The Social Impact of Acne

"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 of psychic suffering than does acne vulgaris."  --Sulzberger & Zaldems, 1948

While known for quite some time, the psychosocial effects of acne have not been fully appreciated until recently. The reasons for this are many. After all, everyone gets acne to one degree or another. In most cases, it goes away on its own. While it's running its course, it is not a serious threat to anyone's overall physical health. In addition, until the last couple of decades, there was very little anyone could do to treat it.

Acne, nonetheless, has a significant impact on a person's outlook on life. Recent studies have detected the following as common among people with acne:

• Social withdrawal

• Decreased self-esteem

• Reduced self-confidence

• Poor body image

• Embarrassment

• Feelings of depression

• Anger

• Preoccupation

• Frustration

• Higher rate of unemployment

The effects listed above are often interrelated, with one effect leading to another and another, only to make the first effect worse. These negative psychosocial effects can have a crippling impact, discouraging patients from pursuing life's opportunities--socially, on the job, or at school.

Actual quotes from people with acne
The fact is, people with acne generally hate the way they look with acne. Let people with acne tell you-here are some testimonials about living with acne*:

Verbatim #1
"I don't look in mirrors.... I am like a vampire--I shy away from mirrors. I comb my hair using my silhouette on the wall to show the outline of my head. I have not looked myself in the eyes in years, and is painful not to be able to do that, and that is a direct result of acne, the acne scarring."

Like a vampire, hating mirrors! Unable to face himself, how can this person hope to face the world?

Verbatim #2
"I think that if I had more self-esteem about the way I looked, I think I would have been more outgoing. I would have gone to more parties. I probably would have been more outspoken in class and would not have felt so insecure about going up and speaking in front of a group of classmates."

Here is an extrovert, turned in on himself (or herself) because of acne. Who knows how different things would have been if he didn't have acne?

Verbatim #3
"It is really humiliating to feel like I have no control over my acne. I hold my head down and I am ashamed to look at: people, embarrassed. I am 25 years old and to be acting this way is very frustrating."

In just three sentences, this person revealed humiliation, lack of control, shame, embarrassment and frustration. With the treatments available today, there is no reason to suffer like this.

Verbatim #4
"It's associated with being dirty, and I hate that, because it's not at all like that. I inherited it from my mother, and she's always telling me that she had the exact same thing and that it will go away. I am mad that I inherited it from her. My dad makes me feel bad because he never had bad skin when he was younger, so he doesn't understand.... I hate that the first thing people see when they look at me is bad skin. I really. really hate that."

Myths about acne are a common source of family conflict. Teenagers tend to be rebellious anyway--do they need to have acne misinformation driving another wedge between them and their parents? One myth that makes this family situation worse: The notion that nothing can be done to clear serious acne sooner than if it were left alone.

Verbatim #5
"I feel like I don't look right no matter how hard I try to dress up and look nice--there is always that area of pimples there, and it is very unsettling. There really hasn't been a day gone by that I don't think about it, or look at my face.... Should I spend that much energy on it? I could be doing other things...instead of wasting 5 to 10 minutes every day looking at my face in the mirror, or playing with it, picking at my acne."

This person is so preoccupied with acne that he almost neurotically picks at it. He is also clearly frustrated, as acne thwarts all attempts at achieving a good appearance.

These testimonials show the extent of the psychological, emotional and social disturbances that acne can cause. Clearing up the acne would relieve the source of these disturbances, but many people don't realize that something can be done.

Many myths about acne, especially regarding diet and hygiene, are still considered to be true. And many parents and older siblings are stuck in the attitude of past generations that nothing can really be done but wait it out.

Making matters worse, there is confusion among people with acne and their families about what works and what doesn't. They are often frustrated by products that promise to clear skin but that don't work for them.

Some nonprescription products may be more effective than others, but dermatologists have treatments that work just about 100% of the time. Most cases of acne can be cleared up with the right treatment.

*Patient testimonials courtesy of John Koo, MD.