Acne and mental health: Amy tells her story

25-year-old Amy is a Youth Ambassador for the Charlie Waller Trust. Amy has suffered from acne for over a decade and was motivated to write this blog as a message to her younger self.

“When I first experienced acne at the age of 11,” says Amy, “it was never something I expected to be still battling with today. For many of us, our teenage years are marked by a period of heightened anxiety and concern about ‘fitting in’ with our peers – fears that my acne only compounded. My friends suffered from the odd spot here and there, but acne quickly became a consistent feature of my day-to-day life.”

A common experience

Amy’s experience is far more common than she initially realised. About 20% of teenagers experience moderate to severe acne, and 85% of 12-25-year-olds report recurrent bouts of acne.

Due to its prevalence and ‘minimal impact on physical functioning’, acne is often dismissed as a short-term ‘cosmetic nuisance’. However, acne is most prevalent during adolescence, a period when appearance takes on heightened significance for youths' self-worth. Consequently, young people with severe acne are at an increased risk of mental health concerns.

Growing field of research

Psychodermatology is a rapidly growing field of study which combines psychology, psychiatry and dermatology. It is based on research showing the bidirectional relationship between our bodies (including our skin), our mental health, and our wider wellbeing.

Psychological factors like stress and anxiety can exacerbate skin conditions, while skin conditions can significantly impact mental health. Consequently, early psychological support is crucial to preventing these outcomes. Amy says:

“Growing up with severe acne made me feel overwhelmingly ashamed.

I was doing all the ‘right things’, like drinking plenty of water, eating a healthy diet, and thoroughly washing my face; however, nothing I tried seemed to make a difference.

“I refused to leave the house without make-up, even if it was for a trivial task like popping to the shops. I avoided sleepovers and sports because I didn’t want my peers to see my ‘real’ face. Managing my appearance became a full-time job.”

Eventually, Amy’s skin began to improve. However, she believes her experience left her with “physical and psychological scars” – something common among acne sufferers. She explains:

“For a long time, I felt extremely guilty about the extent to which my skin had affected my mental health. I didn’t feel I deserved the same support as someone with a ‘proper’ illness.”

At 21, Amy was diagnosed with severe generalised anxiety disorder (GAD):

“I was very fortunate to receive cognitive behavioural therapy (CBT), which helped me to reframe the negative thought processes that I’d become so accustomed to. For example, my therapist banned the words ‘should’ and ‘must’! I realised there will always be someone whose difficulties I perceive to be ‘more severe’ than mine. However, this doesn’t mean I am less worthy of support.”

CBT helped me to reframe the negative thought processes that I’d become so accustomed to. For example, my therapist banned the words ‘should’ and ‘must’!

Recognising support needs

The prevalence of mental ill health among young people with acne is increasingly being recognised. For example, the UK All-Party Parliamentary Group on Skin recently published a report highlighting the impact of acne on adolescents’ psychosocial wellbeing, emphasising a need for early intervention and support.

Similarly, the National Institute for Health and Care Excellence has also, for the first time, recommended mental health support for young people who are ‘severely affected’ by acne.

Although acne can contribute to significant psychological distress, many adolescents do live well with skin conditions. A range of protective factors can buffer against negative body image concerns and promote healthy coping mechanisms.

For example, social support from friends and family can help young people assign worth to other aspects of themselves, such as their personality.

Similarly, practising mindfulness and self-compassion have been found to reduce reactivity to negative thoughts.

Amy says: “My advice to my younger self would be that triggers (things that can initiate and worsen acne) vary from person to person. It can take time to find routines and strategies that work for you. But most importantly, don’t be afraid to reach out to friends and family. They will help to remind you that you are worth far more than your skin.”

Further information is available here:

https://healthtalk.org/introduction/acne-young-people/

https://www.britishskinfoundation.org.uk/

https://www.changingfaces.org.uk/

References:

Bhate, K. & Williams, H., 2013. Epidemiology of acne vulgaris. British Journal of Dermatology, 168(3), p. 474–485.

Brody, J., 2021. The emotional toll of adult acne. [Online] Available at: https://www.nytimes.com/2021/10/25/well/live/adult-acne.html

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Egan, K., Harcourt, D. & Rumsey, N., 2011. A qualitative study of the experiences of people who identify themselves as having adjusted positively to a visible difference. Journal of Health Psychology, 16(5), pp. 739-749.

Hudson, M., Thompson, A. & Emerson, L.-M., 2020. Compassion-focused self-help for psychological distress associated with skin conditions: A randomised feasibility trial. Psychology & Health, 35(9), pp. 1095-1114.

Hughes, O., 2022. The need for psychological support in routine dermatological care across the UK. The British Journal of Dermatology, 187(5), pp. 778-779.

Hughes, O. & Bewley, A., 2023. Is it really ever ‘just acne’? Considering the psychodermatology of acne. British Journal of Dermatology, 189, pp. 11–16.

Longhurst, P., 2022. Incorporating positive body image in therapeutic practice: An overview of construct definitions, concepts and theoretical foundations. Counselling & Psychotherapy Research, 22(2), pp. 257-266.

National Institute for Health and Care Excellence, 2021. Acne vulgaris: management, London, EN: NICE.

Natsuaki, M. & Yates, T., 2021. Adolescent acne and disparities in mental health. Child Development Perspectives, 15(1), pp. 37-43.

Rosenberg, M., 1965. Society and the adolescent self-image. Princeton, NJ, USA: Princeton University Press.

Sears, A., Ali, R., O'Connor, J. & Baron, S., 2022. Establishing and developing a paediatric psychodermatology service and our experience of a new paediatric psychodermatology clinic during the COVID-19 pandemic. Skin Health and Disease. [Online] Available at: https://doi.org/10.1002/ski2.15

[Accessed 1 May 2024]

The All Party Parliamentary Group on Skin, 2020. Mental Health and Skin Disease, London, EN: APPGS.

Tuckman, A., 2017. The potential psychological impact of skin conditions. Dermatology and Therapy, 7, pp. 53-57.