For millennia, acne vulgaris — the most prevalent form of acne — was believed to be strictly a skin condition. In recent years, however, an increasing body of research is proving what so many with acne have always sensed: that acne has a measurable psychological impact.

Acne can keep us from going to school or work — even out with friends. It can make it easier to say no to trying new things. Acne can affect what we wear — or don’t wear. How we style our hair, or how much makeup we put on.

And those are just the obvious things.

Here, we’re taking a closer look at the ways in which having acne can affect self-esteem, and how that in turn affects quality of life. And Dr. Sandra Lee (aka Dr. Pimple Popper) weighs in with some advice for anyone experiencing these challenges as a result of having acne.

What is self-esteem?

This may seem, well, self-evident (couldn’t resist) but with so many concepts floating around these days, it’s worth defining a few of the psychological terms that keep cropping up in relation to skin conditions like acne. While this is only a partial list, it’s enough to help illuminate the subject:

• Self-esteem: our subjective sense of inherent value and worth
• Self-image: the view of ourselves that’s influenced by what others think of us
• Self-confidence: our view of our strengths and weaknesses, abilities and skills

To confuse matters a bit, psychologists, thought leaders and spiritual teachers often disagree on those definitions. Some believe that self-esteem is inseparable from self-image: that we can’t view ourselves without being influenced by our environment. It’s not necessarily to become bogged down in the definitions, though, to understand that the way we feel about ourselves can be influenced, to varying degrees, by outside influences.

How does acne affect self-esteem?

Studies unequivocally show that acne has a negative effect on self-esteem. While this happens across all age groups and both genders, the prevalence is higher in women. Most people don’t seek medical help for their acne, so any psychological impacts of the skin condition may go undetected and/or unaddressed.

While in many cases it’s possible to successfully manage acne with over-the-counter dermatological ingredients, that means that oftentimes, people are either not aware of the degree of impact acne is having on their mental health, or they lack the resources to help handle it — or both.

The signs that someone is experiencing a negative psychological impact from their acne aren’t necessarily obvious. While every individual is different, some of these signs include:

• Social avoidance
• Anger and aggression
• Anxiety and/or depression
• Avoiding eye contact
• Skin-picking disorder

Does acne affect quality of life?

Based on assessment questionnaires that measure quality of life (QoL) factors, research has demonstrated that patients with acne experience statistically significant losses in many categories. Depending on the study, estimates of how many acne patients experience a psychological impact range anywhere from 65% to 100%. Researchers analyze this data in the context of certain features of the patient’s acne vulgaris, like:

• Severity
• Location (face/body)
• Scarring
• Hyperpigmentation (PIH)

Generally speaking, there is a positive correlation between the severity of acne, as well as degree of scarring and post-inflammatory hyperpigmentation, and the psychological impact. In other words, the more severe the acne, the more intense the mental health symptoms tend to be. However, research shows that for many people, even mild to moderate acne has an affect on well-being.

Studies indicate a relationship between acne vulgaris and a wide range of psychological and social/emotional challenges, including:

• Feelings of embarrassment/self-consciousness
• Challenges with daily activities like errands
• Choice of hairstyle, makeup and clothing
• Social/leisure activities
• Participation in sports
• Work/school performance and attendance
• Relationship problems
• Time management (hiding/treating acne)

Managing the psychological impact of acne

For those who aren’t experiencing acne vulgaris, the solution may seem simple: separate your sense of self from your skin. But if things were that easy, we wouldn’t be seeing so many people with mental health challenges arising from skin concerns.

So where do we start? According to Dr. Lee, breaking the task down into manageable steps can go a long way toward easing feelings of uncertainty and overwhelm.

• Educate yourself: while social media has its pros and cons, finding a reputable online source of information (like our blog, for example) will help separate acne fact from fiction.
• Choose effective skincare: look for well-reviewed brands that use clinically-proven acne-fighting ingredients like our SLMD Acne System and Body Acne System.
• Visit a dermatologist: if you don’t see results from your acne regimen after a few months, consult a doctor for help.
• Find friends in common: finding your “tribe” on social media or other online forums can be a source of comfort and advice.
• Take advantage of online resources: many non-profit organizations specialize in connecting people in need with mental health resources.
• Seek help from a therapist: a professional you trust can help you find the tools to uncouple your appearance from your sense of self-worth.

Dr. Lee’s last word

As a dermatologist, I see firsthand how acne can impact a person’s sense of well-being. Even though it’s not life-threatening, acne vulgaris certainly has a psychological impact. If you’re experiencing acne, know that you’re not alone. You can take steps to manage it and there is mental health help out there!

—Dr. Sandra Lee

Contributing studies:

The psychosocial impact of acne vulgaris

How Acne Bumps Cause the Blues: The Influence of Acne Vulgaris on Self-Esteem