Chelsea Fahey had always been celebrated for her looks -- she was a child model and won more than 10 beauty pageant titles, eventually going on win the Miss Teen America 2004 crown.
But beginning in seventh grade, she fought an embarrassing battle against severe acne.
"I would hide my face with my hair, and I would look down so I wouldn't see people's reactions and I wouldn't have to deal with the pain of seeing people wincing," said Chelsea, who is now 18.
The Academy of Dermatology says almost every teen aged 12 to 17 will suffer from some form of acne, but 40 percent of those will develop very serious acne. Instead of pimples, they will get cysts that can cause scarring -- and emotional devastation.
"I didn't make very many friends, not wanting to date anyone," Chelsea said. "I didn't want anyone to touch my face, not looking in mirrors. It was really sad."
She even went so far as to cover all the mirrors in the house, so she wouldn't have to see herself. And she tried everything -- pills, creams, different face washes, medicated makeup -- but nothing seemed to work.
Chelsea's mother, Jane, watched helplessly as her daughter seemed to be fighting a losing battle and retreated further into herself.
"It wasn't just an occasional pimple, it was a cyst underneath the skin and then it would be three cysts and then a forehead and a cheek full and a chin full," Jane said.
But Chelsea refused to talk about the problem -- even to her mother.
"I thought that if I talked about it, I was admitting that I had a problem. And I didn't want to have any more problems than any normal teenager has," Chelsea said.
Jane Fahey was desperate and knew she had to take action to help her daughter. Finally, she convinced Chelsea to see a dermatologist, and they found a doctor who put the teen on a hard-core regimen, prescribing Accutane.
Accutane obliterated her acne, but something unexpected and rare appeared. An unsightly, 3-inch-long scar appeared on Chelsea's face -- a mass of healing skin was trapped beneath the surface of her skin.
"All the scar tissue was healing too much, and it caused this raised bump in my laugh line in the side of my face," Chelsea said. "It looked almost like a caterpillar."
Laser surgery did the trick, flattening the scar. Now, Chelsea uses a topical ointment and strategically applied makeup to keep her acne under control and under wraps.
Dr. Susan Taylor, a dermatologist who practices in New York and Philadelphia, says that she has seen acne develop in children as young as 7 and 8 years old.
"It's very important for parents to realize that it's never too early to take your child to a dermatologist for treatment," Taylor said. "As we have learned from Chelsea's story, acne can be very devastating and it can lead to permanent scarring. So early treatment is so very important."
Taylor said that acne can almost always be successfully treated with some combination of topical creams containing benzoyl peroxide and antibiotics. She cautioned, though, that some medications can have side effects and so their use has to be monitored by a doctor.
Last year, Chelsea was crowned Miss Teen America 2004, the scars of acne well behind her. But if she could go back in time, Chelsea said she would have treated her acne sooner, and she counsels other teens and parents to deal with problem acne aggressively.
"Talk to your parents," she said. "I think that's the one mistake I made. I didn't talk to my parents because I was so ashamed of it, but definitely, if you talk to your parents and parents need to listen, too. They just shouldn't think it's a right of passage as a teenager to get acne. So talk to your parents. Parents, take your kids to a dermatologist and get it fixed."