When the going gets tough

Johanna, a teary-eyed, anxious, 23-year-old file clerk told me that she had suffered
with acne “all” her life. After my usual comment that she must have been an unusual
acne-covered baby at birth, she then told me that she had been suffering from acne
since seventh grade (I guess that seemed like “forever” to her). As she held her
head down, she said that she was ashamed to look at people and that when she
was in high school some of the kids used to call her “pizza face.”
And, indeed, her acne was severe. She had pimples, pustules, and nodules, as well
as blackheads and whiteheads all over her face, shoulders, chest, and upper back.
She told me that she had tried “everything,” by which she meant numerous over-the-
counter preparations that only served to irritate her skin but did little to get rid of
the acne.
Her life was very limited and she stayed home most of the time because social sit-
uations made her very anxious and self-conscious. She felt that the few friends she
had tended to avoid her. Her “best friend” advised her to wash her face more fre-
quently. She felt dirty and embarrassed. She especially dreaded times when she
would have to see her relatives at family holiday get-togethers. She preferred to
interact with people over the telephone or by e-mail.
I saw Johanna in my office for several years. We used both topical and oral ther-
apy to get her acne under reasonable control. She was left with some residual scars
that I couldn’t do too much about, but she seems to now relate more comfortably
with people. And now at age 26 she has a new job as a medical secretary that is
better paying, and yes, it keeps her in the public eye.