Acne and Depression - Living with Blemishes

What are the pressures of living with acne?

Our skin is one of the first things that people notice about us. While most of us realise theres more to life than appearance, those with acne can feel at a disadvantage in a society that seems to put more and more emphasis on looks. Some cope better than others, but many are psychologically as well as physically affected by living with acne. Why is this?

Ignorance There are still those who are prejudiced against people with acne. Sad, but true. They mistakenly believe that people with acne have lower hygiene standards. Even experts frequently use the language of impure skin.
A lack of empathy People who dont have acne often dont truly understand what it feels like to be a sufferer. They can say hurtful things without meaning to. Comments about how youre wearing too much make-up are distressing when all youre trying to do is hide your blemishes.
Its harder to flirt with acne People with acne often feel less confident and shier than those without blemishes. Acne can get in the way of flirting.
Bullying Young people often act rashly and say things they later regret. Bullying during the impressionable teenage years can have a significant impact on someones personality as they grow older.
Professional discrimination First impressions count and acne can make the job application and promotion process harder, especially in industries where looks are important.

How does acne affect feelings and behaviour?

"Acne can be a huge psychological burden as sufferers feel anxious, embarrassed, and stigmatised. Dont suffer in silence. My best advice is to consult your doctor and get treatment as soon as possible. This will stop the disease from interfering with your life and help prevent depression."- Dr med. Markus Reinholz, Dermatologist

Both teenage and adult acne can lead to a loss of self-esteem, and sometimes even an inferiority complex. Studies show that people with acne are more likely to suffer from depression, anxiety and social phobia than those without7. Other studies demonstrate that anxiety and acne often go hand in hand2-4, 7-12. Research also suggests that acne has a greater psychological impact on women than men1.

The psychological impact of acne can lead to behavioural changes and many sufferers:

avoid eye contact with others
come across as shy
hide behind scarves, caps, long hair and/or too much make-up
wear make-up at night as theyre ashamed of their partner seeing the true state of their skin
stop taking exercise or joining in with sport
refuse to be in photos
avoid social interaction

What can I do to help me feel better?

Renowned dermatologist and acne specialist, Dr Markus Reinholz, shares his advice on how to cope better with the psychological impact of acne: 1. Get help The sooner you start medical treatment, the sooner youll get your feelings under control. Research shows that anxiety and depression generally reduce when acne is treated medically 5-9. Your doctor will be able to advise on, and prescribe, the best treatment for your skin as well as to answer any questions you may have. Read Dr Reinholzs advice on when to consult your doctor here. You can also find out more about your options on our website.

3. Look after yourself Exercise (ideally in a group rather than on your own), a healthy lifestyle (time to quit those cigarettes) and a balanced diet. These are just some of the steps you can take to boost your self-confidence, keep your spirits up and support your skin. Find out more in What effect does exercise have on acne and Acne and diet.4. Maintain friendships Were social beings, and quality time with friends is important for our overall wellbeing. People with acne sometimes stop going out, which only makes them more rather than less stressed. If you find it difficult to discuss your feelings with friends and family ask your doctor for advice or consider joining a therapy group.5. Try not to get stressed Easier said than done we know, but stress is known to trigger acne13. You can find out how in Acne and stress. Try some of the various techniques that help people to unwind or ask your doctor for their advice. Flawless skin is an ideal thats hard to achieve, but theres lots you can do to support your skin and keep your spirits up.

1 Ramos-e Silva et al., BJD, 2015, 172 (Suppl. 1): 20-26

2 Yazici K, Baz K, Yazici AE, Kokturk A, Tot S, Demirseren D, et al. Disease- specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol 2004;18: 435-9.

3 Sayar K, Ugurad I, Kural Y, Acar B. The psychometric assessment of acne vulgaris patients. Dermatol Psychosom 2001; 1: 62-5.

4 Khan MZ, Naeem A, Mufti KA. Prevalence of mental health problems in acne patients. J Ayub Med Coll Abbottabad 2001; 13: 7-8.

5 Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998; 139(5): 846-50.

6 Preston K. Depression and skin diseases. Med J Aust 1969; 1(7): 326-9.

7 Polenghi MM, Zizak S, Molinari E. Emotions and acne. Dermatol Psychosom 2002; 3: 20-5.

8 Aktan S, Ozmen E, Sanli B. Anxiety, depression, and nature of acne vulgaris in adolescents. Int J Dermatol 2000; 39(5): 354-7.

9 Schulpis K, Georgala S, Papakonstantinou ED, Michas T. Psychological and sympatho-adrenal status in patients with cystic acne. J Eur Acad Dermatol Venereol 1999; 13: 24-7.

10 Wu SF, Kinder BN, Trunnell TN, Fulton JE. Role of anxiety and anger in acne patients: a relationship with the severity of the disorder. J Am Acad Dermatol 1988; 18(2 Pt 1): 325-33.

11 Grahame V, Dick DC, Morton CM, Watkins O, Power KG. The psychological correlates of treatment efficacy in acne. Dermatol Psychosom 2002; 3: 119-25.

12 Medansky RS, Handler RM, Medansky DL. Self-evaluation of acne and emotion: a pilot study. Psychosomatics 1981; 22(5): 379-83.

13 Impact of psychological stress on acne. Jovic et al. Acta Dermatovenerol Croat 2017; 25(2): 133-141.

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