I was in fifth-grade music class when I discovered my first pimple. It didn’t hurt, there was just a small raised bump on my cheek. I turned to one of my friends and asked if there was something on my face.

She examined it. “Looks like a zit,” she said. “Want me to pop it?”

I recoiled. “Can’t I just wipe it off?” I rubbed my palm on my cheek.

She laughed. “It’s stuck to your face. You can’t wipe it off.” The bell rang and I walked out of the room, horrified, imagining a foreign object growing through my skin.

When I got home, I examined it in the mirror. It was a slightly-red bump, hardly noticeable. I didn’t know what she meant by “popping” it, though I remembered hearing someone being told to pop a zit in an episode of “The Suite Life of Zack and Cody.” I squeezed it until it became angry, red and definitely noticeable. But not a pop.

In truth, I didn’t really know what acne was supposed to look like — I’d rarely seen it in the media, only when mentioned as a joke or partially airbrushed away from actors’ faces on Disney Channel. My parents didn’t have it, and neither did my cousins or my brother. I went home and told my mom, who bought me a face wash with salicylic acid in it. The pimple went away within a few days.

As the acne began invading my face more often, the face wash stopped working. I resorted to YouTube to give me resources for how to treat it myself. Toothpaste, olive oil, aluminum foil, baking soda, honey and lemon seemed to do the trick for other people, but only aggravated my acne-prone and dry skin. I wished I could just pop my pimples and be done with them, but they felt deeper, like they had sprouted from within my pores and I had to dig them out by the roots.

Acne had created an anxious cycle for me: My acne caused anxiety, which caused me to pick and squeeze at it to get rid of it, which only made my skin worse. The stress caused me to break out more, too. 

A couple years later, I started seeing a dermatologist and found out that I had cystic acne, which happens when hair follicles plug with oil and dead skin cells. The doctor told me I was producing more of this oil due to a hormone imbalance. Since there was no whitehead to pop, they would poke my face with a needle and let the acne drain every couple of months, leaving me bleeding and red when I left. I sat quietly in the car as my mom drove me home, dreading the next day when I had to go to school with scabs forming over my red bumps. I felt the pain in every pore.

I tried buying over-the-counter products, using a customizable skin regimen and then switching to creams prescribed by my dermatologist. After none of these worked, I finally began taking an antibiotic that made me more sensitive to sun rays. While the acne cleared up slightly, taking it during the summer left me with months-long sunburns. I couldn’t run cross country without frying my shoulders, and my Spanish teacher frequently asked if I’d just gone on a vacation because of my frequently-burned nose.

I didn’t know if people were looking at me because of my acne or my sunburns — it felt like this new kind of redness brought more attention than a bad acne flare. I stopped taking the antibiotic and switched to a combined birth control pill, which would help balance my hormones and hopefully get rid of my acne once and for all. And though the new pill helped with the acne, it made the anxiety and depression worse, a struggle between the internal and external.

Through the years, my mental health suffered greatly as I watched my face fill with unwanted red dots. Every time I left the house, I felt like everyone was staring at it, and eventually, I grew my hair out so it covered my cheeks. I didn’t make eye contact when I talked to people. When I would pose for photos next to my friends I made sure they had the flash off, and I angled my body so the spots would be concealed.

The thing about acne is that it has the potential to permeate the rest of your life. It’s a badge of anxiety worn on your face, and you never know what would have been different if you didn’t have it. Would I have performed better in that job interview? Would I have had more friends growing up? Is it harder to socialize with people because I’m afraid people don’t actually like me?

Acne is the most common skin condition in the United States, affecting up to 85 percent of people between the ages of 12 and 24 — so why is there so much shame attached to it? Maybe it’s because there are certain beauty standards that we see in the media, and celebrities must be “ready for their close up” with flawless skin. Maybe it’s because people think it’s gross and have internalized the idea that people with acne have bad hygiene: I’ve been told many times to wash my face more, though, in my experience, those with acne are often the ones taking the best care of their skin. They know how much work it takes to avoid a flare-up.

Having acne has taken an immense toll on my mental health, and I’m not the only one; the emerging field of psychodermatology reveals the connection between skin health and mental health. Psychophysiological disorders such as eczema, psoriasis, acne and hives are common “skin disorders that are worsened or, in some cases, brought on by emotional stress,” and “certain emotional states can lead to increased inflammation in the body.” This ultimately can lead to a cycle of mental health negatively impacting the skin.

After going off of birth control for mental health reasons, my acne came back — and it began to scar. Though the bumps themselves came and went, I was left with permanent imprints on my face, a visible reminder of my invisible mental struggles.

I began wearing makeup nearly every day to cover up my scars, which only plugged my pores more. It was a temporary fix, a band-aid for the days when I couldn’t handle the anxiety of going outside with a face full of acne. But it became a crutch, something I had to rely on, because underneath the foundation my pimples started getting worse. It added another aspect to the cycle: Makeup gave me more acne, which gave me more anxiety, which caused more acne and more makeup. I only stopped when I reached the bottom of my mental health barrel last winter, and instead of honing my makeup skills, I switched to working on my self-esteem.

I have gone through plenty of chemical peels and new dermatologists and prescription pills and expensive topicals to know that the best way to heal acne is to work on your mind first. Adding stress and makeup to the cycle just hurts your confidence, when healing comes from treating your skin gently, as well as yourself. Over the last 10 years of dealing with acne, I know my mind and body have a stronger connection than they did before. I am gentler with myself, in my skincare routine and in my self-talk, and know that being OK with myself will always translate into my skin.

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