By Jerry K. L. Tan, MD FRCP

Acne is universal -- at some time or another we all experience this annoying disease. As teenagers we are frustrated with unsightly blemishes, and as adults, we are dismayed that we can still get acne. Acne has a predilection for affecting the face - a primary site for others to gauge our attractiveness. Facial involvement with acne is an ongoing source of embarrassment and concern - especially for those in the formative years of physical growth, self-image development and socialization.

What causes it?

When the pore openings on the face, neck, back, chest and arms become plugged with skin debris, oil produced by the deeper oil glands becomes trapped - resulting in blackheads and whiteheads. As inflammation develops, we start to see red pimples and even deeper lumps, (cysts or nodules). These inflamed spots can then lead to scarring and staining of the skin. (Read about Acne Basics)

Oil production increases during adolescence when the sex hormones are elevated and the oil glands have increased in size. Acne becomes less frequent in the early and mid -20's although some patients can have persistent breakouts in their 40's and beyond.

Facing the facts

While the physical features of acne are readily apparent to us all, the emotional and social impact of acne is often underestimated by non-sufferers. This can be manifested as anxiety, depression, and social withdrawal. Previous studies have shown that those with acne are dissatisfied with their appearance, embarrassed, self-conscious and lack self-confidence. Problems with social interactions with the opposite gender, appearances in public, and with strangers have also been observed.

The mental stress of sufferers with acne can be greater than that associated with other chronic diseases such as asthma, epilepsy, diabetes, back pain, arthritis, and heart disease. Acne patients also have a greater tendency to significant levels of depression and anxiety.

Of particular note is one study in which 18 per cent and 44 per cent of acne patients, respectively reported serious depression and anxiety. To further illustrate the depth of despair experienced by those living with this condition, six per cent of patients in one study reported thinking about committing suicide.

Acne can also affect one's ability to earn a livelihood. A previous study has shown that those with acne were more likely to be unemployed than those unaffected. A recent Canadian study also observed that those with more severe acne were more likely to be unemployed than those with lesser involvement. It is uncertain whether these findings are due to the patient's psychosocial impairment or the negative response by potential employer's to those affected by acne.

The good news

Effective therapy for acne can help reverse both the physical features of acne and the unseen psychological and social impact of this condition. With appropriate treatment, we frequently observe improvement in self-esteem and confidence. From the initial visit where patients may appear withdrawn and sullen, improvement with therapy is typically associated with a more positive outgoing disposition. Studies have demonstrated that effective acne therapy can help reverse feelings of shame, embarrassment, anxiety, and inadequacy.

If over the counter preparations do not control your acne you may need to see a dermatologist and medical prescriptions may be necessary. Available treatments currently available include:

  • Topical prescriptions
  • Antibiotic pills
  • Hormone pills
  • Isotretinoin pills
  • Light and photodynamic therapy

With targeted treatments individualized to acne severity and specific patient needs, there is every likelihood that acne can be significantly improved - allowing one to regain his or her confidence to lead a better, more productive life.

If you or someone you know is suffering silently, feeling there is no hope, turn to a dermatologist or a doctor to discuss the types of treatments available. You can also learn more at Acne Guide.ca


About the author:
Dr. Jerry K. L. Tan, MD, FRCPC: Adjunct Professor, Faculty of Medicine, University of Western Ontario, Windsor, Canada. Director, Acne Research and Treatment Centre, Windsor, Canada. Area of specialty: acne and rosacea.


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