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Breaking out in severe acne on the left side of her face, after the sudden death of her beloved grandfather three years ago, Holly Roach, 24, of Manchester, has tried four different types of antibiotics and three contraceptive pills to banish her painful spots, to no avail.
Hitting rock bottom in September 2019, as her skin became infected with spots which were “almost blue," desperately self-conscious, with even the children she teaches asking what had happened to her skin, she considered quitting the dream job she had just started and hiding away.
Instead, courageous Holly—who has been dating her firefighter fiancé Karl Williams, 25, who she met at 16, for eight years—decided to share her skin journey on Instagram, attracting both much needed support and mindless abuse.
Undeterred, she fought back, saying:
“Someone took one of my Instagram photos and used it on TikTok to give me a makeover using Photoshop."
“They did it on YouTube too. They said it was satisfying to do it. I read the comments—one of them said, 'Ew, what's that on her face?' Another said, 'I just spat out my dinner'."
She continued:
“I didn't sleep that night—it really hurt me."
“I stopped reading the comments, but in the end, it just made me angry. These trolls took my picture without my permission, which I posted to share a positive message, and they used it in that way."
“I was determined not to let this put me off sharing my story and trying to reach other people with similar problems to do some good."
Holly, who has been taking isotretinoin, also known as Roaccutane—medication for severe acne—for three months, says her skin is finally improving.
Attributing her acne to stress after her bereavement in 2016, she recalled:
“I went all the way through my teenage years without having a single spot—I had crystal clear skin."
“But, when I was 21, my grandad died suddenly. We think he had internal bleeding somewhere and went into hospital. It was all very sudden."
She continued:
“I remember my skin was completely clear on the day he died and just two and a half weeks later, at his funeral, I had huge cystic spots on my cheeks."
“It came out of nowhere."
“On the day of the funeral, I remember not wanting to wear make-up because I knew I was going to cry, but I needed to cover up my skin."
She added:
“A few weeks later, I went to the doctors and they put me on antibiotics. They said, 'See how you get on.' It did clear up for a while, but then the pills stopped working."
Holly was diagnosed with nodular and cystic acne—two of the most severe forms. Pus-filled cysts, like nodules, develop deep beneath the skin's surface and burst open, often leading to infection.
She tried a number of different antibiotics, contraceptive pills—to see if it was caused by her hormones—and over-the-counter creams. At most, her skin would improve for a short time, before deteriorating again.
“My skin would clear up on antibiotics. But then it would flare up again. It was painful and frustrating. The cysts were almost blue—they were so angry. Even with layers of foundation and concealer covering them, you could still see them."
In July last year, after graduating from Manchester Metropolitan University with a degree in primary education, Holly landed her perfect role as a primary school teacher.
At the time, she had been enjoying a spell of clear skin, but then she felt new bumps coming up.
“Before, I am sure the acne was a stress response to losing my granddad."
“It didn't make sense this time, as I had no stress at all. This time it came out of the blue."
“I started to feel it flaring up and I could tell it was going to be bad. All the cysts had merged together and I knew that this was going to be worse than ever before."
By the end of September, a few months after noticing the acne returning, just after starting in her role, Holly says she nearly gave up.
“I considered handing in my notice and having a year off work, staying at home and letting my skin get better."
“You need to project your voice as a teacher and I could hardly open my mouth to speak to the children without being in pain."
She added:
“I could not eat and I lost my whole social life. I didn't want to get up in the morning. I would go to work and come home and I wouldn't do anything else."
“And when my skin was really bad, some of the children asked why my face was all bumpy and pointed it out. I would just tell them that it was a bit poorly and they would stop asking questions."
A referral to a dermatologist through the NHS can take months, so Holly's parents kindly booked her a private consultation at the Alexandra Hospital in Manchester.
She said:
“At my lowest, I was getting up and didn't want to put on make-up because it was too sore, but I knew I had to wear it before I could leave the house, as my skin looked so awful. I was doing nothing with my life. I completely lost myself."
“I have never felt pain like it before, either. All the area around the cysts was inflamed and my glands were swollen. I could not sleep on my left side because of my face, which meant many disrupted nights."
Praising the support of her fiancé, Karl, she said:
“He has been brilliant and supportive all the way through. He would reassure me that I was as beautiful as I was before."
She added:
“He would encourage me to go out at the weekends, but if I didn't want to come out or do anything, he would stay in with me and watch films."
“He would devote his whole time to me and would never question any of my decisions."
Then, as she wrangled with whether or not to quit her job teaching five-and-six year olds, she suddenly found the courage to fight back.
She said:
“I couldn't imagine doing anything else—I love it."
Instead, she started sharing her journey online—and received helpful tips from Instagram followers which she says have changed her life.
She said:
“I know I'm not alone and I know I am helping other people."
She continued:
“It makes me realize I have more to offer than my skin. It's made me more aware of what other people are going through, too, and not to judge – we don't know why somebody is the way they are."
Sadly, her bare-faced posts have also attracted cruel remarks and ill-informed advice.
On one occasion, a skincare brand asked if they could share her photo on their page. She happily agreed, but was then inundated with comments.
“People said I looked like I was malnourished, or suggested I had impetigo, which is a highly contagious skin infection."
But people's disregard for Holly's feelings is not restricted to the internet.
She said:
“When I am shopping for skincare, people try to give me advice which I have not asked for. I've even been asked if my acne is a burn."
Holly continued:
“Karl and I were out shopping recently and I had decided to not wear make-up."
“I could just feel people staring at me. Sometimes I am overly sensitive, but even Karl noticed people were staring."
“And if somebody else notices it too, it must be happening. Everyone just seemed to be fixated on my face. We made a swift exit after that."
During the three years that she has battled with acne, Holly has hated having her photo taken and now only agrees to pose for selfies.
She explained:
“I will take a selfie because I am in control of it, but I can't handle pictures being taken of me."
“Because of this, it looks like I've not been at any family events or anything. It's because people have taken pictures in the past and I've thought I looked disgusting, so it's put me off."
She added:
“It's upsetting that my self-esteem has reached the point where I can't even have a picture taken with my mum without picking it apart so much that I just end up deleting it."
While Holly's skin has noticeably improved on her current drug regime, which doctors want her to continue for eight months in total, the side effects are so bad that she has a lip balm attached to her keys, because her lips are permanently dry and cracked.
“I knew I was going to start this medication and there were a lot of horror stories about it, so I use my Instagram account to show a true record of my journey on it."
Holly added:
“It's hard, but the improvement to my skin has been incredible."
“I am absolutely exhausted, I have very dry eyes, so I can't wear contact lenses, my nose and lips are dry, and I have nose bleeds a couple of times a day—usually in the morning and evening."
“But one little boy at school noticed my skin had improved and told me face had got flatter, which was lovely!"
Holly has also reduced her dairy intake to the odd bit of yoghurt and cheese, but only drinks oatmilk and tries not to eat chocolate, in the hope that this will improve her skin.
And she is determined to keep sharing her acne journey online, as she genuinely believes it helps other people, too.
She said:
“I want to tell people in the same situation as me to go on social media and find people in the community who can help you feel like you are not alone."
She continued:
“Finding people on the same journey has been the biggest influence on me getting better and I hope I can do the same for someone else."
You can follow Holly on Instagram @skintrinsic_