Most people are familiar with the unpleasant visible effects of acne, but what about the equally or even more unpleasant invisible effects?

Acne not just skin deep
The American Academy of Dermatology (AAD) cites studies showing that social withdrawal, decreased self-esteem, poor body image, depression, anger and even unemployment are common in people who have acne.

“Acne can be enormously devastating, and that is independent of how severe the acne is,” confirmed Dr Richard Fried, clinical director of Yardley Dermatology and Yardley Skin Enhancement Wellness Center in Yardley, Pennsylvania. “How many pimples or how red or how big doesn’t necessarily tell us a thing about how upsetting it is to the person who owns them.”

The realities of acne
At some point in their lives, most everyone will have acne. The AAD reports that almost 100 percent of youths between the ages of 12 and 17 have an occasional whitehead, blackhead or pimple. More than 40 percent of adolescents in their mid-teens have acne severe enough to require treatment by a doctor. And although most cases clear up by the time the person is in his or her early 20s, many cases persist for decades.

“We are seeing an epidemic of adult acne, so the old rules that ‘just hang in till you’re 18 or 20 and you’ll outgrow your acne’ are absolutely gone,” Fried said. “I have more 35-year-old women in my practice than teenagers.”

And acne may be getting harder to tolerate. “We have to look at it in the context of the society we live in,” Fried said. “There is no tolerance whatsoever for imperfection. Blemishes are more difficult than ever to live with.”

The emotional fallout tends to take the form of both guilt and shame, said Dr Jim Baral, an assistant clinical professor of dermatology at Mount Sinai School of Medicine in New York City.

Feelings of guilt common
“They feel guilt that they are eating the wrong food because of a misconception that food plays a part in acne, which it doesn’t,” Baral stated. “There’s also a misconception that acne is a lack of cleanness, so they have aspects of guilt and shame.” That only exacerbates the problem. “The women tend to cover their faces with hair,” Baral added. “The friction of the hair makes the acne worse.”

In fact, contributing factors to acne are more likely to be hormones and stress, says the AAD.

The good news is that there are treatments that take care of the acne and, by extension, the negative emotional impact. “Usually, once you take care of the acne, those things tend to resolve themselves,” Baral said.

Treatment options
“First, we reassure them that it’s nothing to do with cleanliness and nothing to do with food,” Baral said. “Reassurance often works.”

Some cases of acne can be managed with over-the-counter treatments and even with stress management, Fried stated.

“When over-the-counter stuff doesn’t work, that’s where it becomes appropriate to seek health-care professionals to evaluate,” Fried continued. Retinoids (vitamin A derivatives that promote normalisation of the cells) are a central part of any acne regimen, he added. More severe cases can be treated with the drug Roaccutane or a clone.

Scars from acne can prolong the emotional distress, but laser treatments can also improve scars left by acne by about 50 percent - which, Baral stated, is significant.

“There’s no such thing as untreatable,” Fried said. “It’s just a matter of how aggressive we need to get.”

Treatment can be liberating
And if a person had no previous problem with anxiety or depression, some level of treatment may be enough to smooth out the emotional fallout as well. “I do see effective acne treatment literally being an unbelievably liberating thing for people, absolutely,” Fried said. “They stand straighter, animation comes alive, they make eye contact, they function better in work, in school, with friends. It’s far from a trivial nuisance. Acne can really be quite difficult.”