Andrew, a 29-year-old living in New York, avoids reflective surfaces when out in public. “It’s not that I hate myself,” he tells me. “It’s just that I don’t wanna see myself like this.”
Charlie, a 28-year-old in Washington, D.C., is worried about meeting new people, worried they’ll think his acne means he “has bad hygiene or is weird.”
“I want to tell them, ‘This isn’t the real me! The real me does not have acne like this,’” Charlie says.
For the majority of people who suffer from acne, painful skin blemishes are just part of their awkward teen years. With hormones raging, the glands beneath your face become overstimulated and start pumping oil everywhere. For the most part, genetics determine how bad and how late you’ll have acne, but either way, “if it’s going to go away,” says Dr. Susan Bard, a dermatologist in New York City, “teenage acne usually goes away by the early 20s.”
But what if it doesn’t?
For men like Andrew and Charlie, who lived with bad acne throughout their 20s, it meant another decade of torture and self-doubt — getting stared at, avoiding dates and trying every acne cure on the internet. I talked to Andrew, Charlie and two dermatologists to see what it’s like to have acne well into manhood.
The Emotional Impact
The psychological toll of adult acne is well documented, says Dr. Erum Ilyas, a dermatologist in Pennsylvania. “There are numerous studies that evaluate the psychosocial impact of adult acne, self-esteem-related concerns and social anxiety that accompanies this disorder. Adult acne can affect as many as 70 to 80 percent of women and 5 to 10 percent of men, and studies have shown that the toll adult acne can take can result in social isolation and restriction of activities due to embarrassment, so it’s important for us as dermatologists to recognize the quality-of-life impact.”
Charlie says he grew up pretty self-confident, but “in middle school and the first years of high school, I start seeing myself in pictures and realizing there was a huge gap between the confidence I felt in how I thought I looked, and how I actually looked.”
Acne has influenced every single thing that had impact on his life since then. “There is something particularly helpless about not being able to control how your own face looks. You don’t think that you got a bad grade or some girl doesn’t like you back for rational reasons — it’s because of your acne,” he tells MEL. “Once you experience these feelings of low self-confidence, you don’t forget them. They are impressed in your brain.”
Andrew echoes this sentiment: “I’ve had cystic acne since I was 15, the kind that grows so big it changes the shape of your face,” he says. “People give me the ‘you-are-disgusting’ look, which cripples my self-esteem. I feel very ashamed and helpless. Like this is the best that’s gonna get for me.”
The Social Impact
Charlie describes having a stretch of clear skin in college, thanks to the medication Accutane: “I remember thinking that having clear skin just made me feel more confident to even just ask questions or make comments in class. My grades improved, I joined extracurricular activities and I started a long-distance relationship with the girl I’m still dating all these years later,” he says.
A few years later, however, his acne came roaring back. “I was sent right back into the feelings I had when I was early in high school, even though the severity of the acne was not as bad,” Charlie says. Suddenly, having acne made him feel unworthy of his girlfriend. “You have a girlfriend who you love, want to look good for, but simply do not. It’s embarrassing even if she insists it is not.”
He wants to be the best version of himself for his girlfriend, but his acne prevents that. “The helplessness of acne is what really hurts: not knowing if you are doing something wrong, if there is something wrong with you, if you alone can fix it or if you need help,” he says. “I remember thinking, ‘If I want to dress better, I know how to fix that. If I want to get in better shape, I know how to do that. If I want to have a better haircut, I know what to do. So why the fuck can’t I fix my acne?’”
He adds, “Then it sucks when most of your friends have clean skin and you’re the odd man out” — an “extra-fun dynamic,” he jokes.
Andrew also expresses extreme gratitude in having a partner: “I am lucky enough to have found someone who, despite my acne, decided that I was worthy,” he says of his girlfriend of five years.
Beyond his relationship, though, Andrew says life basically stopped at 15. “I have no photos of myself after 15 years old,” he tells me. “I avoid group photos unless I really don’t have a choice. To this day and I’ve taken only one selfie. I just want to be happy.”
Ilyas says he sees adults with acne every day at his practice. “Adult acne is absolutely frustrating, it can be unpredictable and come in waves such that just when you think you have control over your skin it starts to act up again!” he says. “The comments are all consistent: ‘I’m too old for this,’ ‘I didn’t get this as a teenager; why now?’ [or] ‘I have tried everything.’”
Andrew tried drinking crushed guava leaves: “It was chunky and disgusting. It didn’t help. I tried apple cider vinegar, did absolutely nothing. I tried Proactiv and it worked for three years, but my acne came back with a vengeance.”
Charlie tried prescription-strength pills and creams, too. “Nothing worked,” he says. “There is so much misinformation about acne. What works for one person doesn’t work for you. It’s really hard to run ‘controlled experiments’ for any products or hygiene habits which can easily get pretty fucking elaborate.”
Eventually Charlie just grew a beard to cover his acne, but “the lack of self-confidence was still there, which was weird,” he says. “I had the self-confidence of a relatively attractive, personable young guy coupled with the lack of self-confidence of someone with severe acne. Plus I remember being terrified if I needed to be clean-shaven for an interview.”
The Truth About Accutane
Bard explains that Accutane can often be a permanent cure to chronic acne, but the drug’s potential side effects are strong enough to require monthly check-ins.
“Special registration into a government-mandated program called ipledge is required, which can be a bit cumbersome and requires monthly evaluation by the physician and pregnancy tests for women,” she tells MEL. “Accutane can cause birth defects, so it is crucial to not conceive while on the medication, and two forms of contraception are required while on [it].”
On rare occasions, Bard says, the drug can induce depression and thoughts of suicide, or cause liver damage, but “the close monitoring makes the medication so safe.” In the hands of a board-certified dermatologist, she says, Accutane “can be a life-changing medication” that “can afford a permanent cure in many patients with a relatively short ([roughly] six-month) course.”
Andrew says he eventually turned to Accutane, and the worst side effect he had was excessive dryness. However, even after the drug cleared up his face, his self-esteem remained low. “The confidence is still slow to return. I’ve had to feel this way since I was 15, so it’s understandable that I’m taking some time to get used to it,” he says. “I once passed a huge building and saw my reflection, I looked at the homeless guy on the street and he had flawless skin, whereas I spent hundreds but still looked bad.”
“I feel more at ease now,” he adds, “but long-term acne destroys your self-esteem.”
Charlie had less luck with Accutane. Though it cleared up his skin for years at a time, acne always came back. In 2017 he went on it a third time, but “started to have weird side effects. Specifically, it dried out my ears and eustachian tubes,” he says.
“This caused me to have severe crackling and popping in my ears and sometimes hearing loss and tinnitus. My dermatologist said this is rare, but there is some logic behind the relationship: Accutane dries up everything, including the ENT/sinus cavity. I immediately stopped taking Accutane when those side effects got really bad.”
Charlie has now been off Accutane for a year and has since “taken a more holistic view of acne.”
“Acne is like the low back pain of hygiene and lifestyle,” he tells MEL. “There are so many potential causes; it may just take some time to eliminate and figure it out — I don’t know if I have fixed my acne for life, but I would like to think I have learned something along the way.”
A few of those lessons, Charlie says, is to avoid excessive sugar and dairy, get proper sleep on clean sheets and pillowcases, make sure your razors are sharp so to avoid ingrown hair (or keep a 5 o’clock shadow with an electric razor if you can), clean your face immediately after workouts, and finally, don’t overthink it.
“Basically,” Charlie says, “I learned the beauty industry is a sham and humans survived without toning, daily moisturizer and all that other bullshit for centuries. … You don’t need a daily moisturizer or daily toner and perhaps you don’t either. All I need is a mild soap like Cetaphil Gentle Skin Cleanser, and something to exfoliate all the dead skin off, twice a day. Fancy face soaps just dry my skin out. When I go in the sun for a day, I swear SPF. But a daily moisturizer just clogs my pores and gives me acne.”
Charlie ends with a note for those other suffering through adult acne, and those who don’t. For those who don’t, he asks you to “be a little more empathetic to people who have bad acne. This is been a big life lesson for me.”
For those with acne: “I took pictures of my face weekly and made an album in my iPhone to document my progress and see what was working and what wasn’t. It was actually super-helpful because you don’t always notice when you are improving and what is working.” The point being: “You are not your acne and you can get over this. Just keep experimenting and figuring out what works for you.”