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Mental Health

How Adult Acne Affects Mental Health

For millions of American women, adult acne is both a symptom and a cause of chronic stress.

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It’s totally reasonable to have assumed that once you moved past your teenage years, you also closed the door on your acne years.

Totally reasonable. And totally wrong.

Adulthood, it turns out, isn’t some magical turning point for your skin. You may get a few years of reprieve, but as sure as the sun rises, you’ll find yourself once again standing in front of the bathroom mirror, examining some weird subcutaneous bulge, likely around your chin, thinking, “. . . the hell?”

Adult acne has become so common, in fact, that a New York Times story on its rise reported that women who don’t experience a second bout of acne, especially around the chin and jawline, are the exception, not the rule. The American Academy of Dermatology has said adult cases are climbing, and Balm’s own survey of 750 women last year revealed that 59% of 35- to 50-year-olds in the U.S. are dealing with a second surge of spots. That number has likely gone up in the last couple of months, if tweets about pandemic and isolation-related breakouts are any indication.

“There’s this undercurrent of feelings of shame, feelings of guilt and feelings of 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 doesn’t happen to everyone, but it happens to a surprisingly large number of people.”

So why, exactly, does your face think it’s back in high school? Like everything in adulthood, the answer is a bit complicated and involves a number of irritating factors. Hormonal changes can definitely wreak havoc on the skin. (Fun fact: The swings in estrogen linked to perimenopause can start in your 30s and continue for a decade or more.) Diminished sleep also contributes to the issue, says Renée Beach, an MD and a board-certified dermatologist who works with the Bay Dermatology Centre in Toronto.

“When you sleep less, your body simply has less time to repair itself,” she says.

High-glycemic diets and environmental pollutants have also been cited as potential causes, but many doctors say enemy No. 1 is good ol’ reliable stress. Hormones secreted by the endocrine system in response to stress, such as cortisol, are known to boost the production of oil in the skin glands.

Even pre-pandemic, a day stacked with work stress, kid stress, relationship stress and caregiving stress—plus zero time for yourself—was just known as “Tuesday.” So it’s no wonder our zits have come back for a victory lap.

If the world is becoming more educated about the skin’s “second puberty” (are there two other words you could have less time for?), the very real effect it can have on all aspects of life isn’t openly discussed.

A 2018 study showed that people with acne had a 46% higher risk of developing major depressive disorder.

“It tends to be a very private matter. People keep it in,” says Traube. When people don’t feel their best—especially with acne, he says—they have a natural tendency to want to hide, which can exacerbate the mental health issues related to the skin condition.

Those issues can be serious: A landmark 2018 study in the British Journal of Dermatology showed that people with acne had a 46% higher risk of developing major depressive disorder. The fallout can manifest in other ways, too. A study published that same year from the University of Limerick, Ireland, found that people’s negative perception of how others will view their acne is linked to increased symptoms of psychological distress, as well as sleep impairment and headaches, and even digestive issues.

Traube says his clients feel the impact of their acne in three main areas: their love lives, their careers and their social lives. They talk about feeling “stuck” or “unlovable” — and those feelings are overwhelmingly rooted in how they imagine they are 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. But in that case, as in most of them, “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.”

Separating fact from feeling is central to the work Traube undergoes with his clients. “Three people can have the exact same skin condition and experience it very differently,” he says. 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.”

As important, Traube emphasizes, is normalizing the expectation that acne doesn’t just disappear when you wake up after prom. “When I tell people I deal with clients with acne on a regular basis, I can’t tell you how many of them are just so relieved to know they’re not alone in this.”

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