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Thursday, 24 August 2006 09:28

It’s Very Clear

Written by   Debi Byrnes

The wonderfully tough-talking Rhoda Morgenstern character from the old “Mary Tyler Moore Show” liked to say she had a “bad puberty. It lasted 17 years.” For adults who’ve lived through severe acne, this quip is an understatement.

Adolescence is when most people have their first experience, though not necessarily their last, with acne. Acne affects at least 85 percent of teenagers in the U. S. regardless of race, ethnicity, or gender.[1] According to Dr. Jonathan Fielding, the L. A. County Director of Public Health, by their mid-teens, more than 40 percent of adolescents have acne severe enough to warrant treatment by a physician.[2]

Acne has been misunderstood, misdiagnosed, and mistreated for centuries. Generations past believed that the angry, red lesions and pustules were the results of impure thoughts. As Boomers, we were told that they were caused by eating chocolate and pizza (although good nutrition can diminish the severity of acne, there is no food-based cure). Today, even dermatologists may mistake acne for rosacea and vice-versa, which is really bad news, considering that the treatment protocols for these two very different conditions also are quite different.

I know first-hand that acne scars the psyche as well as the skin. Is my teenage acne gone? Not really—speaking as a licensed skin therapist, my professional assessment is that I will always have a sensitive skin which is prone to inflammation and the occasional flare-up. I will say that time has been good to me, however, and the periodic skin issues I now have will never compare with what I experienced beginning when I was about 13, in junior high school. In fact, many people seem surprised when I describe the past extremity of my acne, although I always think the evidence is unmistakable.

Like someone with body dysmorphic disorder (BDD), my acne absolutely shaped my life in those years. It made me shy to the point of not wanting to raise my hand in class, even though I was a good student and enjoyed my studies from an intellectual and academic standpoint—I just didn’t want to draw attention to myself. Some teens long to be noticed, especially by the opposite sex. By contrast, I just wanted to become invisible. In fact, I don’t really remember very much about my middle school years. I guess the acne made the experience so painful that I blocked the memory out.

One especially harrowing experience came accidentally at the hands of my mother. The hottest teen style at the time was long, straight hair with long, straight bangs—vintage Cher. Being blessed with wildly curly hair, I had to plaster my bangs with goop, tape them down flat, and let them dry to achieve this Cleopatra style. Of course, the constant contact between acneic skin and hair product didn’t help my complexion. One day, my mom wanted to see how I’d look with my bangs grown out, and pushed my hair away from my eyes, exposing my forehead which was the site of my worst congestion and inflammation. She meant no harm, but I have never felt so humiliated in my life.

I lived with what I now know to be cystic, Grade 3 or “severe” acne—the type that over-the-counter preparations cannot impact. Today, a dermatologist might prescribe birth control pills (sheesh, would my mother have freaked!) or a course of antibiotics to bring down the wildfire that was erupting through my skin.

My face felt hot to the touch, tight, painfully sensitive to pressure. And, of course, like most teens, I made it worse by using alcohol-based toners, scratchy scrubber puffs, harsh detergents and abrasives because I thought my skin was somehow “dirty”, squeezing, picking, and popping whenever possible. Many teens are even more drastic in their self-treatment, using dangerous metal implements (pins, needles, razor blades), and caustic household scrubs intended for sinks and tubs. Some even take their own lives because they can no longer live with the shame they feel in response to a skin which is continually producing unsightly blemishes. What Sulzberger and Zaidems said in 1948 is still true today: “There is no single condition which causes more psychic trauma, more maladjustment between parent and children, more general insecurity and feelings of inferiority . . . than does acne vulgaris.”[3] A study of 317 pupils between 14 to 16 years of age found that the 50 percent of participants with moderate to severe acne had higher levels of emotional and behavioral difficulties.[4]

My interest in professional skin care was probably part of my own journey of self-healing. And at the point where some people decide to join the Peace Corps or chain themselves into an ancestral Redwood in order to help save the world, I decided to found a California 501.c.3 non-profit organization called “Clear Up Skin Care”—you can visit my site at www.clearupskincare.org.

There’s more to this work than my website, though. The mission of Clear Up Skin Care is to provide an educational outreach program to adolescents about the physical and emotional effects of acne. I talk with them about how to achieve a clear and healthy complexion, and useful techniques to develop and increase self-esteem.

I take my show on the road, actually bringing the information in person to teens. The program is voluntary, and interactive, consisting of two one-hour sessions.I offer my program free of charge to middle-school students – their ages range from 13 – 15; of course, the girls are typically more receptive, not to mention more polite, than the boys. I began by offering my program at the middle school where I myself spent some of my most miserable years, hiding my face. I’ve since expanded my program to other middle schools, and plan to bring it to a larger national market in the future.

Because I’m working with students in Los Angeles public schools light-years from the coveted 90210 zip code, virtually none of my program participants are from what you’d call wealthy homes. Many are Latino, some Armenian, and some African-American, a little bit of everything representing L.A.’s diversity. Many are the children of recent immigrants, and they quite honestly don’t have the option of going to the dermatologist, since most of them are not covered by medical insurance and are unable to afford the expense.

Teens are confused about different types of skin conditions and what causes them. There’s a lot of misinformation floating around out there. In fairness, the self-serving messages contained in advertisements for cosmetics and skin care products often make this confusion worse. My mission is to bring them accurate, simple information without an agenda. Although I do distribute free product samples (cleansers, medicated treatment gels, acne-appropriate moisturizers and sun products) which are graciously made available by several skin care manufacturers, I am not affiliated with any brand. No one subsidizes my program or pays me to do this work. I do it for the teens themselves. I know what they’re going through, and this is why I had to create my program.

While these kids are infinitely more computer-savvy than I’ll ever be, most don’t have regular private access to the internet, and so I feel my work is unique in that I am bringing the information to them, live, up-close, and personal.

They do not want to be lectured—they like participating and “doing things” rather than just being talked at. Like me at that age, they are shy and rarely will talk about themselves or their feelings. So, we instead act out the life-cycle of an acne pustule (we actually create a congested follicle and let it erupt, like one of those schmaltzy dry-ice volcanoes at a Hawaiian-themed restaurant) and other really gross things—the gross-out factor breaks the ice and appeals to this demographic.

I try to make it fun and challenging—and most of all, I have to keep it really real. Unlike me, these are kids who deal with the pressures of gangs, drugs, divorced parents and fractured families, as well as poverty and other kinds of violence. They are surprisingly worldly in many ways (though heartbreakingly sweet and fragile in other ways).

I even talk to them about their hair. Both boys and girls are really into their do’s these days, and this generation tends to use a lot of hair product. They wear it to bed, and the product coats the pillowcase. Then, they press their faces into that swamp of hair product for eight hours every night! It’s an aesthetician’s nightmare!

I tell them to at least turn the pillowcase inside-out so they have a fresh surface if they don’t feel like doing laundry. I also talk to them about the need to protect their skin from the California sun, and the fact that sun does NOT cure acne, and I talk to the girls about the need to remove their make-up each night. Teens of every era have a terrible time sticking to any kind of regimen, so I know that a lot of this is going in one multi-pierced ear and out the other. But it’s all said with love, and with humor, and maybe some of it will stay with them. I hope so.

The deeper message I try to impart to the teens is this: you are “okay”, and worthy, and valid, even with a broken-out and blemished skin. These young people, like all of us, are barraged, day after day, with a dizzying slew of images of seemingly perfect faces, perfect bodies, perfect teeth, perfect hair, from Britney to Jessica to Tyra to Paris to Shakira to Halle to J-Lo to Lindsay to Beyonce, to a million others. Of course, they aren’t really so perfect. They are perfectly lit, perfectly made up, and then digitally refined by computer artists before the image reaches us! A friend who is a graphic designer has suggested to me that I talk to my classes about the program called Photoshop, and how magazines alter photographs, making skin smoother, eyes bigger, waists slimmer, legs longer, etc., and I do have to say knowing this has made me feel a bit more forgiving toward my own image in the mirror.

In my class, we play a game identifying major celebrities who have “come out” as acne survivors. This is not a mean-spirited exercise—it’s a reality-check, especially important here in Los Angeles. Remember that in the eerie glow of Hollywood, teens as young as 16, meaning they needed parental consent, make the nightly news by proudly describing the “Brazilian Butt Lift” procedure they’ve just had. I mean, give me a break!

On the subtler level, I am telling them that they are still “okay” even when their world does not seem okay—trouble at home, family issues, money worries, etc. Adolescents need an anchor. Ideally, this anchor consists of many things—healthy, loving family, strong community, positive role-models, and peers with whom they share a wholesome value-system. Ideally, this synergistic network of support makes that strange, awkward, revelatory journey from childhood through puberty into competent, responsible adulthood more bearable.

While this ideal alliance of support may not be fully present in the lives of many of the teens I reach, I know that teaching them self-respect and respect for each other, regardless of the condition of their skin, empowers them to go on and be their personal best.


1 Acne Information Package, National Institute of Arthritis and Musculoskeletal and Skin Diseases. DHEW Publication No. (HRA) 76-1639.

2 Many therapies hit the spot for relief of acne. (2002, March). Los Angeles Times, SFVN, sec. S7.

3 Sulzberger, M. B. & Zaldems, S. H. (1948). Psychogenic factors in dermatological disorders. Medical Clinicians of North America, 32, 669.

4 Smithard, A., Glazebrook, C., & Williams, H. C. (2001). Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. British Journal of Dermatology. 145, 274-279.

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