The psychological impact of acne can lead you to feelings of diminished self-esteem and be a source of anxiety when it comes to dealing with the world. If you’re a teen with acne, you may have been told, “It’s no big deal, and anyway, you’ll grow out of it. You’re just experiencing a normal part of life.”

But to you, having acne is a big deal; you feel insecure and lack self confidence. Every day you have to deal with school and other kids who seem perfect (even if they’re not). You don’t feel like you have time to “grow out of it.” The truth is that many folks don’t “just grow out of” acne and others wind up growing into it.

And if you’re an adult, you don’t even get the benefit of having lots of other peers around in the same boat. You have a whole different set of stressors (job interviews, presentations, black tie events, and carpools) associated with your acne. And darn it, you thought you were past this stage anyway.

The main thing to remember, whatever age you are, is that acne is treatable. I talk about ways to deal with the invisible scars that some people carry around with them — the ones that are carried on the inside. Although most other people see acne only on the surface, the burden goes much deeper.

Facing Acne Can Be Tough

Our society places a great emphasis on physical appearance. In a culture where looks are overly emphasized, feeling good about yourself is easier said than done. We’re constantly bombarded with advertising that displays models and movie stars, all of whom are depicted as paragons of beauty and flawless perfection.

They often serve as the spokespeople for health and beauty aids that imply that you can look like them if you “get with it” and do what they do or buy the products they’re promoting. When you see media portrayals of all those people with perfect skin, just remember that almost all of those photos are touched-up and airbrushed.

Some of the models even have acne, just like you! Even mild cases of acne can leave a person with a negative self-image — sometimes well beyond the degree of the actual physical appearance.

These negative feelings are particularly prevalent when you have a concentration of lesions on your face, which is your greeting card and introduction to the world.

Unlike many other skin conditions, acne lesions wind up on areas that often aren’t concealed by clothing. Acne is often a source of anxiety that can impact your self-image and confidence. Some of the things you might be experiencing are:

• Feeling uncomfortable in social settings
• Having less self-confidence
• Becoming more preoccupied with your appearance
• Feeling like you’re trapped in a perpetual adolescence
• Being sad and sometimes getting depressed (see the following sections)

These negative effects and feelings can put pressures on your social, work, or school life. Here are some suggestions that you can use to cope with some of these negative feelings:

• Wash your face no more than two to three times a day (unless you’re a coal miner!).
• Get a new haircut or hairstyle (bangs are great!).
• Spruce up your wardrobe.
• Educate yourself. Read about acne in this or other sources.
• Find the right dermatologist or healthcare provider to treat your acne.

Here are some tips for if and when you start undergoing treatment:

• Stand at least two feet away from all mirrors for the next two months.

• Measure progress monthly instead of daily; be a patient patient!

• Take a picture of your acne when it’s at its very worst. Put the picture in your bottom drawer and don’t look at it for two months, because that’s how long it may take to see significant improvement.

• Be sure you know the names of and exactly how to use your acne medications.

• If you’re still feeling emotionally overwhelmed and possibly depressed, see the next section.

Detecting Depression in Yourself and Your Family

It’s very normal for people with severe acne to feel down and despondent; even mild acne can give you the blues. However, if you or someone in your family is feeling unhappy more often and doesn’t seem to enjoy anything anymore, you need to consider the possibility that you or that person may be suffering from depression.

Here are some of the signs of depression:

• Increased fatigue, low energy
• Feelings of pessimism
• Loss of enjoyment in things that previously gave pleasure
• Crying spells
• Sleep disturbances
• Hating to get out of bed
• Social isolation
• Loss of appetite or the opposite
• Lots of new physical complaints
• Decrease in sexual drive
• Irritability, anger, or aggressiveness
• Feelings of worthlessness and guilt
• Withdraw from family and friends
• Suicidal thoughts

If one or more of these descriptions rings a bell, talk to your doctor about it. If you or your loved one is having suicidal thoughts, seek immediate evaluation and treatment.

Helping Your Child Deal with Acne

Acne affects adolescents at a time when they’re developing their personalities and evolving into adulthood. During this time, peer acceptance is very important to them and physical appearance and attractiveness is highly associated with peer status.

Besides the physical scars that severe acne can produce, your teen may also be suffering emotionally. Acne can be a real drag on a kid’s daily life. Acne on the face can bring out cruel taunts, teasing, and name calling from other kids.

Some kids become so preoccupied with how their skin looks, that they may not want to go to school, lose self-confidence, pull away from their friends, show a dramatic change in their thinking and behavior, become withdrawn, and even may begin to feel depressed.

The following list goes over some of the various teenage behaviors and coping mechanisms that they may develop to deal with acne:

• Grow their hair long to cover their face.

• Become so embarrassed that they avoid eye contact. “Cake on” heavy makeup to hide the pimples.

• Lose interest in sports such as swimming or basketball because of the need to undress in locker rooms and expose their back and chests.

• Become shy and even isolated and prefer to stay in their bedrooms.

• Start to develop any of the symptoms of depression from the list in the “Detecting depression in teens” section.

Here are a few seemingly simple, yet effective, ways to communicate your willingness to help:

• Let your children know how much you care: Give your child adequate time to bring up the subjects of their acne and allow them to address or respond to your questions about the behavioral changes you’ve noticed.

• Listen patiently: They may want to communicate their feelings but have difficulty doing so. Think back to your own teen years. You may not have always felt like it was easy to be open about your thoughts and feelings.

• Don’t be overly judgmental about your child’s appearance: Approach the subject of acne in a gentle, caring manner and try to give a little space when it comes to some of the relatively harmless decisions they make about their clothing and grooming habits.

• Keep the lines of communication open: Take the time to pay undivided attention to your kid’s concerns. It’s important to keep the lines of communication open, even if your child seems to want to withdraw.

• Don’t lecture on the subject: Try to avoid telling your child what to do. Instead, pay careful attention and you may discover more about the issues causing his problems.

Detecting depression in teens

It is common for adolescents — or anybody for that matter — to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks, and the teen experiences other symptoms, then he may be suffering from depression. Determining if a teenager is depressed can be a very tricky undertaking.

Dramatic physical and mental changes seem to take place almost overnight and it sometimes seems hard to tell the “normal” from the “abnormal.” Depression is a more commonly recognized condition in adolescents than it had been in the past.

Parents should look for common signs of depression in adolescents and they should be dealt with in a serious manner and not just passed off as “growing pains” or the normal consequence of adolescence. If you observe some of the signs or behaviors listed in the following bulleted list, they may be indicators of depression.

They’re not always diagnostic of teen depression; however, they may indicate other psychological, social, family, or school problems. Among these are:

• Sadness, anxiety, or a feeling of hopelessness
• A sudden drop in grades
• Loss of interest in food or compulsive overeating that results in rapid weight loss or gain
• Staying awake at night and sleeping during the day
• Withdrawal from friends
• Unusual irritability, rebellious behavior, or cutting school
• Physical complaints, such as headaches, stomachaches, low back pain, or excessive fatigue
• Use of alcohol or drugs
• Promiscuous sexual activity
• A preoccupation with death and dying

Don’t be afraid to talk to your child about feelings. If you sense a change or that something is seriously troubling your child, you may be right. You can even ask about suicidal thoughts. You won’t increase the possibility of suicidal behavior by asking if someone has thought about it.

Asking such a question does not “put thoughts into their heads” but rather is more likely to identify if they may be at risk. If you or your loved one is finding it extremely difficult or impossible to handle the emotional aspects of acne, get help. And, if you don’t feel that you can communicate effectively with your adolescent, get help.

Talk to your pediatrician or primary care practitioner or ask for a referral for counseling. Strong suicidal thoughts are an emergency and call for immediate action. Don’t go it alone.

Accutane and depression

For several years, there has been debate over whether Accutane (isotretinoin), a drug prescribed for serious cases of acne, could be causing depression that results in suicide in teenagers taking this powerful medication.

Lots of kids with acne who have never taken Accutane are depressed. Moreover, since Accutane was introduced in 1982, it’s likely that depression during this time has decreased in those who sorely needed the drug and were successfully treated with it.

Thinking about Therapy

Your dermatologist, internist, pediatrician, school nurse, school counselor, or other healthcare provider may be able to steer you in the right direction and find someone who can help you or your child contend with some of these emotional issues while they work on the physical ones.

The good news is that the vast majority of people suffering from depression can be treated successfully. Speak to your doctor about the way you feel and ask her to treat you or your child or to make a referral to a psychologist or psychiatrist.

Ideally, you or your child’s primary care provider or psychotherapist should maintain a close relationship with your dermatologist so that they can discuss treatment and any changes in medications, and so on. There are many types of psychotherapy and psychotherapists. You can choose from:

• Psychiatrists: They are medical doctors and are able to prescribe prescription medications, if required.

• Clinical psychologists: They usually have a master’s or doctoral degree in psychology.

• Psychiatric social workers: To become qualified as a social worker that provides psychotherapy, a person must have earned a minimum of a master’s degree in clinical social work.

• Counselors: Generally, they may have only a bachelor’s degree in education, psychology, or theology.

Some dermatologists, albeit few and far between, are capable of handling both the physical and emotional consequences of acne. Several of my colleagues have been trained as dermatologists as well as psychologists and psychiatrists.

If you’re fortunate to have access to any of these specialists, go for it! Avoid quick fixes promised by audio and videotapes or books. You can’t find true “quickie cures” for acne or for its emotional components. Both sets of symptoms require time and patience.