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I have a distinct memory of the first time I squeezed a spot. I was about ten years old, standing on a stool and peering up at my face in the bathroom mirror, agitating a dark bump on my nose. After some prodding and poking I attempted to squeeze it, not really sure what I was hoping would happen. But lo and behold the blackhead popped. I was in awe. The dark red hole in my nose, the hard nubbin of what I thought was wax that was now in my hand, the deep satisfaction the popping had given me. I was so excited, so proud and curious, I ran downstairs to do a show and tell of the new hole in my face. From that point on I was hooked to squeezing and picking at my greasy, spot-ridden skin.
Okay, look. I know there are many people who will have read that first paragraph and gagged. And maybe they’re in the right and I’m in the wrong. But I also know there are many others like me who find a perverse, almost compulsive pleasure in picking and squeezing. And while it certainly didn’t start with Dr Pimple Popper, she has helped normalise the need to squeeze (sorry) and opened up the world to what us spotty people have always known: pawing at our skin may not be good for us, but it sure as hell is satisfying.
However, my picking habit became more complicated in my early 20s. My teen acne turned cystic thanks to my only recently diagnosed Polycystic Ovary Syndrome. In the same time period, I was wrangling with my mental health and spot picking morphed from a guilty pleasure to an anxious compulsion. And so my skin got dramatically worse, while my ability to reckon with intrusive thoughts and compulsions hinged at least in part on picking at my skin. The scarring got worse, my skin got worse, my anxiety got worse and what was a dirty little secret was now writ large across my pitted and pigmented cheeks.
It took at least five years to wrangle together a routine that at least went some way to keep my skin in check. Along the way I would make attempts to not pick, knowing that it’s Bad For My Skin, but for a long time I couldn’t see a difference. My skin was "bad" either way! And given the release it would give me from stress or anxiety, even momentarily, I couldn’t make myself be bothered.
By now I have a combination of pills, prescribed creams and a few other additions that I’m fairly happy with as a skincare routine. As a result, in August my skin was the best it’s been since I was about 19 (when I was living in the blissful post-teen, pre-PCOS stage) bar some hyperpigmentation I was working on fading and more deep set scars I was working on accepting. For the most part I rarely get painful cystic spots when they were once a daily occurrence, and the subclinical acne that made my forehead uncomfortably bumpy was largely in check.
So I thought now was the time to really try to let go of one of my anxious habits with a view to control my skin. I also wanted to chart how much my cycle would impact it. Even though I now take the combined pill for PCOS to regulate my skin and the acne, I still experience the hormonal fluctuations and I wanted to see if my squeezing was causing it or making it worse. Or if it was just that damned progesterone. So I set about not squeezing my spots for 30 days.
The first week was surprisingly hard, just in terms of how often I found myself gravitating closer and closer to a mirror, staring down the blackheads on my chin. I would automatically lean in before I’d catch what I was doing and have to literally drag myself away. It’s actually quite embarrassing.
However, I was also at the very beginning of my cycle when my skin is at its best so I was feeling good about denying the picking impulse. I didn’t have any whiteheads and nothing remotely cystic or painful and I wanted to keep it that way thank you very much.
That meant sticking to my honed but fairly simple skincare routine. I use CeraVe Foaming Cleanser twice a day which I love for how gentle and effective it is on my skin. I then have a rotation of either acids, serums or topical retinols that I swap between, because it keeps my skin on its toes. In the morning I’ll either use The Ordinary Niacinamide Powder (which is the only thing I’ve found that effectively deals with the bumpy under-the-skin acne) followed by Heliocare 360 Fluid Cream SPF 50, OR my prescription Duac (a benozyl peroxide cream) on target areas followed by the Medik8 C-Tetra Serum (which helps brighten hyperpigmentation and makes me feel lovely and glowy) then SPF. In the evenings I rotate between my prescription retinol (differin) or an acid-based treatment. I love Sunday Riley Good Genes, and The Ordinary Salicylic Acid 2% Masque. The bonus of working from home is that I can let the products really sink in before applying another, and I can do a face mask any old time.
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It’s also worth noting that I now take the combined pill (Microgynon) to manage PCOS symptoms. This has hugely helped with my cystic acne which was entirely hormonal and couldn’t be reigned in no matter what I used on my skin. This obviously isn’t an option for everyone.
It could be wishful thinking together with a sprinkling of smugness, but by the second week I already feel like I’m seeing a difference. In any case, my skin definitely is not worse. My cheeks are my danger zone for infection because I have such open pores and while I’m seeing blackheads form I’m enjoying the lack of pain on my face too much to interact. I always kind of assumed that whenever I’d squeeze a blackhead or whitehead (especially in my Danger Zone cheeks) it would always end up disastrous, with an infection that both hurt and looked far worse than the original offender.
Dr Zainab Laftah a consultant dermatologist, confirms that this theory is correct. “Although that urge to pick can be difficult to resist, squeezing your spots can lead to more spots developing, skin discolouration and scarring.” In particular, the act of squeezing can push and spread infection around the skin, instead of getting it out. With cysts in particular (which are a collection of pus, dead skin cells and oil beneath the skin) “squeezing can force the bacteria and oil deeper into the skin, resulting in swelling and infection, therefore increasing the risk of scarring.”
Despite knowing all this, I still find it hard to let go of the idea that you need to get the infection out for it to get better. However, Dr Laftah emphasises that isn’t the case. “In the short-term the result of regularly squeezing your spots is inflammation, pain and cysts formation, whilst the long-term effects include skin discolouration and scarring.”
Armed with this knowledge and the high of a successful week, I’m readying myself to face the challenge of week 3 when I expect to be hit by the double guns: the urge to scratch the itch again, and PMS acne.
Reader, I was hit. The picture above was taken at the beginning of the week, before it all went wrong, but my skin did not look this good by the end of it. The day after taking this pic I started to get a swelling on my left jaw that just wouldn’t quit. I found myself worrying about it while I worked, diligently not picking or squeezing, but definitely poking at it. It was red and angry but I didn’t squeeze it.
Suddenly it’s Saturday night, I’m red wine drunk, my PMS is raging and I’m in the bathroom about to floss. Before I can stop myself, I’ve leaned in and started on my skin. After I got the red spot, I couldn’t stop, and I squeezed everything I could see – all over my nose and chin and most disastrously, my cheeks. The euphoria of giving in quickly gives way to guilt as I tipsily stare at my now inflamed, red face.
I called myself a silly bitch and put myself to bed.
Dr Sheri Jacobson, a psychologist and founder of Harley Therapy, tells me that we develop habits as an attempt to either bring pleasure or relieve distress. “Things like picking skin will often be an attempt to soothe oneself or bring about a reduction in discomfort or distress. So it could be an unease with one's own appearance. Generally, we're looking at the aesthetic side and all that that means to a person, because some people it doesn't affect at all.”
Given how worked up I made myself about the spot, it makes sense that I couldn’t maintain the patience I’d exercised the previous weeks and the dam burst. And once I had started, I thought I clearly deserved to feel ugly so why stop there?
This, according to Sheri, is often bound up in a form of self flagellation. “We know that it's not helping, but we continue to do it. That could be because the cycle is so entrenched and it's very difficult to break habits full stop, but also because it's a form of self flagellation or self harm. On an unconscious level, it could feed into things like maybe we don't deserve to treat ourselves better.”
Wow. She got me there!
What should have been a triumphant final week is instead humbling, as I’m reminded daily of my transgressions. A new, painful spot has formed on my cheekbone as well as two whiteheads on my cheek. The spot on my jaw is now a dark red stain and my skin is a range of pinks. As you can see in the pictures the hyperpigmentation has only just begun to fade – I know from past experience it will take weeks, even months to completely disappear.
I’m still buoyed by the results of the experiment, though. The spots I develop are directly linked to the blackheads I squeezed in that wild frenzy the week before and bar the one that started it all, I would likely have had little change throughout my menstrual cycle.
However, I realised that the knock-on effect that my cycle has on me mentally (especially when it comes to body image, mood and general self-flagellation) is much more impactful. Speaking with Sheri made me realise how intertwined my mental health and my skin are: my compulsion to pick ties to my OCD, my acne impacts my self-image, my anxieties and low mood fuel the ‘fuck it’ sense of self-flagellation.
Reigning in my compulsion to squeeze spots is as much to do with trying to maintain the relatively clear skin I spent so long working for, as it is to frankly not hating myself for slipping up. It’s as much about monitoring my mood as it is about the spots themselves. I will never have the skin of someone who has never had cystic acne and I can live with that. Hopefully with time I’ll find ways to stop punishing myself for it in a fit of PMS.