Acne Can Take Big Emotional Toll on Women
Acne is more than skin deep.
This is the overarching message of a new study that looked at the mental and psychological toll that acne can take on adult women.
"Some felt that their acne made them appear less professional or qualified at work, and many described that having fewer peers with acne in adulthood magnified the impact of acne on their mental health, leading to feelings of social isolation," said study author Dr. John Barbieri, a dermatologist at Brigham and Women's Hospital in Boston.
For the study, the researchers asked 50 women with acne how they felt about their acne and its treatment, and the comments were telling.
"Concerns about appearance, mental and emotional health consequences, and disruption to their personal and professional lives were commonly mentioned," said Barbieri, who conducted the study while at the University of Pennsylvania.
When asked how acne affected her job, one woman said, "I feel like I'm not taken as seriously [or] professionally in my career because I have acne."
Another woman described the effect that acne has on her mental health like this: "Sometimes I would go all day. I just wouldn't even look in the mirror." Another noted that acne "prevents me from leaving my house. It prevents me from getting my mail without makeup on."
These aren't trivial concerns. "Acne should not be viewed as a cosmetic problem, given these significant life impacts," Barbieri said.
Many of the women were frustrated with available treatments and had difficulty finding a dermatologist they trusted, the study showed.
Safe and effective acne treatments are available, Barbieri said. These include topical retinoids, topical or oral antibiotics, and spironolactone, which slows down the production of hormones that can lead to clogged pores and breakouts.
And "for the appropriate patient, isotretinoin is a highly effective treatment for acne that can lead to a durable remission," he said. Isotretinoin, formerly called Accutane, now prescribed under the names Amnesteem, Claravis, Myorisan, Absorica and Zenatane, has its share of side effects, including risk for severe birth defects, dry skin, eyes and mouth. There is also some concern about liver problems and depression.
The new study was published online July 28 in the journal JAMA Dermatology.
The research is "an important contribution to the field," wrote Dr. Diane Thiboutot, vice chair for research in the department of dermatology at Pennsylvania State University, and colleagues in an editorial accompanying the new study. "It also captures meaningful information on patient's perspective of treatment success and treatment adverse effects, which inform treatment selection."
Two dermatologists without ties to the study said the findings mirror what they see in their practices.
"Adult female acne patients will tell you that they feel they are perceived differently by friends and especially co-workers," said Dr. Hilary Baldwin, medical director of the Acne Treatment and Research Center in Morristown, N.J. "They often speak of calling in sick to work when they are having a particularly bad day."
And unlike teen acne, acne in adults can last for decades. "Most teens will be finished with their disease within a few years, but adult female acne patients generally have persistence of their disease until their 50s," Baldwin said.
Dr. Angela Lamb is director of the Westside Mount Sinai Dermatology Faculty Practice and an associate professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. She is familiar with the often devastating emotional and psychological effects that acne can have on adults.
"Many women feel very defeated by their acne," said Lamb. "They have tried what they consider everything and they still do not have the skin they want. They do not like feeling like a teenager or not feeling confident giving presentations at work or on Zoom."
But don't give up, Lamb urged. Current medications can get people pretty close to a cure.
"The problem can be finding a physician who is willing to be creative and, in most cases, more aggressive as well as balancing the side effects," she said. "Sometimes it really is about persistence and trial and error."
The American Academy of Dermatology offers more information on how to treat acne.
SOURCES: John Barbieri, MD, MBA, dermatologist, Brigham and Women's Hospital, Boston; Hilary Baldwin, MD, medical director, Acne Treatment and Research Center, Morristown, N.J.; Angela Lamb, MD, director, Westside Mount Sinai Dermatology Faculty Practice, and associate professor, dermatology, Icahn School of Medicine at Mount Sinai, New York City; JAMA Dermatology, July 28, 2021, online
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