Acne, Depression and Suicide

Type 2-3 Acne on Chin

Acne can have a significant negative impact on the psychological well-being of acne sufferers. Acne can increase the risk of bullying, depression and suicide.

For the millions of people who have suffered with acne, the psychological toll of the disease is well understood. The face is the window that connects one’s consciousness with the outside world. The face is also an essential factor in how the outside world perceives an individual. More than any other part of the body, diseases that affect the appearance of the face can have severe emotional and psychological consequences.

Diagram of Psychological Impact of Acne (Magin)
Diagram of Psychological Impact of Acne (Magin)

Scientific research overwhelmingly demonstrates the negative effect that acne has on the quality of life of individuals with acne. Research has consistently shown that severe acne increases the incidence of depression, anxiety, bullying and suicide. Acne, especially severe acne (Acne Types: 3-4), can dramatically alter how an individual interacts with others and how they perceive themselves.

Despite these the profound impact acne can have on people, acne-free individuals often underestimate the impact that acne can have on self esteem and overall mental health. This phenomenon can leave acne sufferers feeling very alone. To better understand the psychological toll that acne can have (and to let people know that they aren’t alone), we have synthesized the data from many studies into four basic categories.

Acne, Anxiety and Depression

For acne sufferers, it is virtually impossible to escape the constant reminders of the disease. Every reflection in the mirror becomes a depressing reality check, and the physical pain associated with inflammatory acne makes it’s presence inescapable. For many acne sufferers, dealing with acne and acne scarring is extremely challenging, both mentally and physically.

Incidence of Psychological Issues in Acne Patients (Dalgard)
Incidence of Psychological Issues in Acne Patients (Dalgard)

Virtually every study conducted on the psychological impact of acne vulgaris has shown that the disease causes a statistically significant increase in anxiety, depression and related mental health problems. On balance, the research indicates that rates of anxiety and depression among individuals with significant acne symptoms are about double those of non-acne sufferers. Acne also causes significant increases in rates of body dysmorphia, anti-social behavior and suicide.

The psychological impact of acne is not all in the mind of the person with acne. Research indicates that children and adolescents that suffer from acne and other skin diseases, experience increased levels of bullying and teasing. Too often this psychological trauma is overlooked or dismissed by parents, physicians and other decision makers. As a result, acne sufferers often fail to get the psychological and psychiatric treatment that they need.

Research shows that the level of anxiety and depression is directly related to the severity of acne symptoms (which seems like an obvious conclusion). Fortunately, improving acne symptoms through effective treatment also improves many of these psychological problems. Effective treatment of the acne itself, in combination with the appropriate mental health support, offers the highest chance of improving the quality of life of acne sufferers.

The Impact of Acne on Social Interactions

Acne Induced Depression by Age Group (Uhlenhake)
Acne Induced Depression by Age Group (Uhlenhake)

Acne vulgaris can have a very negative impact on the social interactions of an affected person. One on hand, acne causes psychological trauma to the sufferer, often decreasing their confidence and self-esteem. On the other hand, the outside world can be hurtful and harsh. Facing challenges from both sides, acne sufferers will often withdraw from interpersonal relationships. Some acne sufferers develop symptoms of anti-social behavior patterns. Anger levels tend to be elevated in acne sufferers.

For acne sufferers who do withdraw from interpersonal relationships and social interactions, the increasing isolation increases the danger of developing a self reinforcing cycle of self loathing. Basically, it’s tough to function normally when you are dealing with problem acne.

Acne and Suicide

Research indicates that people who have acne vulgaris have increased rates of both suicide ideation (thinking about suicide) and suicide itself. The fact that acne symptoms can cause and worsen symptoms of clinical depression make it a risk factor for suicide.

The Role of Acne Medications in Depression

There are some acne medications that are suspected to cause or worsen symptoms of depression. People with a history of depression, mood disorders or any other mental health issue, should discuss these with their medical provider.

Isotretinoin (Accutane) is the acne medication with the most high-profile association with depression and suicide. It has been alleged numerous times that Accutane can cause depression and suicidal thoughts. The association between Isotretinoin and depression primarily originated from parents whose children committed suicide, while taking Isotretinoin. However, the majority of the clinical research indicates that Isotretinoin treatment is not statistically related to suicide or suicide attempts.

Isotretinoin Roaccutane Packaging
Isotretinoin (Roaccutane, Accutane)

The alleged association between Isotretinoin (Accutane) and depression was brought to national attention in the United States when Congressman Bart Stupak claimed that Accutane was responsible for his son’s suicide. Congressman Stupak gave a congressional statement to that effect. Many other parents have made similar claims.

However, the alleged relationship between the treatment of acne with Isotretinoin and suicide is not strongly supported by the available scientific evidence. It is also possible that the severe acne symptoms themselves contributed to suicide and suicide attempts in many of these individuals. Researchers have shown that acne itself is an important contributor to depression. Thus, effective treatment of acne can improve symptoms of depression and reduce the frequency of suicide ideation.

This conflict between parents and researchers may come down to a difference in perception. Non-acne sufferers often underestimate how traumatizing acne is for someone with the disease. Acne patients who experience depression may become withdrawn, and hide their true feelings from the people around them. When an individual commits suicide, it can seem like it came out of nowhere. That person may have seemed OK on the surface, but they were battling deep emotional trauma on the inside. Family and friends of those left behind often look for a reason, an explanation for how the tragedy could have happened. It is easy to assign the blame to a pill, a real world menace, the product of a callous corporation. It helps to have a reason, something or someone to blame for your loss. It’s understandable. But being understandable does not necessarily make something true.

In conclusion, it is certainly possible that treatment of acne with Isotretinoin could cause psychological symptoms, including depression, but the causative relationship between Isotretinoin and suicide is not supported by the current body of scientific evidence.

References

Acne in Victorian adolescents: Associations with age, gender, puberty and psychiatric symptoms. Kilkenny, et al. 1997.
Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. Smithard, et al. 2001.
Acne vulgaris and depression: a retrospective examination. Uhlenhake, et al. 2010.
Acne Vulgaris and the Quality of Life of Adult Dermatology Patients. Lasek, et al. 1998.
Acne, anxiety, depression and suicide in teenagers: A cross-sectional survey of New Zealand secondary school students. Purvis, et al. 2006.
Anxiety, Depression, and the Nature of Acne in Adolescents. Aktan, et al. 2000.
Anger and acne: implications for quality of life, patient satisfaction and clinical care. Rapp, et al. 2004.
Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. Sundstrom, et al. 2010.
Body dysmorphic disorder symptoms among patients with acne vulgaris. Bowe, et al. 2007.
Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study. Magin, et al. 2008.
Prevalence, Severity, and Severity Risk Factors of Acne in High School Pupils: A Community-Based Study. Ghodsi, et al. 2009.
Psychiatric Aspects of the Treatment of Mild to Moderate Facial Acne. Gupta, et al. 1990.
Psychological sequelae of acne vulgaris. Magin, et al. 2006.
Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents. Do ,et al. 2009.
Psychosocial effect of common skin diseases. Barankin, et al. 2002.
Quality of life issues for South Africans with acne vulgaris. Mosam, et al. 2005.
Self-esteem and body satisfaction among late adolescents with acne: Results from a population survey. Dalgard, et al. 2008.
Social Anxiety Level in Acne Vulgaris Patients and its Relationship to Clinical Variables. Yarpuz, et al. 2008.
Suicide in Dermatological Patients. Cotterill, et al. 1997.
The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Mallon, et al. 1999.

Type 2-3 Acne on Chin