It’s no secret that stress and mental health are major contributing factors to the development of adult acne. The higher our cortisol (that’s the major stress hormone) levels, the more likely we are to see increased sebum and skin dryness due to a weakened skin barrier (both things that lead to the formation of acne). And this correlation between mental health and acne is a two-way street—the two directly impact each other. But just how seriously can acne impact mental health?
The Connection is Proven
Quite seriously, it seems. A landmark 2018 study in the British Journal of Dermatology showed that people with acne had a 46% higher risk of developing a major depressive disorder. The fallout can manifest in other ways, too. A study published that same year from the University of Limerick in Ireland found that people’s negative perception of how others will view their acne is linked to increased symptoms of psychological distress, sleep impairment, headaches, and even digestive issues.
But it’s not like the relationship between acne and mental health is an entirely new and recent discovery. A study published in the Medical Clinics of North America all the way back in 1948 (yes, really) found that “there is no single disease which causes more psychic trauma[...]more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne vulgaris.” And not much has changed. According to a Glamour article published in 2019, the psychological burden of dealing with adult acne has been compared to the burden of dealing with other diseases like epilepsy, asthma, diabetes, and arthritis, in terms of the toll that it takes on a person’s quality of life.
“When I tell people I deal with clients with acne on a regular basis, they’re just so relieved to know they’re not alone in this.”
The Impact is Real
But the very real effect that acne can have on all aspects of life isn’t discussed as frequently, openly, or urgently as it should be. “There’s this undercurrent of feelings of shame, guilt and worthlessness that can accompany [adult] acne,” says Matthew Traube, a California-based licensed clinical therapist who specializes in psychodermatology (a niche field focused on the psychological stress of dealing with skin issues). “It tends to be a private matter.” When people don’t feel their best—especially when it comes to acne—they have a natural tendency to want to hide, which can exacerbate the mental health issues related to the skin condition.
A 2017 study found that, while we know that adult acne is on the rise, research on adult female acne—including its severity and treatment—is still lacking. And yet, four years after this study was published, the lack of research persists. While we now know that adult acne is on the rise (especially in women) and is often accompanied by depression (particularly in women over 36 years of age, where depression is reported in 10.6% of adult acne cases), the psychological effects of adult acne are not being appropriately treated. In fact, they are often not addressed at all, even though they can, and continue to, infiltrate many crucial aspects of a person’s life and well-being.
The effects of adult acne are not just psychological but psychosocial as well. Traube says his clients feel the impact of their acne in three main (and major) areas: their love lives, careers, and social lives. They talk about feeling “stuck” or “unlovable” — and those feelings are overwhelmingly rooted in how they imagine they’re being perceived by others.
He recalls a client who, despite her executive title, was positive that her colleagues thought less of her abilities because of her acne. In most of these cases, “it’s very hard for people to come up with evidence-based examples of people actually shaming them,” Traube says. “Were other people noticing her acne? Sure, to a certain degree, but not nearly to the extent that she was feeling it.”
There is Hope
Separating fact from feeling is central to the work Traube undergoes with his clients. To challenge feelings of anxiety and inadequacy, he uses approaches based in cognitive behavioral therapy (changing thought patterns), acceptance-based therapy (anticipating and accepting negative thoughts) and exposure therapy (practicing interactions that are the source of stress). “If you can help people reduce the focus on their skin and transition out of the ‘I can’t do X, Y and Z because of my skin’ mind-set, that’s when the real healing occurs.”
And as is always the case, carrying feelings of shame and stigma can only do more harm, so an important first step, Traube says, is normalizing the expectation that acne doesn’t just disappear when you wake up the morning after high school prom. “When I tell people I deal with clients with acne on a regular basis, they’re just so relieved to know they’re not alone in this.”
The relationship between adult acne and mental health disorders is complex, but since depression is “two to three times more prevalent in acne patients than in the general population,” it’s clear that acne patients should be offered options for mental health treatment alongside the treatment of their adult acne—whether it’s the cause of their depression or not. This includes the development of mental health screening tools that can be integrated into dermatologists’ practices, allowing them to assess their patients’ mental health and skin health simultaneously.
Until that happens, it’s crucial to acknowledge your feelings and recognize them as normal. (May we suggest scrolling up and re-reading the stats above whenever you need that reminder?) “Three people can have the exact same skin condition and experience it very differently,” says Traube. If your experience with adult acne is tied to feelings of anxiety or depression, you might find it extremely helpful to reach out to trusted loved ones or a mental health professional to discuss your symptoms. Most importantly, if you’re struggling with your mental health due to acne, remember that you’re certainly not alone.
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Dermatologist Q&A: Why Does Stress Take a Toll on My Skin?