In this unusual study, participants voiced their frustration with a condition that often resists treatment and can leave emotional scars.

Acne is the most common skin disorder in the United States, impacting up to 50 million people annually, according to the American Academy of Dermatology Society. Although we often think of acne as a natural (and minorly annoying) part of puberty, it can persist into your thirties, forties, and even fifties.

More than just a physical condition, acne can have enormous long-term psychological effects. For a study published in July 2022 in the journal JAMA Dermatology, researchers undertook a novel approach to finding out just how persistent the emotional toll can be.

About 60 participants with active acne or acne scars were asked to write a “Letter to My Disease,” personifying their condition to express their feelings about living with what many subjects called an “intruder.”

The research revealed the lack of control over their symptoms that many people with acne feel. The condition is largely genetic: If one of your parents has acne, research says you have an almost 80 percent chance of living with it yourself.

The study also found that the psychological burden caused by acne scarring can be significant and persist well into middle age.

Participants were between 13 and 45 years old and came from six different countries. About half had active acne, while the other half had acne scarring. Both groups were asked to imagine their acne or acne scars with human characteristics, and then write a letter to their condition.

“While there are many studies on the emotional effects of acne, this is the only one using a personification technique,” says Jerry Tan, MD, who served as the lead researcher of the study. “Furthermore, [the study] extended beyond active acne to also include acne scarring, which allowed for understanding the longitudinal burden,” says Dr. Tan, who serves as an adjunct professor of dermatology at the Schulich School of Medicine and Dentistry in London, Ontario, Canada.

The personification activity revealed that participants overwhelmingly felt like their acne and scarring significantly impacted their self-esteem and made them feel self-conscious. For example, one woman from Germany wrote to her acne, “I don’t feel beautiful with you, and my self-esteem is lower because many others don’t like my looks either.”

Participants with active acne were more likely to experience low self-esteem, shame, and embarrassment. In contrast, participants with acne scars were more likely to feel defeat and acceptance of their condition, rather than holding on to hope.

Many letters described how participants would avoid being photographed or looking in the mirror because of their acne or acne scars. When they did go out in public, some people wrote that they went to great lengths to hide their condition, with one participant from the United States writing, “I can’t go out in public without makeup. I’m afraid of people pointing it out and making me feel self-conscious.”

Some participants wrote about becoming hyperfocused on their condition, associating their self-worth with the state of their acne, rather than the sum of all their other valuable personal characteristics.

Helplessness and powerlessness, from having to deal with a condition they could not fully understand or control, was also commonly described in the letters. One participant accused her acne of being “an intruder endowed with its own will, having decided to move in without being invited.”

By including participants with diverse ages who were dealing with both active acne and acne scarring, this study demonstrates the emotional impact of acne can linger well into adulthood.

Tan says that the best way to prevent such a long-term emotional burden is to seek effective treatment early on, which could reduce the risk of long-term scarring.

That means not downplaying your acne. Julie Harper, MD, a Birmingham, Alabama–based board-certified dermatologist, says that often acne patients don’t feel like their concerns are valid, knowing that their providers also treat skin cancer and other life-threatening skin conditions.

However, Dr. Harper says everyone deserves to feel good about their skin, even if it takes trying more than one treatment plan — or more than one provider. “Finding a dermatologist who is educated and committed to helping you can lead to radical improvement,” she says.

Treatment-wise, if scarring is your main issue now, Tan says, “There are many options for scar repair, including surgical and device or procedural options,” like specialized chemical peels, dermal fillers, and radio frequency microneedling.

Although you may not be able to control your acne, you can control its impact on your self-esteem and confidence. Do what you can to keep a positive attitude, shift focus towards your positive attributes, and be patient as you work to find the right treatment options.

If you find that your acne or acne scarring is taking a significant toll on your emotional health, counseling may be a good option, suggests Harper. However, if this study leaves you with one take-away, let it be that experiencing an emotional toll from your acne or scarring is very common, and you are not alone.

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