By Pauline Odhiambo
It's hard enough being a teenager — dealing with physical changes, emotions, relationships and all the attendant pressures of life that come with transitioning out of a carefree childhood.
South African Lunathi Nokele had an additional burden to carry throughout her teenage years, one that subjected her to unwanted scrutiny and triggered low self-esteem.
Lunathi, 26, suffered for many years from cystic acne, which causes large, red, and painful cysts to form underneath the skin. Unlike regular pimples, cystic acne is more likely to cause scarring and be more challenging to treat.
This severe form of acne develops when oil, bacteria and dead skin cells get trapped in the pores, often causing intense swelling. "My skin looked horrible; I couldn't even look at myself in the mirror," Lunathi tells TRT Afrika.
"Strangers would stop me on the street and ask what happened to me. Some appeared concerned about my appearance and wanted to help."
Lunathi would routinely try out various treatments based on recommendations, but none of these worked.
Worse, even well-intentioned advice from people close to her would make her feel more miserable.
The constant attention reminded Lunathi that she looked different from other girls. "I tried covering it up with make-up, only to realise that it could, at best, camouflage the dark spots.
Make-up can't hide acne," she recalls. "I even used bleaching creams to get rid of the dark spots.
I tried home remedies using lemon, honey, and turmeric, none of which made any difference."
Damaged confidence For those suffering from cystic acne, especially in the delicate teenage or adolescent phase, the most challenging part of living with the condition is the erosion of confidence.
"My sense of worth sank even lower when the acne got worse during my university years, during which there was this intense pressure to dress up and look nice. I wasn't able to do that," the young woman recalls.
"I couldn't go out with my friends. I would just stay in my room because I didn't feel confident about facing the world. That's when I made up my mind to see a dermatologist."
According to the World Health Organisation (WHO), acne is among the top five common conditions that account for 80% of all skin diseases.
It can appear in different parts of the body, including the face, shoulders, back and arms, and can be very stubborn.
Acne requires consistent treatment and can be expensive, depending on the severity of the affliction.
"I visited two dermatologists, the first one in 2018 at a public hospital. She prescribed pills and said I should moisturise my skin regularly. She also advised me to wash my face using mild soap. I tried that, but once I stopped the pills, the acne came back," says Lunathi.
The second dermatologist she visited was a private practitioner who charged about 800 rand (US $45) for the consultation and another 900 rand ($48) for medication that lasted just a couple of weeks.
But skin experts say treatments do not necessarily have to be costly to work.
"Products range in prices, and the lower range ones can work just as well for some people as the high-end ones," says Dr Lerato Masemola, an aesthetic medicine specialist who recommends retinoids to treat cystic acne.
Retinoids, a form of Vitamin A, are available over the counter, but stronger variations have lasting side effects and are to be used only if prescribed by a doctor.
"The side effects include heightened skin sensitivity, dryness and even mental health issues like depression, which is why retinoids are not often the first course of treatment," says Dr Masemola.
Balancing hormones
The aesthetic medicine specialist recommends antibiotics alongside basic skin hygiene based on the diagnosis.
"The cornerstone of good skin hygiene is a daily cleansing routine that can help keep the pores unclogged. Investing in a good cleanser that does not leave the skin feeling dry is important," she explains.
Beyond basic cleansing, some experts recommend hormonal therapy like oral contraceptives, which are often effective in treating pimples, acne nodules and cysts, among other skin ailments.
However, some people are not comfortable with balancing out the hormones with contraceptives for fear that it can lead to other side effects like anxiety and weight gain.
Importance of diet For Lunathi and others with similar cases of cystic acne, eating a balanced diet and avoiding certain foods help clear the skin.
"I know dairy is a trigger for many people, so I try to avoid that along with some oily foods and fizzy drinks," she tells TRT Afrika.
"I also have a skincare routine that I follow consistently." In the past two years, Lunathi has noticed her skin getting clearer. The dark spots have lightened too.
"Make-up now sits well on my skin because I no longer have these large pimples across my face," she says, brimming with confidence.
Dr Masemola advises anyone suffering from cystic acne or similar symptoms to seek medical help immediately.
"It is important to seek medical care to treat cystic acne, especially if home remedies aren’t working. There's a risk of causing further damage to the skin if you wait too long to treat it."
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