Physical and Emotional Scars continued...
Adolescence, when acne is most common, is already a turbulent time of life. Having severe acne just adds to the intense emotions teens are feeling. When Feldman and his colleagues reviewed several studies of teens with "problem acne," they found that 14% reported feeling depressed. More than 23% of the kids said they'd thought about committing suicide, and nearly 8% had tried to take their own lives.
Acne -- and its emotional effects -- don't end at age 18, either. "In the teenage years it's expected and it's within the norm to have acne," Feldman says. "You get to be 30 or 40 and you may still have acne and it's no longer the norm, so it becomes an issue socially and psychologically.
That may be why depression is two to three times more common in adults with acne than in the general population. Women are particularly vulnerable to self-consciousness and a loss of self-esteem from acne, studies find.
Grossbart often sees patients who turn their loathing of themselves and their acne inward by picking at their skin. "I've seen people with minor acne whose skin would be perfectly fine if they weren't attacking it," he says. "Some people do serious damage." Constantly popping and picking at pimples can turn a minor breakout into a permanent scar.
Acne and depression can quickly turn into a vicious spiral. Stress and anxiety fuel acne outbreaks. Depression can magnify skin problems, making acne seem far worse than it actually is. "Sometimes people will blame their skin for everything that's wrong with their lives," Grossbart says.
Complicating the issue, one of the most potent drugs used to treat acne, isotretinoin, has depression as one of its side effects. Not every study agrees that isotretinoin increases the risk of depression, but dermatologists still use caution when they prescribe this drug, and they carefully monitor patients for depression symptoms while taking isotretinoin.
Coping With Acne
Having severe acne can seem like a huge burden to carry, but it's not a lifelong sentence now that so many effective acne treatments are available. "We can control just about anybody's acne, no matter how severe," says Feldman.
Acne treatments attack pimples on two fronts. Dermatologists prescribe a number of different acne medications, including retinoids, antibiotics, and benzoyl peroxide, to clear the skin. Meanwhile, psychologists help patients deal with the emotional effects of skin problems. "There are a range of psychological techniques you can use to intervene. I use relaxation, imaging, focused psychotherapy, and hypnosis or self-hypnosis," Grossbart says.
Both experts stress the importance of following whatever acne treatment your doctor prescribes. "Medicines don't work if you don't use them," Feldman says. That may sound obvious, but just as depression causes people to lose interest in life, it can also make them ambivalent about using the very treatments that can relieve their acne -- and with it, their depression.