Overcoming the Emotional Scars of Acne

August 17, 2006

A seminar featuring a diversified panel of experts helps to educate about teen and adult acne.

Dr. Richard Fried was on hand to clear up acne myths and misconceptions.
Overcoming the Emotional Scars of Acne

A seminar featuring a diversified panel of experts helps to educate about teen and adult acne.

Acne affects nearly 85% of the population and takes a toll on relationships, self-esteem and one’s outlook on life.

Take Charge of Life!, an event focusing on acne and the latest skin care tips on how to treat and prevent acne and other skin care-related problems, was held recently at the Hudson Hotel in New York City. The event was sponsored by Galderma Laboratories, makers of Differin, to raise awareness among the media of the prevalence and impact of acne.  According to Rachael Pay, managing director of Euro RSCG Life Public Relations, the event coordinator, the overall aim of the presentation was to encourage young people to take charge and speak with a dermatologist to learn how to manage their condition. Approximately 30 editors from top women's, men's, teen and parenting publications were in attendance.

Panelists included Dr. Gilda Carle, Dr. Richard Fried, Dr. Linda Stein Gold and actress Sabrina Aldridge.

Attendees were apprised of some acne facts and misconceptions:

Severe acne can be treated with topical treatments, oral antibiotics or a combination of both.

Acne Facts

• Acne is one of the most common skin problems, affecting more than 80% of young adults and teenagers.
• Acne is a disorder resulting from the action of hormones on the skin’s oil (sebaceous) glands, which leads to plugged pores.
• Testosterone, a hormone present in both males and females, increases during puberty and stimulates the sebaceous glands of the skin to enlarge, produce oil and plug pores.
• Acne breakouts generally begin around puberty, but may continue or start in adulthood.
• Acne shows up as whiteheads, blackheads, pimples, and, in some people, deep painful bumps that look and feel like boils.
• Close to 100% of people between the ages of 12 and 17 have at least an occasional whitehead, blackhead or pimple, regardless of race or ethnicity. By their mid-teens, 40% have acne severe enough to require some treatment by a physician.
• Acne most commonly occurs on the face, but can also appear on the back, chest, shoulders, neck and upper arms.
• Acne triggers include puberty, menstrual cycle, ovulation, childbirth, stopping birth control use, menopause and hormones.
• The life cycle of a pimple can take eight to 12 weeks to run its course.
• Squeezing, picking, or pinching acne pimples can contribute to infection, inflammation and scarring.

Dr. Linda Stein Gold discussed current methods of acne management.

Acne Misconceptions

• Consuming chocolate, greasy food and caffeine does not lead to acne.
• Acne is not caused by dirt or lack of cleanliness.
• Washing too often or too vigorously or using harsh or drying soaps or cleansers will not make acne better and can actually irritate the skin, causing acne to worsen.
• There is no overnight cure for acne.

Psychological Impacts

Dr. Richard Fried discussed the psychological impact of acne. He is a board certified dermatologist and licensed clinical psychologist, as well as the clinical director of Yardley Dermatology and Yardley Skin Enhancement Wellness Center, immediate past president of the Association of Psychocutaneous Medicine of North America and author of Healing Adult Acne: Your Guide to Clear Skin and Self Confidence.

According to Dr. Fried, the occurrence of acne is “epidemic,” and most common in young adult women. Living with acne can be very stressful, and that stress can cause the condition to worsen. Indeed, according to the doctor, acne can diminish, ruin and even take lives.

The physical considerations of acne can include scarring and post-inflammatory hyperpigmentation, while the psychosocial considerations can include poor self image, social withdrawal, scholastic or work impairment, high financial cost, anxiety, depression (30%) and suicidal ideation (more than 7%).

Interestingly, the psychological impact of acne is not necessarily correlated with its severity. Social, psychological and emotional problems can be as great as those patients suffering from disabling asthma, epilepsy, diabetes, back pain and arthritis, Dr. Fried explained.

Teen acne can cause poor self-image, social withdrawal, academic impairment, anxiety and depression.
Teens suffer emotionally from poor skin due to a cultural emphasis on beauty, sexuality and perfection. Parents can compound problems by reliving memories of their own adolescent acne, and focusing on issues such as social success, scarring and inadequacy.

Dr. Fried stated that successful acne treatment is taking so long due to confusion brought on by information overload from the Internet, TV and print sources. Other reasons why a person may not seek treatment may be feelings of inadequacy due to celebrity obsession, false promises and expectations, agitation, alienation and isolation.

The obligation of a treating physician, he concluded, is to provide realistic expectations and accurate information, as well as effective treatments and relapse prevention and control.

Wounded Self Esteem

Sabrina Aldridge, an actress on MTV's 8th & Ocean, model and acne sufferer, shared her personal story on how she suffered from acne on and off camera, sought treatment and regained her confidence. Showing her before and after photos, she reflected on how difficult it was to have a twin sister, also a model, with perfect skin, and how her self esteem suffered in the modeling world.  

“I wasn’t getting modeling jobs because of my bad skin,” Ms. Aldridge said. “Filming MTV’s 8th & Ocean was very difficult for me because I was living in an apartment full of models that all had perfect skin, including my twin sister. I experienced what it was like to feel ugly during a time when I should have looked my best.

Dr. Gilda Carle encouraged acne sufferers to see a doctor to control bad skin.
“I was given the opportunity (on the show) to open up about my bad skin issues and I took it head on to show each young person watching that even models deal with insecurities and skin problems just like everyone else and that no one is perfect.” Although she felt good about airing her skin problems on national television, ultimately Ms. Aldridge was left with one option—fix the problem, get better skin and never look back.

Internationally renowned psychotherapist and relationship expert Dr. Gilda Carle offered tips for a take-charge attitude. Professor of psychology at Mercy College, NY and author of Don’t Bet on the Prince and Teen Talk with Gilda, Dr. Carle encouraged acne sufferers to not let acne run their lives, and stressed the importance of self empowerment through attitude and the resolve to seek treatment.

Treatment Options

Dr. Linda Stein Gold, director of dermatology clinical research at the Henry Ford Health System in Detroit and division head of dermatology at the Henry Ford Health System in West Bloomfield, MI discussed recent advances in treatment.

According to Dr. Gold, acne affects 85% of people aged 15-24, while 12% of women and 3% of men will be affected until the age of 44. Additionally, women are 80% more likely to seek professional help for their acne. Acne treatments are broken down into four categories, she explained. They are:

Topicals: Topical creams, gels or lotions with vitamin A acid-like drugs and benzoyl peroxide. Antibiotics may be prescribed to help unblock pores and reduce bacteria.

Oral antibiotics: For those with more severe acne, oral antibiotics such as tetracycline, doxycycline, minocycline or erythromycin are typically prescribed, many times in combination with a topical retinoid. Topical retinoids may be a good choice for patients with dark skin, as these agents help improve inflammatory acne and may reduce hyperpigmentation. Only a doctor can prescribe topical retinoids.

Birth control pills: Birth control pills may significantly improve acne, and may be used specifically for acne treatment.

Actress/model Sabrina Aldridge was plagued with acne while her identical twin was not.
Other treatments: Isotretinoin may be used in cases of severe unresponsive acne, although there are side effects to this drug, including birth defects. Women may also use female hormones or medications that decrease the effects of male hormones. Photodynamic therapy, using the blue wavelength of light, can be helpful.  

One topical retinoid recommended by the panel was Differin (adapalene) gel or cream, 0.1%. The gel is clear, odorless and water-based, while the cream is formulated for patients with dry skin.  According to Dr. Gold, trials show that Differin gel 0.1%, when combined with other acne products, improved the efficacy of an acne regimen. A 65% reduction in comedones and inflammatory lesions was seen during a 12-week treatment with Differin as part of a clear-skin routine. Studies have shown that patients using Differin experienced fewer problems with stinging, burning, peeling and skin redness than with other topical retinoids.

Acne medications should be used regularly and consistently, added Dr. Gold, even when skin clears, to help prevent the formation of new pimples.

The message taken away from the Take Charge! event was simply that—to take charge of acne is to have the power to prevent its possible long-term physical and psychological effects. Many more options exist today for dealing with acne, and advances in treatment have come a long way toward easing the suffering of those with bad skin.