How To | Appearances

A Conversation About Acne

“How much money do you think you’ve spent on acne treatment shit in your lifetime?”

Chloe Caldwell: I’m really depressed with acne lately and would love to talk about it with you. I’m also curious if you can think of any writers or books where the narrator struggles with acne. I know David Shields does it. Elizabeth Wurtzel, a little. Who else?

Chelsea Martin: I don’t know. I remember Holden Caulfield watching his roommate pick his acne in Catcher in the Rye and feeling sad for the roommate.

Chloe Caldwell: I didn’t have acne until adulthood. My skin was awesome until I was twenty-two. But when I did get a zit it would be one HUGE zit. My friend even pointed that out to me once in the high school cafeteria. Like, “Your skin is really nice but when you get one it’s huge.” I was like, yeah, I’m lucky.

Around age twenty-two I began getting acne. Hormonal. I used my mom’s prescriptions from her dermo, a super drying spot treatment called DUAC. But I continued to live in New York City and not go to a dermo. I guess it wasn’t that bad. When I moved to Seattle at twenty-three I remember it getting super bad. I remember it was SYMMETRICAL. And I was like, WTF. So that’s when I started trying different stuff like Proactiv. But honestly I don’t remember going to a dermo then either.

I didn’t have health insurance from age twenty till twenty-eight so that stopped me from taking actions I should have. Stupid.

Then I moved back home to Hudson. It started getting worse but it wasn’t until I was twenty-five that I started getting cysts. But my cysts aren’t always acne, exactly. They’re more like an infection, like people get them on their scalp. So that complicates things because they don’t come to a head, and nothing topical works.

I started being a dermo slut but it was never great. I always felt like shit about myself or cried when I left cause I never went until the acne was already really bad and I was in crisis. I wasn’t super proactive about it; I guess I was in denial. The dermos gave me all that benzoyl peroxide bullshit that aggravated my skin more. It dried everything the fuck out, which is really bad and unnecessary but feels necessary when you’re desperate.

Chelsea Martin: My face exploded in acne when I was fifteen. I tried all the easy/amateur stuff at first, like Proactiv. I started taking my mom’s birth control pills. (Really weird that I didn’t go get my own prescription, not sure how I feel about this. I mean, eventually I got my own.) The birth control helped a little.

When I was sixteen I went to the dermatologist and got on antibiotics. Oh my god, it helped so much. It didn’t completely solve my problem, but the acne was very manageable, i.e. never fewer than three zits at a time, never more than like seven.

I stayed on antibiotics for eight years!!! I knew it was bad because obviously being on antibiotics is super fucked up, but even if I missed just a couple days of pills my face would explode again, so I stayed on the antibiotics. I got cut off from my insurance at some point and had to start buying black market antibiotics online. I got through college with manageable acne and just used creams and stuff to deal with the zits that came up.

When I was twenty-four, I stopped taking antibiotics and then a few months later I stopped taking birth control. I got freaked out and I didn’t want to take pills every day anymore. My face exploded again, of course. That’s when I really started researching acne and experimenting with my diet and behavior and stuff. I did a month where I cut the caffeine, sugar, gluten, soy, and dairy from my diet completely, and my skin was great that month! But it was really difficult and expensive and time-consuming to figure out what to eat and prepare it. So I started eating more normally again, but I was more conscious of what I ate because it felt like I had proof that my diet was part of the problem. I did stop drinking coffee at that time, because that felt like something I could do easily, and just cut back on the other stuff as much as I could.

Acne and Other People

Chloe Caldwell: Last fall when we were at the Standard Hotel at one point I let out a frustrated groan and said, “My SKIN!” and you were sitting on the bed and said, “Don’t talk about it,” and I said, “Don’t talk about it?” and you said yeah, and I said “Okay,” and was sort of amused. I think I wanted to talk about it cause I wanted you guys to know that I KNEW I had shit on my face. Or something. I had a super painful cyst but you can’t see it in the pics we took in the photo booth that still live on my fridge. What are your coping skills for the psychological effects of acne?

Chelsea Martin: My main strategy for coping with acne in public is denial. I just try to put it out of my mind. That’s probably why I said that to you at the hotel. Even when I don’t have that many zits and I have makeup on I still feel horrible about my skin. It might have been because we were with other friends. I try not to complain about acne with people who don’t have it because they always say things like, “Oh, I hardly notice it,” which pisses me off, lol. Or they give me stupid little suggestions.

When I first started breaking out I remember talking to my friend and I could see that she was looking at my acne. I could see her eyes move around my face looking at it, and then she touched her perfect facial skin and said, “Ugh, I’m breaking out!” It made me feel so embarrassed and ashamed to know that my acne was so apparent that I made other people feel self-conscious about their own skin. I’ve always hated it when someone with much nicer skin than mine tries to commiserate with me about acne.

Chloe Caldwell: When I worked at a jewelry store in New York City, still not thinking my skin was so bad, a customer (male) said to me, “My cousin has skin like you, ruddy.” WTF?

When I went to babysit once I had a huge cyst and the woman I worked for saw it and asked if I’d just had my molars out. I said yes . . . and started thinking maybe I’d start using that to tell people when I had cysts, blame it on molars out.

Once on the subway when I was around twenty-three, this guy saw me picking at my face and sort of kindly mimed to me, telling me wordlessly to stop doing it. It sounds like he was being a dick but it was actually kind of nice, and he was right.

As a nanny in Seattle I remember the little girl telling me I had pimples. “Why do you have those?” I remember telling her, “They’ll go away,” Even though she was a child it was embarrassing. I remember hoping people didn’t notice but then when a fucking four-year-old pointed it out, I was like, fuck.

Chelsea Martin: I had a Chinese coworker at this cafe I worked at in college and she called my acne “bean” and brought up my “bean” all the time in conversation. Like, “Why do you have so much bean?” I found it a little endearing even though it also hurt my feelings. Do you think there is a right way for people to broach the topic of acne with you?

Chloe Caldwell: I look for a certain level of compassion. It drives me nuts when people say, “I never notice your acne, how bad can it be?” Even my therapist told me recently she doesn’t notice it. I was like, you haven’t seen it! You see me an hour a week. And I don’t post any photos when I have it, though I’m tempted to start, and love the celebs and writers who post about their acne on Instagram. It must feel liberating. I saw a review of my book recently where the chick gives me shit and says I was complaining about a lip pimple. Sure, okay, get back to me when you’ve had to pay $180 five times a year to get a needle in your cheek, and stay home the next day while it heals, and then you have a scar for life, in a place that everyone can see. I’d kill for just a lip pimple. But people who have never struggled with acne and try to talk you down mean well but truly don’t get it. Similar to eating disorders, you know?

Chelsea Martin: I definitely have an angsty, “Fuck you, you don’t understand,” attitude when people try to tell me my skin looks fine. But then on the other hand, because I’ve written about acne a bunch, sometimes I feel like I have to apologize for my skin not looking worse? The thing is, I’ve had acne for fucking fifteen years straight. So even when I’m not in the middle of a full-blown breakout, my skin still looks like shit. It’s never going to be pretty.

Acne and Diet

Chelsea Martin: I’ve been trying to avoid dairy for pretty much my entire adult life. It’s so hard because I love dairy so much. But I definitely notice I break out more when I eat a lot of dairy. This past year I’ve mostly stopped eating meat and eggs, too. I only drink coffee on special occasions, because I think it raises my stress levels, which I think contributes to acne. Do you find that diet plays any role in your breakouts?

Chloe Caldwell: Like you, I am super prone to stress and I go in phases with coffee. Right now I’m off it. But I’m not as good with my diet as you because there’s been times I’ve been eating whatever I want and my skin was awesome so I don’t have the “proof” yet. I’m a pretty healthy eater when I’m home, but when I go out of town it’s harder to do. I know you love dairy. I remember you ordering a Brie sandwich somewhere and loved you for it. My acupuncturist wanted me off gluten, and on herbs, and that worked well for around eight months. It seems everything “works” at first and then I grow immune to it. I’m obsessed with looking at how much sugar is in everything.

When we went to Jamaica, I hadn’t really met you for longer than five minutes and I remember being on the beach ordering drinks (god that trip was so fun!!!) and you asked for yours without sugar and I was like, Oh wow, she’s on my team.

Chelsea Martin: I’ve thought a lot about doing a Candida cleanse. Apparently it’s helpful for people who have messed up their digestive systems by being on antibiotics for a long time. You basically can’t eat sugar, gluten, alcohol, dairy, most meat and fish, caffeine, anything fermented or moldy like nuts . . . Ugh. It would be the worst.

Chloe Caldwell: Those diets are so hard. I don’t know why I am so resistant to it. Usually it goes back to money. My acupuncturist really wants me to do it, and I told her, “But I’m poor, and bread is cheap.” And she said, “So is kale.” I usually eat pretty healthy but I definitely eat wheat and cheese. I just ate whatever I wanted in France, and my skin was so good, but someone just told me that you can eat cheese and then break out from it three weeks later. Maybe it was you who told me that.

Chelsea Martin: Kale is not as cheap as bread!!! And yes, it was me, and it’s actually three months.

Chloe Caldwell: Three months! I actually keep a food/skin/mood journal now. Each night I write what I ate, if I drank alcohol, what state my skin is in, and how my mood was. Living on the wild side.

Acne and Self-confidence

Chelsea Martin: Do you notice a change in your self-confidence when your skin is relatively clear?

Chloe Caldwell: 100%. Absolutely. I am a different person when my skin is clear than when I have an entire situation on my face. When my skin is fine, it’s almost as though I feel I need to go get everything done—errands, go on dates, etc. Because I know it won’t last. There is an enormous difference between having a conversation with someone with shit all over your face and having clear skin. Over the summer my skin was so stressed out, I had to reschedule recording videos for my Catapult online class—twice! What about you?

Chelsea Martin: I definitely hold myself differently when my skin is doing really bad. I feel like my posture and the way I hold my head change because I’m physically trying to hide acne. Even when I’m not breaking out, I never feel great about my skin. I’m always worried about the lighting casting shadows on my pockmarks or something.

Chloe Caldwell: I completely relate; I’m anxious about sunlight, and there are certain restaurants and stores I won’t eat or shop in because of the lighting. I’m always dimming the lights if possible, and turning overhead lights off.

Acne and Treatment

Chelsea Martin: I got a really good job when I was twenty-seven, and suddenly I had a whole bunch of money. I spent it all on getting my teeth fixed and I started seeing an acne-specific esthetician in San Francisco. (It’s called SkinSalvation, highly recommend.) She would give me shots of whiskey, pop all my zits for me, and tell me what products to use and how to touch my skin and what to eat and what supplements to take. Everything I do now is based on what she told me. I can’t do everything, because it is actually really expensive to eat well and take supplements and I don’t have a fancy job anymore. Also some of the stuff she told me to do is very annoying and time-consuming. For example, she told me to rub ice cubes on my face twenty minutes twice each day. How annoying! But it really helps.

Chloe Caldwell: At age twenty-six I had to get a cortisone shot on a huge recurring cyst each season. Having a needle coming towards your face is seriously the worst feeling. I remember at one point the doctor and nurse thought my eyes were closed before they injected the needle but I opened them and saw the nurse miming to the doctor to take a pic of my cyst cause it was so fucked. I felt like such a freak in that moment.

Acne and Money

Chelsea Martin: Something my esthetician told me is that a lot of skin products you see in stores, even high-end stores, even brands that are specifically made for treating acne, are full of ingredients that cause acne. It’s infuriating. It’s not bad enough that we have acne, but we’re tricked into using products that are going to give us more acne so we’ll have to buy more stupid shit to treat a problem that is being exacerbated by the stupid shit we’re using to try to get rid of it. How much money do you think you’ve spent on acne treatment shit in your lifetime?

Chloe Caldwell: That is a daunting question. I’m sure I’ve spent—between products, facials, cortisone shots, and medications—hundreds of thousands of dollars. Fuck me. Sometimes I get pissed that my extra money goes to my face, and I can’t spend it on something else, like clothes or whatever, the way other people do.

Chelsea Martin: At any given time I have in my possession about $600 worth of acne products and supplements and acne-safe makeup. That, every couple months, for fifteen years? Plus the occasional facial? I think I’m looking at like $60,000. Plus all the products I don’t end up using all of. Plus all the fragrance-free hair products and laundry soap. Plus the extra cost of food and special diet stuff.

Acne and Dating

Chelsea Martin: When me and my boyfriend Ian were first dating I brought up my acne problem and how I’d been dealing with it for years, and he said that he couldn’t tell when he was far away but once he got closer (I guess when we started making out) he noticed that my skin had “been though a lot.” He wasn’t being mean about it. I think he thought he was being practical or something. But, ugh. I had never heard anything more hurtful and wanted to just die. Do you have any special way to broach the topic of your skin with people you’re seeing?

Chloe Caldwell: When I was younger I was a big get-up-early-and-put-makeup-on-before-the-guy-wakes-up person. Like Kristen Wiig in Bridesmaids. It was awful. I probably even set an alarm. I just couldn’t function without powder or foundation, (I was super into Bare Minerals). It was exhausting to get up and do that and then go back to bed.

When I went on birth control and was dating someone, I had the “initial breakout” and ended up being honest with the person I was seeing, just saying, “My skin doesn’t usually look like this, it’s a phase, and it’s really embarrassing.” It’s hard to do that. You feel so ashamed, vulnerable. It sucks because it feels like your face is betraying you.

Current Acne Routines

Chloe Caldwell: I’m really all about this brand Naturopathica that I cannot afford. I use their Oat Cleansing Facial Polish every day. It has overall calmed my skin, hydrated it, and taken the redness and splotchiness away, and you can use it as a mask too. I’m HUGE on sunscreen and wear one with Vitamin C every single day. I also keep hydrosols around to balance PH, and spray them on my face in the morning, and if I ever pick at my face, because they sterilize.

Though I was scared of them for a long time, I’m into thick moisturizers now with Vitamin C to reduce scars and hydrate, and use them at night. I’ll use Neosporin on my breakouts or sometimes Mario Badescu Drying Lotion. I need so much hydration; I finally learned that drying out my skin was only leading to more problems. I also like sea buckthorn oil. I use a Retinol (the brand IMAGE) at night, which has been amazing. Recently I cried during a facial and they felt bad for me and gave me a bunch of free samples. I take fish oil pretty regularly to reduce inflammation.

Chelsea Martin: I moisturize a lot too. I use Vivant Day Treatment Lotion with SPF. I’m OBSESSED with moisturizing, have not missed a day since I was fifteen, which I think has helped minimize the damage to my skin a lot. Sometimes I add jojoba oil to the lotion or use a hydration gel.

I’m also obsessed with OptiZinc supplement. I try to take it three times a day, but it’s usually more like twice. It upsets my stomach big time if I take it without a full meal. It is supposed to reduce inflammation, which helps blackheads not turn into pimples. I definitely have a bigger breakout when I don’t take it. And it’s pretty cheap.

Acne and Writing

Chloe Caldwell: I’m curious how you broach acne in your writing. “My Year of Heroin and Acne” was definitely the scariest thing to publish, but one of the most fun and easiest to write. But though I wrote about my acne problems in that essay, I never do in other essays. And I didn’t give the narrator in Women any acne.

Chelsea Martin: I wrote an essay for Vice about wiping urine on my face as a form of acne treatment. I think it’s interesting that both our essays deal with acne in relation to something way more shocking (Heroin/urine facials). Like acne wasn’t enough of a topic on its own, we had to make it flashy or something. But from what I can remember, no one who commented or emailed me said anything about the pee, people only wanted to commiserate about acne or give me treatment tips.

Chloe Caldwell: True. I was searching the internet during that time reading about acne and reading about drugs, but they were never written about together, which is why I thought it would be interesting. I was dog-sitting that night in an apartment with no wifi. The next morning I took my computer to a cafe to use the wifi. I have never received so many emails about something I’d written. There were possibly sixty. People were giving me unsolicited advice and attaching photos of themselves and their children. Though well-intended, I found it very stressful and upsetting. It’s not like I was writing a Reddit discussion thread asking for advice.

Chelsea Martin: I also had way more response to my acne + urine essay than anything else. Mostly people wanting to share what worked for them. Which I totally get, because if I ever found “my thing” I would very much want to share it with other people who were struggling.

Chloe Caldwell: We almost included photos in this conversation but decided not to, because everyone would be looking at our skin to make sure it’s as bad as we say. But since my acne is often under the skin, you can’t always see it in photos.

Chelsea Martin: Yeah, same. If I’m not having a huge breakout, I can usually cover my scars and blotchiness pretty well with makeup. Also, photos are beside the point. This isn’t about some particularly bad breakout. This is about years and years of dealing with the same problem with no end in sight. Plus I’m not super eager to put hideous photos of myself on the internet.

Chloe Caldwell: We both do lots of readings and travel. Does that stress you out? I worry a ton about traveling. I feel like every time I come off of an airplane my skin is wrecked. But 2012 was the only time my acne was too bad to do a reading and I canceled. What about you—does reading with acne ever scare you and do you remember one incident in particular?

Chelsea Martin: It’s totally scary. Everyone has full permission to just stare at you while you’re reading and there is usually bad lighting and someone taking photos or video that then show up on Instagram. On top of that is the pressure to perform well and to expose yourself in whatever way your writing is exposing you that time. Readings are just horrible. One time someone reviewed a reading I did and noted my acne in the review. It was done as if my acne were an accessory, just something I happened to be wearing that night and could be used to describe who I was. It felt horrible.

Acne and the Future

Chelsea Martin: It’s funny how every single acne product’s advertisements are like, “I tried everything to cure my acne, and then I tried this and it finally worked!” I want to believe so bad . . . but I feel so pessimistic about anything ever working.

Chloe Caldwell: I know what you mean. “I tried everything, and nothing worked UNTIL sea buckthorn oil! UNTIL magnesium pills! Until I toned my face with piss!” I guess what I should do is get a blood test to see what my hormone levels are. There’s a medication called Spironolactone that I think I want to try. It blocks testosterone and promotes estrogen.

Chelsea Martin: I have never heard of Spironolactone. I haven’t been to a dermatologist since I stopped taking antibiotics and have kind of sworn off dermatologists and derm medications. I just read an article about it, though. It looks interesting . . . Do you feel optimistic that you’ll someday have clear skin?

Chloe Caldwell: I’m not giving up. Update: Since we’ve begun this conversation a month ago, I’ve gone on Spironolactone. For three weeks when I started, I had the best skin of my life. I was even getting compliments! Then two days ago I got a cyst. It is something I’ll always struggle with, and I have to put more work into it than “regular” people, but everyone has their cross to bear, right? For some it’s weight, for some it’s chronic yeast infections, hair loss. Does all the stuff you do for your acne feel like “work” also?

Chelsea Martin: God yeah. Sometimes it feels so unfair. Other times I blame myself. Like, there must be something I’m doing wrong, or something I did in the past that triggered this nightmare. Or I handled it poorly and shouldn’t have been on antibiotics so long.

I think we both feel conflicted about whether to end this on a positive or negative note, but to me, both options feel kinda fake. Having acne sucks and a big part of me believes I’ll never completely get rid of it. But a part of me also feels like the end is in sight, that I’m going to find the right combination of products, or that my hormones are going to level out.

Chloe Caldwell: I know what you mean. Sometimes I feel like it’s karma for anything bad I’ve ever done in my life. But it’s almost like if we have no hope about it getting better, we should just kill ourselves. Just kidding. I’m doing more work now than I ever have on my acne and I have to believe I’m climbing upwards. At least we have each other, Chelsea!