Acne and adolescent mental health

Co-authored by Srisindhu Medukonduru and Eunice Y. Yuen, M.D., Ph.D.

Acne is a common skin condition worldwide, with a global prevalence of 9.4%. Interestingly, acne is more prevalent in high-income and developed countries than in poorer regions. Acne typically begins in the teenage years, affecting 85% of young people, both men and women, and can continue as a chronic condition into adulthood. The problem with acne goes beyond just appearance; in fact, acne can have lifelong economic, social and psychological impacts, including loss of employment, lack of a social life, self-esteem and body image issues, depression and anxiety.

It’s no surprise that acne takes a toll on vulnerable teens. In a study that analyzed how teens see and feel about themselves and how others react to their skin, teens with acne were most often perceived by others as shy, stressed, lonely, bored, unhealthy, and rebellious. 64% of teens with acne surveyed felt embarrassed about their acne, 71% of teens with acne reported lower self-confidence or shyness, and 43% said they had difficulty finding dates or making friends. Overall, these results indicate that acne negatively impacts how we are perceived by others and ourselves, making it a major mental health concern.

Medical Causes of Acne

Acne can present with a range of symptoms depending on severity. It can range from pores clogged with oil and dead skin cells to severe lesions followed by scarring, skin redness, and pigmentation. Acne primarily occurs on the face, chest, and back of adolescents and young adults. A systematic review found that the onset of puberty, family history, oily skin type, and high body mass index (BMI) are most strongly associated with acne development. These genetic and hormonal factors alter the production of sebum, an oily substance released to keep the skin hydrated. Unfortunately, skin with high sebum levels can attract bacteria associated with acne formation and inflammation.Propionibacterium acnesDietary factors such as dairy products, high fat intake, high glycemic load, and spicy foods may increase the risk of acne, while a high intake of fruits, vegetables, and fish may prevent acne. Personal factors such as lack of sleep, high stress, and use of cosmetics are associated with increased acne development, and frequent face washing may reduce the risk.

Teenage Mental Health Issues

Adolescence is a developmental stage with rapid physical and hormonal changes. One of the most prominent features of adolescence is acne, along with external factors that exacerbate its occurrence, such as academic struggles, fear of failure, and social pressure. Acne is associated with higher rates of mental disorders, such as depression, anxiety, and even suicide, among teenagers. Potential symptoms such as low self-esteem, embarrassment, sadness, and social isolation may be prevalent. With appearance becoming so important to a young person’s self-esteem and peer approval, it is true that acne can make teenagers more susceptible to mental health issues. Having acne in a visible location can also lead to negative messages and bullying from peers. Moreover, severe acne can leave permanent scars on the face. Acne severity is strongly correlated with not only the psychological health of teenagers, but also their overall quality of life and cumulative life course risk of mental disorders that continue into adulthood.

Acne affects most teenagers, but its psychological impacts may be more severe for teenage girls, racial/ethnic minorities, and sexual and gender minority (SGM) populations. Research has shown that women with acne are more self-conscious than men, have a negative self-concept, and are more likely to be viewed by peers as shy, stressed, and introverted. A national cross-sectional study found no differences in mental health outcomes between white and minority acne patients. However, minority teenagers are less likely to see a dermatologist and less likely to receive appropriate acne treatment, so they should be aware of the possibility of hidden pain. SGM youth have a higher baseline mental health risk than their peers. The psychosocial impacts of acne may be even worse with or without discussion of gender-related treatment. Let us, as family members, health care providers, and communities, be more compassionate and supportive of these vulnerable youth.

What can we do to help teens who suffer from acne?

More work is needed to address adolescent mental health and acne care, but there are some interesting programs: Multidisciplinary integrated acne care across mental health services, primary care, and dermatology services exists to address mental health concerns in teens with acne. Other innovative web-based interventions supporting self-management for appropriate use of topical acne treatments have also been suggested to be feasible. Medical and mental health providers need to work collaboratively to make appropriate referrals.

For Teens:

• Mental stress can be a major factor in causing facial acne, which can further take a toll on a teenager’s mental health. Stress management is very important.
• Creating a daily and weekly routine schedule, including regular sleep-wake cycles and meal times, can help minimize unexpected stressful events in your teen’s life.
• It may be worthwhile to develop creative coping strategies, such as fun extracurricular activities or hobbies, to escape the stress of schoolwork.
• Find someone at school who can help, like a counselor, teacher, or coach, and talk to them about how you’re feeling and what you can do to improve your situation.

Notes for Parents:

• Teens may feel ashamed or even stigmatized about their appearance and may not seek help, leading to isolation. Parents can offer support in a variety of ways.
• Active listening and understanding provide a supportive space for teens to talk about self-esteem and self-image issues related to their skin condition. Parents can help by focusing on what their teen is doing right, rather than commenting on what they are doing wrong.
• If possible and affordable, take your child to a pediatrician who can accurately evaluate the skin condition and refer you to a dermatologist. Seeing a dermatologist can be a long wait, which may not be practical for some families.
• If teenagers experience bullying, social exclusion or other psychological difficulties due to their skin condition, they may not receive support and their worsening mental health problems may be left untreated. In such cases, parents should make appropriate reports to the school or the relevant authorities.

Acne is a common skin condition among adolescents and is most often caused by stress, unhealthy diet, genetics and hormonal changes. These changes in appearance can have a negative impact on a young person’s mental health and wellbeing as they can make themselves less attractive and more susceptible to hurtful comments from their peers. If a young person’s skin condition becomes emotionally distressing with concerns of depression or anxiety, parents may consider seeking support from counselling or mental health services. It is important that young people receive support from their parents and seek medical and mental health support to receive appropriate treatment.

Srisindu Medukonduru, a junior at Independence High School in Frisco, Texas, wants to study public health with hopes of becoming a health policy analyst working to address global health disparities.