Zits. Jerry Scott and Jim Borgman’s title comic with the same name adds some humor to the pleasantries of coming of age. However, the annoyance of zits, often signaling the transition to puberty, can be more of a nuisance, and even become a bane of an existence. Acne is one of the most common skin conditions that features blackheads, whiteheads, and pimples with or without pus. The blackheads and whiteheads commonly appear on skin as a result of excess sebum (oil-like substance) plugging hair follicles and the larger inflamed pimples are usually due to skin bacteria overgrowth.
Acne is common and affects 85% percent of teenagers and also continues into adulthood.[2,3] It most commonly pops up on the body between the age of 16-20, but can also affect adults over age 25 and continue through age 40 to 50.[4,5] However, over the age of 20, women are affected at higher rates than men.
Several factors can affect acne severity, but one common factor is stress. In student studies, acne worsened around time of examinations and became more prevalent around other stressful times, especially in males. When oil gland production was examined during high and low times of stress in the same individuals, researchers found no differences in production, suggesting that the increase in acne around stressful times is not simply a matter of producing more or less oil, but other factors are involved too.
As acne can be stressful, be assured that acne is not due to poor hygiene and cannot be easily fixed by increased washing. Additionally, even when you start on treatment regimens, you may not see any improvements for 1-2 months, and the acne may even worsen during initial treatment stage.
Psychological Stress of Acne
Often, a patient’s perception of acne can be quite different than that of his or her care provider. It is important to talk to your provider if your acne is affecting your life negatively. The profound psychological effect of acne was initially mentioned in the 1940s, “there is probably no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feeling of inferiority and greater sums of psychic suffering than does acne vulgaris.” Given the psychological impact of acne, a patient’s mental health should be taken into account when treating acne.[11,12]
Depression and anxiety are reported in approximately 18% to 44% of acne patients and 6% of acne patients have suicidal tendencies. As acne is associated with significant mental health morbidity, treatment is crucial for appearance’s sake as well as mental well-being. If you feel anxious or depressed, especially about your acne, find a care provider that you feel comfortable and honest telling him or her about your feelings. Your care provider should speak with you about interdisciplinary therapy to help with not only the acne, but also the mental health struggles as well. A start to the treatment plan often includes education about the mind-skin connection; helping reduce stress on the mind can help reduce the inflammation on the skin.[6,15] The feelings of anger and frustration about your acne is common, and your care provider can help develop a treatment plan that suits your needs and achieves your goals.
Psychological Effects of Acne in Those with Darker Skin
In individuals with skin of color, post-inflammatory hyperpigmentation and keloid scarring are more common as potential complications of acne than lighter skinned patients. In African American, Latino, Asian, and Arab-American populations, acne was often reported as the most common skin condition.[18-20] On a microscopic level, acne on darker skin presents slightly differently than on Caucasian skin, which may be likely why acne on ethnic skin leaves darker areas of pigmentation called post-inflammatory hyperpigmentation. If you have darker skin, the acne scarring and discoloration may distress you more than the actual acne. The hyperpigmentation can be present for much longer than the original acne and can affect self-esteem and confidence. In the treatment of ethnic skin acne, care providers often try to prevent the inflammation that causes this post-inflammatory hyperpigmentation. Your care provider can work with you to develop a treatment plan that addresses the acne to prevent scarring and treat the discoloration with a topical like azelaic acid and tretinoin.[22,23]
Treatments to Improve Quality of Life
While treating acne can improve the disease, other treatment modalities and options are available to patients to specifically help improve their quality of life. Your primary care provider can advise creams, pills, and medicated body washes to help with the acne, as well as other medical therapies such as exclusion diets and yoga to help improve the psychological aspects of disease. Yoga, in particular, helps reduce stress and is another potential option to help manage tension and anxiety related to acne. One study done on college campuses, where many of the participants included students within the acne age range, showed that yoga may help reduce symptoms of stress and worry.
* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.
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Rapp DA, Brenes GA, Feldman SR, et al. Anger and acne: implications for quality of life, patient satisfaction and clinical care. Br J Dermatol.2004;151(1):183-189; PMID: 15270889 Link to research.
Shah SK, Alexis AF. Acne in skin of color: Practical approaches to treatment. Journal of Dermatological Treatment.2010;21(3):206-211; PMID: Link to research.
El-Essawi D, Musial JL, Hammad A, et al. A survey of skin disease and skin-related issues in Arab Americans. J Am Acad Dermatol.2007;56(6):933-938; PMID: 17321004 Link to research.
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Fitton A, Goa KL. Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders. Drugs.1991;41(5):780-798; PMID: 1712709 Link to research.
Bulengo-Ransby SM, Griffiths CE, Kimbrough-Green CK, et al. Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients. N Engl J Med.1993;328(20):1438-1443; PMID: 8479462 Link to research.
Magin PJ, Adams J, Heading GS, et al. Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients' experiences and perceptions. J Altern Complement Med.2006;12(5):451-457; PMID: 16813509 Link to research.
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Eastman-Mueller H, Wilson T, Jung AK, et al. iRest yoga-nidra on the college campus: changes in stress, depression, worry, and mindfulness. Int J Yoga Therap.2013(23):15-24; PMID: 24165520 Link to research.