As a dermatologist, I see the emotional and physical scars of acne in my office every day. This skin disease can be devastating in terms of self-esteem and confidence – its impact is very real. I have focused on acne for this very reason for many years in my practice and during my residency. Actually, as a dermatology resident, I studied the relationships between acne and emotions and published several papers on the topic.
Meanwhile, despite the fact that acne is the most common skin condition in the United States, its mental and emotional toll continues to be underappreciated.
However, there is now hope for recognition of this reality and a change due to a new study in the British Journal of Dermatology. Researchers from Canada used a very large United Kingdom database which tracked visits to primary care doctors. Remarkably, the sample size of acne patients involved 134,427 men and women (compared to 1.7 million controls without an acne diagnosis)! After an initial diagnosis of acne, the researchers looked for a subsequent diagnosis of major depressive disorder over the next 15 years. There was an increased risk of major depressive disorder within the first 5 years after an acne diagnosis, especially in the first year – 63% higher in patients with acne. The key word here is disorder; that is, levels of depression serious enough to interfere with daily functioning. Major depressive disorder is its own bona fide risk factor for many other diseases and is, of course, potentially life-threatening.
This study joins several other recent studies which have looked at acne patients over time — in 2016, researchers from New Zealand found that acne patients (in a study spanning 23 years) had a 45% increase in anxiety disorder risk. My acne patients are also much more likely to struggle with either anxiety or depression, as demonstrated in these studies.
Clearly, skin disorders are NOT just skin deep. In fact, the skin and the brain are intimately connected, and as dermatologists, we need to evaluate each patient in an integrative, comprehensive way if we truly want to determine the best course of treatment. I have been taking a comprehensive approach to my patients for years, asking about their stress levels, sleep patterns and coping mechanisms in addition to examining their skin, and this study only provides even more evidence supporting this approach. I want to bring this discussion to the forefront. It’s a reality that many people live with every single day and cannot and should not be ignored.