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In recent years, open discussions between patients and medical professionals have revealed the impact acne has on the psyche. The following are some of the problems that patients with acne face.

 

Self-esteem and body image

 

1. Some embarrassed acne patients avoid eye contact.

2. Some acne sufferers grow their hair long to cover the face. Girls tend to wear heavy make-up to disguise the pimples, even though they know that this sometimes aggravates their acne. Boys often comment: "Acne is not such a problem for girls because they can wear make-up".

3. Truncal acne can reduce participation in sport such as swimming or rugby because of the need to disrobe in public changing rooms.

 

Social withdrawal/relationship building

 

1. Acne, especially when it affects the face, provokes cruel taunts from other teenagers.

2. Some find it hard to form new relationships, especially with the opposite sex.

3. At a time when teenagers are learning to form relationships, those with acne may lack the self-confidence to go out and make these bonds. They become shy and even reclusive. The main concern is a fear of negative appraisal by others. In extreme cases a social phobia can develop.

 

Education/work

 

1. Some children with acne refuse to go to school, leading to poor academic performance.

2. Some people with acne take sick days from work, risking their jobs or livelihood.

3. Acne may reduce career choices, ruling out occupations such as front-line reception and sales that depend upon personal appearance.

4. Acne patients are less successful in job applications; their lack of confidence being as important as the potential employers' reaction to their spotty skin.

5. More people who have acne are unemployed than people who do not have acne.

6. Many young adults with acne seek medical help as they enter the workforce, where they perceive that acne is unacceptable and that they "should have grown out of it by now".

 

Does acne cause depression?

 

In some patients the distress of acne may result in depression. This must be recognised and managed. Signs of depression include:

• Loss of appetite

• Lethargy

• Mood disturbance

• Behavioural problems

• Wakefulness

• Spontaneous crying

• Feelings of unworthiness

 

In teenagers, depression may manifest as social withdrawal (retreat to the bedroom or avoidance of peers) or impaired school performance (lower grades or missed assignments). Severe depression from acne has resulted in attempted suicide and, unfortunately, successful suicide. Worrying statements include: "I don't want to wake up in the morning"; "I'd be better off dead"; "I'm worthless"; "You'd be better off without me". Parents, friends and school counsellors need to take heed when they start to hear these types of comments.