Skin Conditions Like Acne Are Exhausting, But Stop Beating Yourself Up

"I don't know who needs to hear this today, but I want to make the point that your skin, and skin issues such as acne, are not markers of your health or wellbeing, regardless of what you may be led to believe," said consultant dermatologist, Dr Anjali Mahto, in a recent Instagram post. Her words struck a chord with her thousands of followers (many of whom took to the comments section to share their experiences), myself included. How many times have I blamed my breakouts on eating the 'wrong' food, not drinking enough water, or wearing makeup? The answer is too many, but I know I'm not alone.

Skin and self-blame are largely intertwined. Whether you're living with acne (as I have done since age 11), eczema, rosacea or another of the hundreds of skin conditions people experience today, there is always that niggling feeling that you're doing something to cause it or that you are doing something wrong. Where has this come from? The cult of wellness has a lot to answer for, arguably facilitated by social media. Twitter, Instagram and Reddit are a handful of platforms awash with wellness bloggers, influencers and so-called experts offering advice on topics such as diet, exercise and products in relation to looking after your skin. But the noise can be incredibly damaging.

Dr Mahto acknowledges that lifestyle is a factor in the condition of your skin but emphasises that skin conditions are layered. "Nutrition, sleep, exercise, skincare routines, smoking, alcohol intake and more are all important factors in looking after our general health and organ systems of the body, skin included," said Dr Mahto on Instagram. "However," she continued, "over recent months, where many are spending more time at home on social media and engagement has been high, I'm seeing a lot of 'wellness' accounts push the idea that the condition of our skin is a marker of general health."

Dr Mahto's post suggested that phrases such as "you are what you eat", "good skin starts from within" and "inner glow" flood social media, potentially placing the blame on individuals. If you have acne, for example, you will likely have heard that your spots are a result of not drinking enough water or eating too many dairy products. Those with rosacea, like skin positivity campaigner, Lex Gillies, work tirelessly to quell myths such as rosacea is caused by drinking or makeup makes rosacea worse. For Dr Mahto, these ideas ignore the many other things that may contribute to skin conditions, such as hormones, genetics and psychosocial and environmental factors, for example stress and pollution.

"I can't tell you how much this bothers me as both a practicing clinician and as a life-long acne sufferer," continued Dr Mahto in her post. "Being told by large wellness accounts that your skin problem is effectively your fault because you don't look after your health (as your skin is merely reflecting what's inside) leads to a very difficult place of self-blame, shame and stigma." Dr Mahto says that she has lost count of how many times her recent acne patients have told her that they feel their skin problems are their doing, that wellness culture has led them to feel that they aren't trying hard enough.

Interestingly, Dr Mahto said that she has plenty of fit patients across all age ranges who struggle with their skin. "They are not doing something wrong with their lifestyle and are otherwise some of the 'healthiest' people I know. For many, cutting out a large number of food groups and spending considerable amounts of money on skincare routines does not help get the skin better; rather, it perpetuates a cycle of stress, anxiety and powerlessness," she wrote on Instagram. Restricting certain food groups also has the potential to lead to unhealthy obsession and disordered eating. While wellness has its place in skin and body health, Dr Mahto hits home the need to recognise that conditions such as acne are medical. Ditching dairy or drinking an extra litre of water may not have the effect you're after. If anything, it only serves to emphasise the myth that skin conditions are something we can easily control, which in most cases isn't true.

It isn't just wellness accounts, though. Friends and family play a part in blame and self-flagellation, as Maya* tells R29. "When my skin was at its worst and family members saw how bad it was, they felt obliged to tell me to do or stop certain things, blaming me for something that felt out of my control. At times, their advice would be repetitive and exhausting, especially when I had already tried everything they had recommended, and I would see no results." Maya recalls feeling self-conscious when told that she "wasn't drinking enough water", "eating too much chocolate" or "wearing too much makeup". She says: "I would keep a two-litre bottle of water with me and make sure I finished it by the end of the day. When I woke up the next day with new breakouts, I would be so quick to blame the food I ate the night before."

Maya says she has learned to take her skincare issues one day at a time, otherwise it becomes overwhelming. "It's very hard to not blame myself because not only am I seeing [my skin] and getting upset about it, but it attracts unwanted attention. I've just accepted my skin is the way it is. I can limit my diet for my skin but once I slip up on eating too much chocolate or oily food, the whole self-blame and guilt comes back again."

For Sadhbh, blaming herself for her acne was commonplace but learning about what causes it (polycystic ovary syndrome or PCOS) has been freeing. "I blamed myself for my inability to stop squeezing my skin, what I ate, or something fundamentally wrong with me that meant the skincare that should solve all my problems wouldn't work. I figured I had to be doing something wrong, as no one else I knew had suddenly developed cysts age 22." Sadhbh was told: "Don't eat dairy (I didn't in the first place), don't drink (no comment) and don't pick. It's tricky because I felt like I couldn't talk about it without eliciting unwanted advice."

Sadhbh says the best thing she has learned is to filter out when others associate being a good person with having clear, dewy skin. "It seems trivial but when you see celebrities say that their skincare routine is fighting for trans people or voting against Trump, it's really annoying. It says that your moral compass dictates how bad your sebum build-up is or how erratic your hormones are, when it's always luck and money that makes them look that good." For Sadhbh, reminding herself of that and taking detailed pictures of her skin texture and trying not to flinch at them is helpful. "Though if I get drunk and attack my cheeks I will always blame myself (rightly) when that results in a cyst a few days later."

Beyond wellness, skincare shaming also leads to self-blame in regard to skin. Recently, products like face scrubs and some cheaper, high street brands have become demonised online among skincare communities, leading people who use them to believe that they are doing something wrong or aren't taking care of their skin properly. Of course, this isn't the case. "I love skincare but after rent, bills, food shopping and so on, I don't have that much money to splurge on high end products," says Abbey*. "I keep reading that the exfoliator I'm using is 'bad' for my skin but I think it's actually working to keep my acne under control, as it's a lot better than it was before. I like my affordable routine but sometimes I can't help but feel like I'm not using the right products or that I don't care about my skin."

Dr Mahto agrees that for many, limiting food groups and splurging on expensive skincare does not benefit the skin. "Rather, it perpetuates a cycle of stress, anxiety and powerlessness," Dr Mahto said on Instagram. "We need to recognise that conditions such as acne are medical. They are not cosmetic issues which will simply get better with the right face wash." In other words, it pays to get advice from a specialist.

If you're struggling with your skin and would like further advice, speaking to your GP might be your first port of call, as they may be able to refer you to a skin specialist or dermatologist. If you'd prefer to see a private specialist, the British Skin Foundation and the British Association of Dermatologists are excellent resources, while the General Medical Council register can help you locate a trusted expert. Online support groups such as Skin Support can also provide legitimate medical advice on dealing with skin conditions. And while it may be difficult to practise skin positivity, shaking the potentially dangerous notion that your skin condition is your fault is a good place to start.