Pimples, spots, plooks, pustules, boils, eruptions, carbuncles, zits… If there are dozens of different words for snow, there must be at least as many in the school bully’s armoury for spots, or to give the condition its mercilessly judgmental medical name, acne vulgaris. I was a gloriously acnified teenager – we aren’t talking about the odd sprinkling of spots here and there, more a deeply crusted carapace. I can still feel the heat rising under my throbbing adolescent skin as I traced the ugly bulge of each new ravagement, moving my fingers from one drying scab to the next like a never-ending game of join-the-dots. At times it felt as if I was wearing some grim Halloween mask, and how I wished I could just take it off and reveal my perfect, wholesome skin beneath. Looking back, I was lucky enough to come through those challenging acne years with only a few physical scars, and most of those are on the back of my neck, out of sight, leaving my face relatively blemish free. But only now, more than 30 years later, am I also considering the deeper, emotional scars that the condition left. And these scars are so much slower to heal. The lifelong impact of acne is something the medical profession is finally taking seriously. At the end of June, the National Institute for Health and Care Excellence (Nice) recommended mental health support for those who have been affected by their acne, stating that acne vulgaris and the scarring it leaves can have a strong psychological effect, potentially causing anxiety or depression. That’s not a surprise, but I am amazed it’s taken so long for it to be recognised. Dr Tanya Bleiker, president of the British Association of Dermatologists, said: “Acne has a particular effect on appearance, so in addition to depression and anxiety it can be damaging to self-image, leading to isolation and sometimes to severe mental health disorders. This is often at a time in life when people may feel vulnerable. The severity of the acne is not always linked to the severity of the mental health impact, so it is important that there is a better understanding that even mild acne can have severe effects on emotional wellbeing.” I remember my first pimple so well. I was 13 and in the first foothills of puberty. The zit was a fairly innocuous bee sting of a lump on my top lip. I almost welcomed it. I figured with it would come broad shoulders, a hairy chest and more than just bum fluff on my chin. In fact, it heralded 15 years of inflamed skin, livid welts and a relentless assault on my fledgling sense of self. You’d think I’d be over it all by now, but I’m thinking about my spots more and more – and the acute cruelty of being dealt such a blow just when it feels you can cope with it the least. Would I be the person I am today if I hadn’t lived with those terrible spots? It seems we often superficially sail through the events that have a delayed impact on our later lives. We cope with them at the time, take them in our stride, only to become unmoored by their aftermath later in life. I’m not saying my acne was a life-changing event. People have had to deal with so many things that are so much worse. And what real difference could a few spots make? But for me and my own experience of acne… Well, maybe that is what I am saying. That having acne was awful and it has left a lasting legacy. Back then, spots were just something you put up with, that you grew out of. We all had them. But my spots were gruesome. They defined who I was. I was “the spotty one”. For years I lived with that identifier. And spotty people were unclean, dirty, imperfect. And that was me. I wonder if that’s why I have always tried so hard to make people like me. That I care what people might say about me behind my back. My apparent confidence was to make amends for the setback of my skin. I recently stumbled across the acne positivity movement. Over the past few years a growing number of bloggers have been openly, and with searing honesty, talking about their skin issues. On social media they put up bare-faced selfies. Young, clear eyes staring out over the battlefield of their cheeks alongside hopeful statements, like: “The sum of you is greater than any imperfect part,” and: “Never let acne be the reason you cry.” There are pictures of (mostly) women with their makeup on, a cloak of lumpy foundation, and then the same picture again, but with no makeup. They’re brave and brilliant, but they also do make me cry. Here are some of the things that happened to me because of my bad skin. One of my nicknames was Pink Floyd. I was named after their album, Dark Side of the Moon, because my face was cratered like the surface of the moon. It was better than the name I had before: Chunder, because my pustules made people feel sick. Weirdly, I never got called Pizza Face, that was reserved for Pizza Face Ken (aka Blackhead Ken), the other boy in my class with dreadful skin. Every time someone called me Floyd, even if it was meant fondly, I’d feel a hot flush as if my pimples were flashing red. Whenever we sang the hymn Love Divine in school assembly, my stomach would lurch as I knew that when we hit the line “pure and spotless let us be” everyone in the seats in front of me would turn and look at me, miming squeezing spots on their blemishless cheeks and foreheads. It was funny. Of course it was, and I laughed along. Looking back, though, it seems pathetic that I tolerated it. But they were right, I was covered in spots, so what could I expect? I once worked out that the only parts of my entire body that I hadn’t had a spot on were the soles of my feet. Of all the thousands of spots I’ve endured there are some I can still remember. When a particularly big one arrived you knew that you’d be living side by side for a few weeks, and you’d get to know each other pretty well. I remember one giant that sat on the side of my nose for weeks. It was so big I could actually see it if I squinted downwards, disrupting my vision. They hurt, too. It’s not just that they were unsightly; they were painful. You can’t forget you have them. The worst ones are in the areas that move – the corner of your mouth, the line of your nostril. They are a constant reminder. You’ve got spots, remember? How could you forget? And even if you did, someone would soon be along to remind you. Floyd! I tried everything. I was on Amoxicillin for months at a time. Clearasil, Quinoderm, vitamin E cream, azelaic acid. I didn’t eat chocolate for at least five years. Ken tried washing his face in urine. None of it worked. We just had bad skin. Today, kids are put on Roaccutane – and the results are spectacular. But there are side-effects to deal with, too. There are no easy answers. With age and time, my acne finally disappeared. It was as if the heat and rage of my adolescent skin finally burned itself out. I can still remember the last spot. It was a gigantic final fling that bubbled up on my throat on the morning of my wedding, when I was 26. I woke with what looked like a second Adam’s apple, a baby Vesuvius that had erupted overnight. The sharp collar of my fresh white shirt rubbed at it all day, leaving the mound shiny and sore… When I look back now at the photos of our lovely, happy day, my eye is drawn immediately to my neck and that epic final flare-up. Maybe somehow my youthful skin knew that that day was its last hurrah and from now on we were to be grown-up, professional, smooth-skinned. The irony is that I have good skin now. People compliment me on it. And whenever they do I always blurt out that I used to have “terrible acne” as if somehow that made it OK that I was now spot-free. The scars have faded, but they are still lurking there. I’m not sure how far down they go. I survived acne. It doesn’t sound like much of a boast. But when I look back I realise it is actually quite a feat. It’s all I can do not to think of it as “bad” skin. It’s not, it’s just skin. I’ve spent years feeling mortified that I had acne. I felt ashamed of it. I’ve felt myself blushing writing about it here, because there was always a hovering sense that in some ways it was my fault and if only I’d washed more or eaten more healthily I’d have had smooth and flawless skin. That isn’t true, but no one tells you that. And that is what I’d like to say to the younger version of myself: “Yes, you had acne, but it wasn’t who you were.”