Persistent acne and the misery it causes

For nine years, Keziah Wanjiru has known no peace. It was in primary school in 2012 that Keziah, now 21, discovered abruptly just how others viewed her skin.

“Sometimes I wish we had masks then so that I could at least cover my face and my classmates would stop with all the questions,” she told the Star during an interview.

Dr Roop Saini, a certified dermatologist, says acne is a skin condition characterised by inflammation of the skin that can cause spots and pimples.

The main cause of acne is hormonal, that is why acne is commonly seen in children who have hit puberty, between nine and 20 years old. Adult acne or persistent acne is what occurs in individuals whose acne persists after the age of 30.

“This hormonal change makes the sebaceous gland (oil-producing gland) more sensitive, and it produces sebum (oil) that lines the surface of the skin. The over-production of this oil plugs the pores of the skin, causing the bacteria to invade and cause acne,” Dr Saini explained.

More than 90 per cent of the world's population is affected by acne at some point in their life, making it the eighth-most prevalent disease worldwide.

According to research carried out in 2015 in Western Kenya by the International Society of Dermatology, the acne prevalence in Africa was high, ranging from 0.1-8.9 per cent, and western Kenya showed a great prevalence of 11.2 per cent. 

Keziah is just one of the many people who have gone through torture due to acne.

At the age of 12, Keziah barely knew what was wrong with her face. Being in a mixed boarding school made it worse for her as she was bullied by both boys and girls over her condition.

“I had no idea what was going on with my skin and this left me in the dark because my parents, too, thought it was a stage I would eventually pass.”

She believes her monthly cycle triggered the whole situation because at age 10 is when her acne began and pimples developed around her chin and cheeks.

She thought it would soon end and get her normal life back. But she was wrong.  Little did she know that that was at the beginning of a long treacherous journey.

ACNE AND MENTAL HEALTH

Anyone who's ever had a skin issue knows it's more than skin deep. In a study done by The British Journal of Dermatology, researchers found that 63 per cent of acne patients have an increased risk of developing depression compared to patients who did not have acne.

Keziah’s acne intensified when she joined high school. She grew increasingly anxious, certain that everyone she came across was looking at her skin.

Brushing that feeling off was successful in Form 1 but in Form 2, she became more aware of herself. She was no longer the strong girl with the abnormal skin anymore. That is when her depression kicked in without her realising.

“In Form 2, everybody has an opinion, and some go to the extent of verbal and emotional abuse. Being the class president could not spare me,” she recollects.

It reached a point she got used to everybody always asking what was wrong with her face, pushing her further to loneliness and mental torture. Her depression increased. Anxiety and lack of self-esteem forced her to quit her position as class president. She began living her solitary life throughout her remaining years of high school.

It was at her first year in campus that Keziah’s parents thought she should seek medical attention and know the root cause of her acne.

“It took me almost six months before I could get the ‘perfect’ remedy, but it was all worth it,” Keziah says with excitement.

“It was a little fatiguing for my parents, especially because we had no insurance cover, but I strictly took my meds and religiously followed what I was advised.” 

Though it took time and she was almost giving up, after two months, she began to see some progress.

She had been diagnosed with nodular acne and put on oral antibiotics and some lotions and creams.

“It’s been almost three years now acne-free. Honestly it's a fresh start for me,” she said.

By noticing her skin issue and seeking medical attention, she now understands, through her dermatologist, her skin type and how she should take care of it.

TREATING THE CONDITION

Dr Saini says treating acne is a personal journey and is different for everyone.

“It is only right if you see a certified specialist before you prescribe anything to yourself. For example, many think acne is caused by hormonal imbalance. Interestingly, chances are people with acne can have a normal hormonal balance,” she said.

Misconceptions on acne include claims it can be dried out with toothpaste, lemon juice or garlic. However, Dr Saini said chances are using those products with a very high PH would irritate the skin and make the condition worse.

Dr Saini added that people with acne should avoid squeezing the spots as it not only aggravates them but may cause scarring, which is expensive and cumbersome to treat.

Exfoliating is the process of removing dead skin cells from the surface of your skin using a chemical, granular substance or exfoliation tool.

Exfoliation by people with acne should be avoided by any means since the skin is already irritated.

“If you are cleansing your skin and removing makeup, try using a gentle soap or an oil-free soap as a substitute, not forgetting water, of course. Your skin will then flourish if it is backed up by a well-balanced diet, including fresh fruits and vegetables,” Saini advises.

Scientists believe that following a low glycemic diet (foods that are digested and absorbed relatively slowly) may reduce acne because this diet eliminates spikes in your blood sugar. To manage acne, fried and sweet foods should be reduced.

Saini also advised people in the beauty industry to choose products labelled as non-comedogenic (should not cause blackheads or whiteheads) or non-acnegenic (should not cause acne).

Those prone to acne should use oil-free or water-based products.

WHAT TO AVOID

A lot of caregivers or parents think that when acne is left alone, it will ultimately heal. Dr Saini cautions against this.

“Please don’t let your child suffer with acne for too long because of scarring, which is very time-consuming and expensive to treat. So, prevention is better than treating. Keep in mind every scar has both a physical and emotional component.”

She said use of home remedies cannot manage acne since some of them have not been certified or scientifically proven to efficiently work.

Acne can be managed in various ways, she said, such as checking one's hormonal levels for both males and females once in a while.

A blood test is one of the most common ways to test hormone levels. This test can detect testosterone, estrogen, cortisol and thyroid levels. Washing the face twice a day using gentle soaps is recommended, but one should avoid over washing the face as it dries the skin.

For people who use makeup, the non-comedogenic type is advised. This makeup does not clog the pores on the skin and cleanses your face at the end of the day.

When one is sick with acne, masking, facials and exfoliation should be stopped since the skin barrier is already irritated. This will allow the healing process to continue as you follow the prescribed drugs.

One is supposed to have enough sleep. It is called beauty sleep for a reason. Exercise and drink water and wash your face and have a balanced diet.

Sunscreen should be avoided and medication taken as advised by the doctor. Some wrong type of sunscreen can cause a chemical reaction on the skin that leads to more acne.

Seek treatment from a certified dermatologist if the acne persists.

Edited by T Jalio