Breaking Out And Freaking Out: My Acne Experience

I got my first pimple the summer before my freshman year of high school. It was on my forehead — a big, red, inflamed dot on an otherwise blank canvas. I wasn’t really sure how to approach it. I didn’t own makeup to cover it up, everything online advised against popping it, and at-home remedies with toothpaste and baking soda seemed sketchy at best. So I was forced to brave the first day of high school with my zit. I cried when I got home.

Over the span of freshman year, that pimple multiplied and spread. A variety of dots littered my forehead, a combination of tiny comedones and pus-filled whiteheads. My skin became increasingly oily, producing a reflective shine that only grew worse over time. It was official: I had fallen victim to the acne epidemic. 

My mom eventually took me to the dermatologist and I was prescribed adapalene and clindamycin, topical medications targeted at reducing acne. I was told to follow a strict regime: 

1. Apply adapalene at night. Start with three times a week, then work up to every night over the span of a month.
2. Apply clindamycin every morning after washing face. Make sure skin is completely dry before application.

And that routine worked! During the summer after my freshman year, my forehead cleared up completely. I went into my second year of high school feeling confident, happy, and acne-free. For the next three years, I followed that exact regime: Adapalene at night, clindamycin in the morning. As long as I stuck to that routine, my skin would be clear.

Or so I thought, until I woke up one morning with a bump on my chin. It was freshman year of college, my first year in Santa Barbara. I was in the residence hall communal bathroom and felt the bump while washing my face. This was a new phenomenon — prior to this, my skin issues only lived on my forehead. My chin, which was once smooth and uninterrupted, now seemed to have produced a deep, painful, under-the-skin cyst.

This was the start of a new era, and a significantly more sinister one. Four years after my initial breakout, it seemed as if my acne had returned in a different way: hormonal. Hormonal acne is caused by a hormonal imbalance, and is the female body’s way of reacting to internal changes. Androgen hormones (which include testosterone) are the main contributors to hormonal acne, as they produce high amounts of sebum (pore-clogging oils). Hormones can lead to an increase in inflammation, oil production, clogged pores, and production of acne-causing bacteria. So now, instead of breaking out topically, my skin was now reacting to an internal strife. My seemingly solid routine was now ineffective against my hormones.

These under-the-skin chin pimples became a consistent problem throughout the remainder of my first year in college, and well into summer. They would last upwards of a week, throbbing in pain and impossible to pop or subdue. Every time one would eventually die down, another one would show up the next day. It was a constant struggle, one that I had no idea how to address.

When I went home for the summer, the dermatologist switched me from adapalene to tretinoin, a retinoid that increases skin cell turnover. My routine was altered:

1. Apply a pea-sized amount of tretinoin at night. Start with two times a week, then work up to every night over time.

The first skin change I noticed was intense dryness. My skin felt tight and red, dry at the touch. I read online that this was a common side effect, so I continued. I next noticed an increase in acne. It started with small bumps on my forehead, like the ones I had in high school four years prior. Those bumps turned into bigger spots, not only on my forehead but all over my face. My skin was flush with texture, redness, irritation, you name it. No area of my skin was clear. I read that the beginning of tretinoin use can lead to a purge due to the skin cell turnover. My dermatologist told me the same thing, and encouraged me to continue using it. 

So I did, to my own personal chagrin. Every time I thought my skin was bad, it got worse. I went to sleep with upwards of ten pimple patches in hopes that I would miraculously wake up the next day acne-free. I wore layers of concealer to cover the discoloration. I went on multiple internet deep dives for advice, altering everything from the towels used to dry my face to the food I ate on a daily basis. 

It became obsessive and all-consuming. I couldn’t figure out why tretinoin seemingly worked for everyone but me. Not only was I already suffering from hormonal acne, but the added irritation of my new topical medication resulted in a whole other set of issues. At times it was the only thing on my mind — my phone screen was a constant loop of reddit threads and forum posts. My camera roll was flooded with “progress” pics, despite there not being much progress to document. Selfie after selfie of blank stares, sad eyes, and countless zits, pimples, comedones… you name it. 

People with clear skin don’t understand the toll that acne can have on your mental health. While there are more severe health issues than bad skin, the visibility of it adds an emotional edge to the struggle. In a world where visual appearance and beauty is valued, marks on your skin and face can greatly impact one’s mental health. 

I found my skin controlling my every action. Throughout the majority of fall quarter, I rarely left my apartment because I was convinced that everyone would see and judge me based on my skin. As breakouts became more and more frequent, I became more and more insecure. I felt as if I didn’t deserve certain things — I didn’t deserve to go out, to flirt with people at parties, to take pictures with friends. I hated that pimples affected me so severely. I hated that acne made me feel so ugly. 

Eventually, I switched dermatologists in search of a cure. I felt helpless, hopeless, and had honestly given up at that point. I was willing to try anything to get rid of the nightmare that was my skin. 

My new dermatologist prescribed an oral medication called spironolactone. Spironolactone is a diuretic used to treat high blood pressure and heart failure. The medication lowers blood pressure by targeting specific hormones in the body, which in turn targets acne-causing hormones as well. Lower amounts of androgens leads to lower amounts of sebum. I started a new routine:

1. Take 100 mg of spironolactone every day: 50 mg in the morning, 50 mg at night.

I had low expectations at the beginning. After my long struggle, I didn’t believe that a pill could solve the mess that was my skin. But, with incredible patience and persistence, I began to notice considerable improvements in my skin. Over the next five months, the dots and spots on my face slowly faded away. I noticed that new breakouts stopped appearing, and parts of my skin were becoming smooth again.

By April 2024, I was 100% acne-free. For something that was so consuming, the solution was so simple. I’m now only left with scars and hyper-pigmentation, reminders of my year-long struggle. The scars are not ideal, but a huge improvement from how my skin was before. I regained the ability to leave my apartment, go outside, and interact with others without obsessing over my acne, being able to live my life with confidence. 

The fear of acne still follows me. The other day, I noticed a small bump on my forehead. It was practically invisible — skin-colored and resting just above my eyebrow. Yet, upon seeing it, I freaked out. While my skin has been clear for about two months, I still live in fear of returning to the person I was. The one who spent hours each night staring in the mirror. The one who cried on the phone to her mom almost every day. The one who felt less than, just because of her skin.

I want to make something clear: the point of my journey is not to promote or negate a certain treatment. Everyone is different. Some people require a whole array of medications, topical and oral, while others don’t even need to wash their face. There is no universal treatment or solution, because the “best acne treatment” entirely depends on the person seeking treatment. 

I hope that my acne journey offers a helping hand, a form of solace for those who have experienced or are experiencing the same thing. The isolating experience of breaking out is no joke — the emotional toll of acne is often overlooked. 

Sure, we live in our skin. It’s how we present ourselves to the world and how we view ourselves. And acne, whether it be a few pimples or a full-on breakout, can go a long way in affecting one’s confidence.

But people are so much more than their skin. We get so caught up and self-consumed in our own appearance, we become convinced that other people are just as critical. This is rarely the case. 

Here’s how I know: the other day, my friend shared her skincare journey with me. I was shocked. To me, she was my kind-hearted, funny, beautiful friend. I had no idea that she was a fellow acne sufferer. In fact, I never even noticed she had acne.

And I promise you, no one notices yours.

• acne
• beauty
• health
• skincare