystic Ovarian Syndrome (or PCOS), which is itself a cause of acne and oily skin, and she returned in my twenties. I'm 40 now - and a consultant dermatologist - and I've had intermittent treatment since then when needed. I now understand that for me acne is a chronic condition that worsens and worsens over time, but I dare not hope - not even in my profession - that there will be a permanent cure.
When I started my medical training, I realized, among other things, that the skin is very important to me and that I can empathize with patients who have problems with their skin. My goal is to catch them before they cause long-term physical damage in the form of scarring or psychological damage from deteriorating mental health. I don't want my customers to do the same thing I did back then and to spend time and hard-earned money on products that don't work for deep or inflammatory acne.
What have I learned? I like to keep things simple. I know it has become popular to use multiple products in the morning and evening, but I am very picky about what I put on my skin. I believe less is more, and it's important to stick to mild cleansers and moisturizers and use a prescription acne treatment every night, which is a mixture of vitamin A (retinol) and benzoyl peroxide. There is no doubt that if you have mild acne or clogged pores, using products that contain salicylic acid and the above can help.
Chemical peels can do a great job of improving skin tone and changing pigmentation, while lasers have been fantastic at removing my own indented or atrophic acne scars. I still have some on my left cheek but they no longer bother me so I stopped treating them further. As I've gotten older, there are also a number of antiaging treatments that I like. These include occasional injections - botox or filler - as well as tightening the skin of the lower face with high-frequency ultrasound. You can often read horror stories in the press, but if these treatments are done well, no one should know you have done them.
Like so many others, I have tried standard measures such as avoiding dairy products and reducing my sugar consumption. That made no difference to me and my acne. My diet is now fully inclusive and I am not restricting myself - I just eat what I want.
I still suffer from outbreaks and I suspect this will continue to be the case for years to come. With many chronic conditions, there is a constant risk that things will get worse, even when things seem to be going well and everything is under control. But getting older helped. I just realize that my skin is only a very small part of who I am and what I can achieve.
My advice to anyone struggling with acne: speak to your family doctor directly or make an appointment with a dermatologist. It can be easy to spend time and money on skincare products that may not work, and it is better to seek professional advice early on. No one should suffer or despair about their skin, and no one should underestimate how you feel or how it affects you.