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Acne: A patient's point of view
Hendon S39
J AM ACAD DERMATOL VOLUME 51, NUMBER 1
Acne: A patient’s point of view Jill Hendon Birmingham, Alabama
D
uring my second year of college, at age twenty, I began a severe acne outbreak. Before this episode, I had experienced the typical teenage acne problems. I never realized that acne could become so severe. I developed large cystic acne on my face. I tried all the over-the-counter treatments with no success. Being a college student, I did not have transportation, so I went to the student health center for help. The doctor prescribed an antibiotic. I saw a dermatologist who performed injections of cortisone and an antibiotic. There was some improvement, but after a few days, my acne was as bad as ever. By this time, I had been prescribed several types of antibiotics. None of them touched my acne problem. I could not believe that the person in the mirror was me. I had been an attractive person and took pride in my appearance. Now my face was covered with large, red, draining bumps. I could not understand why this was happening to me. I wished that I could wear a veil. I had been working to help support myself while in school but I could no longer face the public and had to quit working. I was finally able to see a reputable dermatologist who right away explained that my only hope was isotretinoin. He prescribed the maximum dose, which I took for six months. About half way through treatment, I developed severe muscle pain in my back and legs. It hurt just to get out of bed. I remember one day I was on campus and decided to go to the cafeteria. I walked with my backpack full of books. On the way home, my back hurt so badly that I almost had to have someone call assistance. My doctor mentioned lowering my dosage but I refused. I was desperate to cure my acne problem. I was in nursing school and the workload was intense. Somehow, I managed to continue my studies. However, there were many days when I did not want to go outside of my home. I was very withdrawn and emotionally strained throughout college. Needless to say, I did not make many friends and was unable to participate in extracurricular activities. I
0190-9622/$30.00 ª 2004 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2004.01.024
had had a boyfriend during this time, but my physical and emotional stressors eventually ended that relationship, leaving me feeling more alone than ever. The isotretinoin was successful in getting my acne problem under control. The cysts went away, but I was left with severe scarring and skin discoloration. I obtained my nursing degree and moved back home. Fortunately, my parents agreed to pay for corrective plastic surgery. My dermatologist recommended a surgeon. I had scar removal for the raised scars, followed by deep dermabrasion for the pitting scars. The dermabrasion was extremely painful. It took a full two weeks to recover. The results, however, were amazing. My skin was nowhere near as clear as before the outbreak, but for the first time in over a year, I felt somewhat normal in appearance. I soon got my first job out of college and began my career. After the isotretinoin treatment, I was prescribed minocycline as maintenance. I continued the medication for nine years. I also have a chronic liver disorder, so there was a constant worry in the back of my mind as to whether the long-term use of antibiotics could be causing liver damage. The medication caused no noticeable side effects so I felt the benefit was worth the risk. I still had noticeable scarring, but my acne remained under control. After getting married, I got pregnant at age thirty. I had to stop taking the minocycline and my acne flared. This time it affected my back, chest, and arms. There was little that could be done because of my pregnancy. After the birth of my daughter, I began another round of isotretinoin. This time, I had to pay for the medication, which is quite expensive. Now my back and arms are somewhat scarred, but the acne is again under control for the time being. I would love to have another child, but can’t imagine going through another battle with acne. There is always a fear of another outbreak. My case was more severe than most. However, I know firsthand that acne can be a devastating, life changing disease. I am so thankful that there are now effective medications. I continue to depend on knowledgeable physicians and effective medications to aid me in the battle against this disease.
J AM ACAD DERMATOL VOLUME 51, NUMBER 1
Acne: A patient’s point of view Jill Hendon Birmingham, Alabama
D
uring my second year of college, at age twenty, I began a severe acne outbreak. Before this episode, I had experienced the typical teenage acne problems. I never realized that acne could become so severe. I developed large cystic acne on my face. I tried all the over-the-counter treatments with no success. Being a college student, I did not have transportation, so I went to the student health center for help. The doctor prescribed an antibiotic. I saw a dermatologist who performed injections of cortisone and an antibiotic. There was some improvement, but after a few days, my acne was as bad as ever. By this time, I had been prescribed several types of antibiotics. None of them touched my acne problem. I could not believe that the person in the mirror was me. I had been an attractive person and took pride in my appearance. Now my face was covered with large, red, draining bumps. I could not understand why this was happening to me. I wished that I could wear a veil. I had been working to help support myself while in school but I could no longer face the public and had to quit working. I was finally able to see a reputable dermatologist who right away explained that my only hope was isotretinoin. He prescribed the maximum dose, which I took for six months. About half way through treatment, I developed severe muscle pain in my back and legs. It hurt just to get out of bed. I remember one day I was on campus and decided to go to the cafeteria. I walked with my backpack full of books. On the way home, my back hurt so badly that I almost had to have someone call assistance. My doctor mentioned lowering my dosage but I refused. I was desperate to cure my acne problem. I was in nursing school and the workload was intense. Somehow, I managed to continue my studies. However, there were many days when I did not want to go outside of my home. I was very withdrawn and emotionally strained throughout college. Needless to say, I did not make many friends and was unable to participate in extracurricular activities. I
0190-9622/$30.00 ª 2004 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2004.01.024
had had a boyfriend during this time, but my physical and emotional stressors eventually ended that relationship, leaving me feeling more alone than ever. The isotretinoin was successful in getting my acne problem under control. The cysts went away, but I was left with severe scarring and skin discoloration. I obtained my nursing degree and moved back home. Fortunately, my parents agreed to pay for corrective plastic surgery. My dermatologist recommended a surgeon. I had scar removal for the raised scars, followed by deep dermabrasion for the pitting scars. The dermabrasion was extremely painful. It took a full two weeks to recover. The results, however, were amazing. My skin was nowhere near as clear as before the outbreak, but for the first time in over a year, I felt somewhat normal in appearance. I soon got my first job out of college and began my career. After the isotretinoin treatment, I was prescribed minocycline as maintenance. I continued the medication for nine years. I also have a chronic liver disorder, so there was a constant worry in the back of my mind as to whether the long-term use of antibiotics could be causing liver damage. The medication caused no noticeable side effects so I felt the benefit was worth the risk. I still had noticeable scarring, but my acne remained under control. After getting married, I got pregnant at age thirty. I had to stop taking the minocycline and my acne flared. This time it affected my back, chest, and arms. There was little that could be done because of my pregnancy. After the birth of my daughter, I began another round of isotretinoin. This time, I had to pay for the medication, which is quite expensive. Now my back and arms are somewhat scarred, but the acne is again under control for the time being. I would love to have another child, but can’t imagine going through another battle with acne. There is always a fear of another outbreak. My case was more severe than most. However, I know firsthand that acne can be a devastating, life changing disease. I am so thankful that there are now effective medications. I continue to depend on knowledgeable physicians and effective medications to aid me in the battle against this disease.