Analytical and descriptive themes with representative quotes or authors' descriptions
| Analytical and descriptive themes | Representative quotes or authors’ descriptions |
| Acne viewed as a short-term condition | |
| Identifying potential causes or triggers of acne | I didn’t like it, like it made me self-conscious, acne, and I’d rather I didn’t have them. But I did see it as, you know, the thing that most teenagers get. So I was kind of cool with it.12 (male) I think diet is important because what you put in your body, it affects how your body works and how your body looks. If you eat dodgy food your skin won’t look healthy13 (male, Leeds acne scale 0.1) |
| Expectation that treatment will cure acne not control it | It was kind of just sort of a keeping it at a certain level as opposed to absolutely like clearing your whole skin and making it sort of a lot better.14 (male) I went to the doctor because my skin was upsetting me so much. I’m just praying the antibiotics they’ve given me will fix it.19 |
| Impact of acne not recognised | |
| Perceived physical impact | The fact is that I cannot be normal, when it hurts and is red. It pains and oozes out at times and hurts to smile, and then I cannot feel happy, even if I want to. Also the marks that get left behind, I feel bad about it because it makes my face ugly looking.20 |
| Perceived psychological impact | It was just embarrassing trying to talk to people and you’ve got pimples and people are looking at you and you are trying to hide it as well. It makes you feel embarrassed.18 (female) ‘Very embarrassing, not nice to look at, very self-conscious, always think people are looking at you, they probably can’t see it’21 |
| Perceived social impact | ‘Oftentimes, when I have to go to any kind of party or any kind of social event and if I have too much acne, a big pimple, I don’t want to go because I don’t want anyone to look at my face.’15
‘I would really get upset when I had to go in for a job interview, and I would be afraid that the employer might think that I couldn’t do the job correctly because of my appearance. It is a little bit better, now that I am older and a little bit more secure in myself, but still I find it hard if I look in the mirror and see my face broken out.’15 |
| Perceived blame | ‘I avoid eating sweets but if I eat one piece of chocolate, my family tell me that’s the reason I break out. If I leave my face towel on the couch for 1 second, they tell me that’s the reason I break out.’17
When I look in the mirror it makes me perceive myself as someone who is lazy, someone who should be out there doing something which sort of brings low self esteem between me any myself in front of the mirror.25 (female) |
| Perceived trivialisation | I had one doctor who did have it when he was young, he had acne scars and that. He was(a)bit more sympathetic but there were ones that didn’t. To be honest, some of the GPs they just wrote the script out and “Off! On your way.26 (male) ‘definitely have had some confused feelings regarding the medical establishment, because different practitioners have told me, “Here, take this, try this medicine,” and it really hasn’t worked out that well. Also, a lot of the time I felt from the doctors a kind of attitude that there really wasn’t much they could do for me anyway, and this made me feel very frustrated. I felt sometimes just discounted, or like I am not really being listened to at times’.15 Another man had been refused time off for his ‘trivial’ hospital appointments by his immediate superior and had had to obtain permission from the director, an act that had led to frictions.21 |
| Perceived control over acne treatments and acne | |
| When you get a severe bout of acne like that it does tend to reduce the sense of self control that you have over your body … and if you can gain some of that control back then it makes you feel a little bit more empowered(…)it helps with the overall self-image.27 (about CAM) (female) ‘I really can't control it. It’s just no matter what I do. It’s there, I can't get rid of it. I can't slow it down, or fade it away, or anything.’11 ‘With other things, you know that if you put enough effort in, you can achieve what you want, but with acne, no matter how much time you spend putting various treatments on your face, or looking at yourself in the mirror, you cannot make it go away, and that is very frustrating.’17 | |
| Barriers to acne treatments and use of coping strategies | |
| Concerns about perceived adverse effects and effectiveness of acne treatments | Antibiotics. I didn’t, at first, really want to take them because I didn’t want to put something in my body that wasn’t natural.27 (female) ‘I’m still hesitant to use Retin-A again because it is a very harsh topical medication, and I know from [what other people] have experienced and vaguely what I had experienced…in the distant past there are a lot of harsh reactions…there’re other problems that kind of come from it. So it’s solving 1 problem, but then you’re dealing with these other things as well.’28 |
| Desire to use CAM and behavioural strategies | I probably go for the more natural stuff. I probably prefer the teatree oil face wash cause it’s just a bit more natural. I guess you are not putting too many foreign chemicals in your body… When something’s very chemical you never know what might happen29 (male) I always feel better, when I suddenly feel I’ve got to start looking after myself again, I’ve got to treat myself better, [drink] more water, [eat] healthy, the whole lot, [look] after my face, [do] the routine.18 (female) |
| Concealment/compensation | (Y)ou compensate [for] one physical disability by trying to look different in another way… Go to a martial arts class or go to a serious gym, not an aerobics gym, and you’ll have your cleft palates and your stutterers and your acne sufferers.18 (male) Subsequently, using make-up to cover acne could be a dilemma. Some participants also commented that make-up offered only partial concealment of acne, including of the skin texture such as raised lumps and flaking scabs.12 |
| Variable advice and support | People used to recommend creams to get rid of it – like acne creams and face washes, yeah it’s nice positive feedback – you know say ‘this might work and try it out’ but half the time they never work. But I thought it was quite useful.25 (male) My mum is good getting me to doctors and try- ing all the creams… she just wanted me to be comfortable in my own skin. My mum would probably support me the best.25 (female) “With my family, it seems to be the best. They joke about acne, accutane and the side effects. So the humour makes me feel really comfortable about it when I’m with them”17 |
| Comparisons to earlier self and others | ‘I don’t feel equal to them because they are normal and I am not. Would you rather buy an unblemished apple or an apple with lots of dents and bruises? Nobody likes damaged goods.’17
I don’t think my face is as bad as other people’s. Sometimes when you see people with bad skin you think why am I being so stupid.25 (female) |