There is no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums psychic suffering than does Acne vulgaris. – M. B. Sulzberger and S. H. Zaldems, 1948
For anyone with Acne vulgaris the psychological implications can be devastating, yet it is only in recent times that these effects have been fully appreciated. Doctors and other health professionals now realize that teenagers with acne are the most vulnerable and likely to suffer, as adolescence is a time of significant emotional, physical and social development.
The prevalence of acne can have profound effects, more so than other skin conditions because it is so visible. In a society where the importance of appearance is so great, a person with acne is more likely to suffer from a lack self-esteem and confidence at some time.
Such is its significance that many doctors and dermatologists now consider clinical depression a serious side-effect of acne, and the more severe the acne, the greater the severity of depression.
However, depression does significantly reduce when acne is successfully treated, and according to a report in the Journal of Cutaneous Medicine and Surgery, the psychological effects of acne should always be taken into account at the beginning of treatment.
There are several aspects of acne which contribute to its psychological effects, including the distribution of spots on the skin, age, social pressures and misconceptions. Acne is usually very obvious, and in most cases it cannot be covered with clothing, so it tends to be on full view.
As many teenagers experience acne at a time when they are discovering their own identity and when peer acceptance is very important to them, acne can lead to acute self-consciousness and sensitivity – it does matter what others may think of you.
However, it is not just teenagers who suffer. Adults with acne may also experience feelings of rejection, with loss of self-confidence and self-esteem, especially in the work place. Misconceptions about acne contribute too.
According to research in Dermatology Online Journal, 30 percent of acne patients mistakenly believed their acne was caused by poor skin hygiene, and similar beliefs led to feelings of guilt, embarrassment and shame.
Most doctors these days are sympathetic to the feelings experienced by those with acne, and will try to support them through their treatment. However, the degree of psychological distress varies from individual, and it can sometimes difficult for doctors – and parents and partners – fully to understand your feelings.
Make sure you discuss this when you see your doctor, as your psychological health is important, and may even influence your treatment. Don’t be surprised if your doctor asks you more questions about your self-esteem and feelings than about your spots in future consultations – he or she needs to know you are coping.
Signs of psychological problems
There are some common signs of psychological distress. Typical signs include:
- Low self-esteem or confidence;
- Avoiding eye contact;
- Girls wanting to wear heavy amounts of make-up;
- Growing long hair so it can hang over the face;
- Poor body image;
- Anger and frustration;
- Staying away from – or making excuses to avoid – swimming and other sports where you need to change in front of others or expose your skin, especially if you suffer from acne on the body;
- Bullying – others, especially teenagers, may be quick to mock those with acne by name-calling or exclusion from peer groups;
- Relationship difficulties;
- Refusing to attend school;
- Refusing to go to work;
- Taking sick days and jeopardizing employment;
- Limiting work choices – for example, excluding jobs where you meet and greet the public and image is important;
Some of these reactions are just part of normal experience, but if you feel they’re causing undue distress or becoming very pronounced, do make an appointment with your doctor. Here is a video slideshow in words describing a sad story of a young girl who suffered extreme psychological effects as a result of bullying. This happened all just because she suffered from acne.
It created a social calamity in her life around her. This is the case of extreme consequences and is sadly on the rise! Her biggest mistake was not taking the first step in approaching a local doctor or a dermatologist to address the issue.
Remember, you are not alone. At any one time, more than 90 percent of teenagers have acne, while 30 percent of the general population suffers from acne. Acne doesn’t discriminate; if doesn’t care about your gender, background, education or financial status. But the good news is that acne treatments will and can help, and the sooner you treat your acne, the quicker your acne will respond.
Depression usually builds up over time, but it can also take a while before you or someone around you realizes you are depressed. If you do feel down, anxious or depressed about your acne, then make sure you make an appointment to see your doctor and discuss the way you feel.
The Acne Support Group suggests around 12 percent of people with acne will feel suicidal, but acne does not have to go untreated. If your acne is being treated with isotretinoin, then there is a chance you may become depressed, a side-effect of this particular drug. If this is the case, or you think it may be, then make sure you see your doctor or dermatologist immediately.
Signs of depression include:
- Loss of appetite
- Behavioral problems
- Lack of self-confidence
- Reduced quality of life
Any parent of a teenager will know how common it is for adolescents to retreat to their bedroom, and mood swings, irritability, feeling up and then down are very common during these years. However, teenagers with acne may suffer from depression, and may not only spend long hours in their bedroom but also withdraw socially from both family and friends.
They may suffer at school; grades can go down, or they become uninterested in their studies and start to fall behind in schoolwork. If you think this is happening then seek medical help, book an appointment with your doctor, and also inform the school. Your child’s teacher or tutor, school nurse or counselor may be able to offer some help and advice.
Don’t let your teenager suffer from acne for any longer than necessary: make sure the acne treatment is appropriate and be certain to follow all instructions correctly. Also try and ensure your teenager attends follow-up appointments with the doctor to evaluate the treatment and its success.
If you really think treatment is not working, then encourage him or her to ask for it to be changed. Being supportive during these difficult years will be challenging but your child needs to know you are always there to help.
Treatment for depression
There are a variety of medical treatments that your doctor may advise, and thankfully depression can nearly always be treated effectively. You may be prescribed antidepressant tablets, such as Prozac, or counseling, which can help build confidence and self-esteem. Group therapy may also be offered, or the contact details and introduction to a self-help group.
If you are suffering from depression, there are a number of ways you can help yourself:
- Get out every day in the fresh air.
- Take up exercise. It can be as simple as going for a walk or a cycle ride. This is something you can do on your own if you really want to, but doing it in company is more sociable.
- Eat a healthy diet. Make sure you get your necessary vitamins and minerals and your essential fatty acids. (Refer to my article on Acne and Diet)
- Take a vitamin B supplement to increase serotonin levels, a hormone responsible for mood. Low levels of serotonin are known to cause depression. (Refer to my article on Acne and Diet)
- Have a massage. It will help you to relax.
- Take up a new hobby.
- You can take St John’s Wort as a natural antidepressant, but if you are taking any other form of medication, check with your doctor first.
- Try yoga, Tai Chi or relaxation classes.
- Make sure you get adequate sleep.
- Cut back on alcohol and caffeine.
Read my article on the Relationship between Stress and Acne for more reference.
In rare cases, some people who suffer from mild acne may have a disproportionate view of themselves and think they are suffering from severe acne. This perception affects their body image, and they may suffer from psychological and social symptoms.
Dysmorphophobic acne usually requires medical treatment, and isotretinoin therapy may be prescribed on a low-dose, long-term basis. In the worst cases this is a body image disorder, similar to anorexia nervosa.
Acne myths and misconceptions
There are many misconceptions about acne. Doctors and dermatologists are often surprised to find that their patients believe many of these misconceptions. Unfortunately, such mistaken beliefs can unnecessarily increase feelings of anxiety and guilt in those with acne. The most common include:
- Acne is caused through bad hygiene and dirty skin. This is simply not true. Blackheads are the colour they are through oxidization, not dirt.
- Washing more will help. No, it won’t – in fact; you will probably make your acne worse, as you are likely to irritate the skin with all that scrubbing. However, if you do not wash your face at all, and leave make-up on your skin, you are likely to encourage bacteria to multiply.
- There is no cure for acne. There are several very effective treatments for acne, which can keep your spots under control.
- A suntan will improve acne. This is not true either, as you are more likely to dry your skin, increase wrinkles and age your skin. However, the most important concern is that you may increase your risk of skin cancer.
- Covering your spots with make-up will help. To an extent this is correct, but only if you use non-comedogenic products and you don’t suffer from moderate to severe acne.
- Sex or masturbation causes acne. Simply not true, but acne is linked to the sex hormones, in particular testosterone.
- Fatty foods and chocolate cause acne. Ok. You have to refer to my article on Acne and Diet. Anyway, it’s milky chocolates that you have to avoid. You can eat dark chocolates which has anti-inflammatory properties.
- Only teenagers have acne. No, they don’t! From babies to adults, acne can affect anyone, regardless of age.
- Acne is a contagious disease. No, it isn’t. You cannot catch acne or pass it from one person to another.
- Acne appears only on the face. Another misconception: acne can appear on other parts of the body too, the most common being the back, shoulders, chest, arms and neck.
- Squeezing spots will clear them up. This might be tempting, but in some cases can lead to scarring, pocks and holes in the skin. Better to have a spot for a few days than a scar for life.
- All acne medications are the same. No, they are not. The modern medications of today are more or less combination types. Some are configured for certain kind of skin or type of acne. Some are ‘quick-fix’ solutions, mainly for very mild acne.
- Acne can disappear overnight. Unfortunately not acne can take weeks, months and in some cases years to treat, but it can be controlled with medication.
- Acne is simply a cosmetic condition. No, not true: acne is recognized as having psychological and physical implications.
Supporting someone with acne
Very often, the person most likely to be supporting someone with acne is a parent. However, if your partner has developed acne, for whatever reason – pregnancy, stress or hormonal activity – it is worthwhile understanding what you can do to help.
Learning as much as possible about the condition, types of acne and treatment is useful. If the person is not using any medication, then do suggest that he or she consults a doctor, as it is so important for acne to be treated as early as possible.
You may need to reinforce the idea that the acne is not a direct result of something the person has done, or is doing, and that he or she has nothing to feel guilty about. Keep a close look-out for any signs of anxiety or depression.
Teenagers is particular are difficult to monitor, as they can often be moody and irritable and suffer mood swings, but try and encourage frank discussions of their feelings when they are in a good mood. Acne is difficult to live with, whether you are a teenager or an adult, but having someone who supports you and loves you for what you are, and not how you look, is the biggest support you can give and they can have.
For some reference, read my article on “Facing Acne: How to Cope with its Effects.”