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Have you ever had a big pimple on your forehead or chin? Almost everyone has, especially during those acne-prone teenage years. In reality, no one else probably notices that pimple, but to you it's like a huge neon sign flashing ZIT…ZIT…ZIT.

With severe acne, that neon sign doesn't just flash once in a while. It happens all the time. Some people get so worried that everyone is staring at their pimples that they don't want to leave the house.

Though acne itself isn't a serious health condition, living with long-term acne can be every bit as devastating as having a chronic disease like diabetes or epilepsy. The shame and embarrassment of regular breakouts can be overwhelming enough to cause depression. Some people with severe acne even try to commit suicide. And the emotional scars can linger long after the pimples have faded.

Jennifer Liston (her name has been changed to protect her privacy), a consultant from Darien, Conn., started getting breakouts when she was 15 years old. By the time she'd reached her 20s, her acne had gotten so bad that it was having a real impact on her social life.

"It definitely made me more insecure in the dating world," she says. Thinking men didn't want to go out with her because of her acne, Liston closed herself off to relationships.

The stress of her acne made her breakouts even worse. "I feel that the emotions came out through more acne," Liston, who is now 38, recalls. "It was a vicious cycle and it kept getting worse and worse."

Physical and Emotional Scars

Liston's situation isn't unique. Steven R. Feldman, MD, PhD, says he's seen many patients whose acne is so distressing that they don't want to venture out of the house because of it.

Acne is particularly troubling because of its visibility and its intimate relationship with our self-esteem. "The skin in general, and particularly the skin of the face, is the way we see ourselves. It's the way others see us, and most importantly, it's the way we think others see us," explains Feldman, who is a professor of dermatology in the Wake Forest University School of Medicine and author of the book Compartments.

Severe acne can ignite a number of different emotional reactions, according to Ted Grossbart, PhD, a licensed clinical psychologist in Boston and assistant clinical professor of psychology at Harvard Medical School. It can make people feel ugly and unloved enough to get angry at themselves or at the world. And, just as Liston experienced, acne can lead to a sense of loneliness and isolation. "People withdraw and see themselves as uniquely afflicted in a way other people can't understand," says Grossbart, who also authored the book, Skin Deep: A Mind/Body Program for Healthy Skin.

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