Under My Skin

From Avon to Accutane — and beyond

I had perfect skin when I was nine, smooth and clear. I asked my mom why some people got zits and she said it was because they didn’t wash properly; that you needed to rinse off all the soap before dabbing (never rubbing) with a towel. Relieved prevention was so easy, I became fanatical about it, splashing my face with water until my arms ached. Although I couldn’t have articulated it at the time, the fact that my skin remained unblemished felt like a sign that I was a good person, a clever person; a person whose efforts would always be rewarded. Turns out, my hormones just hadn’t kicked in yet.

Two years later, they did.

My parents got divorced, I got my period, and my skin exploded. It started with blackheads, a few open pores, rosacea. Then the pustules: big and red, with swollen yellow heads, they splattered my forehead and chin, formed clusters along my jaw. In Spanish class, when my teacher launched into one of her long monologues, I’d run my fingers across my face, counting zits. Eight. Nineteen. Veintiséis.

For some people, acne was an invitation to give me unsolicited advice, however bluntly. A guy I had a crush on slipped into the chair next to me in assembly and whispered, “Ever heard of Clearasil?” One of my friends told me red clothes didn’t flatter me because (pointing at my face) “You know.” In chemistry class, a girl I hardly knew took me aside to say that she used Pond’s cold cream every night and had never had a problem with her skin. I tried to imagine what that might be like: to be able to look mirrors head-on, without squinting.

I started using my mom’s Avon foundation, which she kept in the bathroom. It came in a thick plastic tube that smelled like roses and was two shades too dark for me, but it was better than nothing. After a few months, she noticed my theft and bought me a tube of my own in a color that matched my skin tone. I started applying it with a damp sponge, following instructions I’d found in Mizz magazine. I also added medicated cover-up, green primer (“to combat redness”) and translucent powder. I got up an hour earlier to make time for this routine, but it didn’t make much difference.

When I was 14, my dad took me to see a dermatologist. He waited in the hallway while this petite, lightly-pockmarked woman in her late sixties counted the zits covering my face, chest, and back. She said my skin was a seven on her 10-point scale, which seemed both harsh and accurate. “Do you ever look in the mirror and cry about how your skin looks?” she asked, when we were seated on either side of her polished oak desk. “No,” I said. I didn’t tell her that most days I got home from school and cried in front of the TV, weighed down by misery for no particular reason. She raised her eyebrows. “You must be very well-adjusted.”

After a series of creams and antibiotics that only gave me flaky skin and diarrhea, she prescribed Accutane when I was 18. This drug was so strong I had to sign a form promising to have an abortion if I got pregnant while taking it, even though I was a virgin. Possible side effects included liver damage and suicidal depression but neither of us seemed to care as long as it cleared up my zits, which it did. I moved a couple of hours away for college, fell in love with a boy from home, and stopped being a virgin. After about a year, the effects of the medication wore off and my skin exploded all over again. But I had bigger problems.

I went to Florida with my boyfriend during Christmas break and felt out of sorts, exhausted and cranky. I got a run in my tights on the way to Disney World and couldn’t stop crying. Back at college, there were damp stains on my wall. I threw some clothes and books in a bag and took the train home. I thought I’d go back in a couple of weeks, when I felt better. I didn’t. (Go back, or feel better.)

I saw a psychiatrist who said I was depressed and gave me Prozac. When that didn’t work, we tried Paxil, citalopram, mirtazapine, venlafaxine, and amitriptyline. Meanwhile, my GP diagnosed my exhaustion, muscle pain, and lack of stamina as ME/CFS, also known as chronic fatigue syndrome. There’s no cure, and my depression never lifted either, but I learned to live with the symptoms. I started a blog and stumbled into a job as a freelance journalist, which meant I could work from home in my pajamas.

When I was 28, I felt well enough to risk a trip to New York, where I met up with Keris, a friend I’d made through blogging. In some ways, it was fantastic: I saw The Lion King, ate lunch at Carnegie Deli and shopped in Macy’s like a tourist cliché. In others, it was an overreach: I was more delicate than I’d realized, mentally and physically. Rude taxi drivers made me tear up and my feet swelled so much I could barely fit them into shoes. But in Sephora, I found a new foundation: a mineral powder you swirled onto your face with a brush, a few grains at a time, so you could have as much coverage as you needed. I thought it camouflaged my zits better than anything I’d tried.

On my last day, Keris and I went to the top of Rockefeller Center. It was early November, crisp and slightly overcast. We took the escalator to the highest observation deck and looked down on Central Park. Suddenly, the sun broke through the clouds, warming my face, and turning the tree canopy below a soft yellow. I felt a burst of euphoria, like the world was huge and beautiful and none of my problems mattered that much.

I was still on a high that evening, on my way back to my hotel, when I ducked into a gift shop to buy a Christmas ornament: a miniature Statue of Liberty punching her way out of an “I ♥ NY” bag. At the counter, the cashier, a tall, balding man, stared at me. “This,” he tapped his cheeks with a thin finger. “How long?”

I frowned, puzzled. “Sorry?”

“THIS!” He shouted, frantically jabbing his cheeks, chin, and forehead with both hands. I felt the stares of the people who had formed a line behind me. My face flushed, but part of me wanted to laugh: I didn’t have as many zits as he was indicating. No one did.

“I just want to buy this,” I muttered.

“No, HOW LONG?” He yelled, slapping the counter.

I raised my voice. “I just want to buy this, please.” Finally realizing I wasn’t going to engage, he let out a long sigh and took my money, shaking his head.

On the plane home the next day, I’d just finished my chipotle chicken when the flight attendant, a woman with high cheekbones and a gray chignon, came to clear our trays. I was sitting by the window, a woman I’d only exchanged hellos with on the aisle. As I passed the attendant the remains of my meal, she beamed.

“You know, you have a lovely smile,” she said.

“Oh. Thank you.” I was surprised. I’d been lax about wearing headgear as a teenager and still had a gap between my front teeth. She obviously appreciates a more unconventional beauty, I flattered myself.

“And I’m sure your skin could be helped,” she added.

Or not. I snapped open my in-flight magazine but my new friend was undeterred. She leaned over the woman on the aisle, who diplomatically kept her eyes on her book.

“Is it… acne?” The flight attendant whisper-shouted. I looked at her out of the corner of my eye and nodded.

“Well, I’m a consultant for this new skincare range and I’m sure we have something that could help you.” She rummaged in the front of her cart as I fantasized about a crash landing.

“Here we go,” she said, pulling out a couple of flyers and handing them to me. I shoved them into my backpack without saying thanks so she’d understand how hurt and embarrassed I was.

“Have a great flight,” she sang.

After I got off the plane, I went into a small airport bathroom, dragging my bags into one of three tiny stalls. I put down the toilet lid and sat there as other women came and went, mostly in pairs, talking about what a great time they’d had or how they couldn’t wait to get home. I leaned my face against the tile, tears rolling down my cheeks. I’d enjoyed parts of my trip, but I’d also learned that no matter how well I coped with my health problems or what excellent taste I had in souvenirs, the only thing people noticed was that I had zits. They didn’t make any effort to find out who I was.

Then again, I thought, did I show them? When people were rude, I didn’t stick up for myself. I bought the ornament. I took the flyers. Because part of me felt like they were right, that if I were truly worthy of respect, then I’d have better skin. But waiting for other people’s approval so I could like myself was probably the wrong way round.

I dug out the flyers the flight attendant had given me, covered in pictures of cleansers and moisturizers with medical-sounding names. I ripped them up, posted the pieces in the sanitary bin, then opened the stall and dragged my luggage to the sink. The mirror showed my hair was frizzy, my eyes were puffy, and I’d cried off all my make-up, so my zits were more noticeable than ever. I washed my hands, re-did my ponytail, and got out my new mineral foundation. Then I stopped. I put it back in my case, swung my bag onto my shoulders, and walked out of the bathroom just as I was.

***

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