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Acne: More Than Skin Deep

Stacy McBain
Dermanities January 20, 2003; 1(1)

Dealing with acne has been a personal battle I have fought for over half my life. I cannot begin to estimate how many hours I have spent worrying and obsessing over my complexion. While my acne could hardly be classified as “severe,” the effect it has had on my life has been significant.

Numerous research studies have been conducted looking at the psychosocial impact of acne. The ill effects acne can have on emotional well-being are remarkable. These effects include depression, anxiety, anger, decreased self-esteem and confidence, issues with body image, embarrassment and social withdrawal, preoccupation with appearance, confusion and frustration, and limitations in lifestyle and activities.1-5

Because acne can be, and often is, dismissed as a mere cosmetic problem, the impact it can have on one’s emotional health and well-being is often dismissed as well. This has been my experience growing up with acne. I remember people would tell me “This is just a phase; it is just part of growing up.” However, my personal favorite comment was, “You will grow out of it.” Well, I am now twenty-six years old, about to become a physician, and I have yet to “grow out of it.”

My requests to see a dermatologist largely fell on deaf ears. Such action was deemed unnecessary; as this was something “everyone” goes through, and I was frequently reassured that “your complexion is a lot better than some other teenagers.” Somehow, that statement was little consolation to a self-conscious teenage girl.

I remember scrubbing my face two to three times a day, thinking that the cleaner my face was, the clearer that it would be. This regimen would often provoke a flare-up and only added to my frustration.

My mother would occasionally take pity on my plight and allow me to stay home from school. Skipping school was the first of many ways having acne has altered the way I think and live.

My parents never wanted me to wear make-up, thinking it would only contribute to my acne. This was always a major source of conflict growing up. While I hated wearing make-up everyday, I felt that it was something that I could not do without. I viewed make-up pretty much the same way that I viewed food and clothing – as a necessity of life. Even today, I never leave home without first putting on concealing cosmetics.

Spending the night away from home has always been a source of anxiety for me. The fear that I might be seen without my make-up means that I have to wash my face and go straight to bed, and in the morning, I shower and apply make-up before anyone sees me. There has never been any casual lounging in pajamas over morning coffee.

Even today, I avoid camping and swimming because my skin condition might be exposed. Besides, who wants to be the girl that brings make-up along on an overnight camping trip? My greatest fear in Gross Anatomy had nothing to do with cadavers or dissection, but that I might get something on my face and have to wash it off in lab. I do not know if I will ever be comfortable with someone touching my face, and am not sure if anyone would even want to.

These are things that I think about everyday. While most other people see acne only on the surface, the burden and disease goes much deeper than some could ever imagine. I cannot remember a time when I did not worry about such things. It can be exhausting at times, but I am sure that most anyone with acne will tell you, it just becomes a part of your life and daily routine.

Today I still continue to be plagued by acne. My face bears the scars from fourteen years of blemishes, and I still bear the wounds from fourteen years of emotional burden. How can acne still be considered a “benign” condition when it exerts such a dramatic effect over a person’s psyche and emotional health? The power of one’s physical appearance cannot be underestimated. Nor can we underestimate the power that dermatological disorders have over how we view ourselves, and perhaps even more importantly how we believe others perceive us.

REFERENCES

1 Aktan S, Ozmen E, Sanli B. Anxiety, depression, and nature of acne vulgaris in adolescents. Int J Dermatol 2000; 39: 354-357.

2 Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol 1999; 140: 273-282.

3 Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998; 139: 846-850.

4 Koo J. The psychosocial impact of acne: Patients’ perceptions. J Am Acad Dermatol 1995; 32: S26-S30.

5 Gupta MA, Gupta AK, Schork NJ, et al. Psychiatric aspects of the treatment of mild to moderate facial acne. Some preliminary observations. Int J Dermatol 1990; 29: 719-721