AcneNet This Month
December 2000

Most acne that appears in pre-teen years or adolescence disappears spontaneously before 

ages 25-30. Some acne persists into later years. Much less frequently, acne appears after ages 25-30.  Most acne that does not spontaneously disappear after adolescence can be successfully treated by a dermatologist. Severe acne requires longer and more aggressive treatment.

These basic facts about the natural history and treatment of acne are important, but they fail to touch on the most important fact about acne for a great many people with acne—its negative impact on their emotional and social well-being.

Even close friends and family members may not understand how emotionally devastating acne can be. Perhaps because acne is a non-fatal condition confined to the outer layers of the skin, perhaps because acne is usually associated with adolescence and is thus perceived as a "kid’s disease", many people who do not have acne just do not understand the psychological and social impact of acne.

Lack of sympathy may also be due to a widely-held belief that acne is somehow the fault of the acne sufferer. For instance, the person with acne "doesn’t take care of him or herself." Or, the person with acne "eats all the wrong stuff and gets acne." These myths persist and are hard to eradicate. For some people, it may be easier to accept a folk myth than to learn the truth about the causes of acne.

"My friends call me pus-face, and laugh," a 16-year-old girl wrote to AcneNet. "I try not to cry but it really hurts. Even if a boy asks me for a date I won’t accept because I’m afraid I’ll embarrass him if I’m seen with him."

This girl’s experience (paraphrased, not quoted directly), is a poignant example of social isolation caused by casually cruel indifference of friends. The friends may even think they are being "funny" with their remarks. While this girl’s acne may well disappear within the next several years, acne will have left psychological scars that may be difficult to heal.

Family members may be insensitive to the emotional stress of acne, or they may be fully aware of the emotional problems and may themselves be emotionally stressed—especially if the person with acne is a son or daughter. A mother described her 35-year-old son’s two decades of social isolation:

"Since he was 15 years old he has had blackheads, red inflamed bumps and pus-filled pimples all over his face, chest and back. He was treated for acne but it came back, so now he won’t see another doctor. He acts like his life is over. He never goes out because he is ashamed of the way he looks. What can I do but pray for a miracle?"

The emotional stress of acne can touch everyone in the family. This mother is devastated by the emotional distress of her son.

In general, acne has a higher "severe" ranking among people with acne than among those who have not experienced acne. The difference in attitude is often more apparent to those with acne than to those without. When 2,000 military recruits 18-19 years old were questioned regarding their attitudes toward acne, most of those with acne rated it as a "severe" condition while those without acne tended more to call it a "minor problem" or had no opinion.

The same study by an acne investigator showed that having acne was believed to be an occupational handicap by young men who felt they had been turned down for jobs because they had acne. For the majority of the young men with acne, the most important feature of acne was its appearance—"very embarrassing", "not nice to look at", "makes one very self-conscious".

Interviews conducted with acne patients by an acne investigator showed that more than half of those interviewed said they believed their acne made it more difficult to get or keep a job, or made interpersonal relationships with supervisors and other employees more difficult. The interviews revealed only the perceptions of the persons interviewed, with no objective cross-checking of actual employment status. The interviews were revealing of the beliefs of acne patients regarding the effect of acne on their lives.

Self-consciousness about acne can be a precursor to clinically identified depression.

"I spent hours in front of the mirror looking at myself," a young woman wrote. "I couldn’t believe this was me and I guess I kept hoping it wasn’t. I got so depressed I almost lost my family."

The young woman said she was finally treated for depression after a dermatologist recognized the symptoms.

Acne can be emotionally distressing and socially isolating, but people with acne need to believe they are not as isolated as they feel. Millions of people have acne, so having acne does not make one an unusual "freak"—it is a common condition about which there are many myths and misperceptions. Acne has physiologic causes—it is not caused by poor diet or poor hygiene, as may still be believed by some who seem to think that acne is somehow "deserved" by those who have it. These attitudes are persistent and hard to change—something that every person with acne must learn to live with.

A general physician or dermatologist with whom the acne patient can form a good relationship can be a source of support. Dermatologists especially understand that, for the person with acne, acne is not a "minor" condition.