Acne and the resulting scarring have always been seen as a nuisance, but a superficial one with little attention paid to the effects it can have on our mental health. But there is evidence to suggest that the emotional and psychological repercussions of what has long been dismissed as a “skin issue” can be severe. The British Journal of Dermatology found that there was a 63% increased risk of depression in a person with acne compared to someone without. And given the knock-on effects our moods can have on our skin, this may be particularly dangerous.
“Acne and depression can be a vicious circle,” notes Dr. Sophie Shotter of the Illuminate Clinic. “Someone can feel unhappy, which causes social anxiety, and the subsequent increase in stress hormones can worsen their acne.”
“Research has shown that patients with acne are at an increased risk of severe depression,” she adds. “And a different study has shown that over 20% of respondents with acne have attempted or considered suicide.”
The most obvious link between acne and depression is the social stigma surrounding the condition and bullying from those who have had it since childhood, which was the case for Nikki Mattocks, 22. “Throughout most of my teenage years I had acne and I was prescribed all sorts by the doctor. I remember kids in my block of flats that used to play outside calling me names and saying they wanted to play dot-to-dot on my face. This really impacted my self esteem for a long time – sometimes I wouldn’t leave the house.”
Nikki now campaigns about mental health and many others have taken similar strides to create something constructive out of their acne experiences. One of the most famous and influential is beauty mogul Huda Kattan whose own issues with acne led to her building her Huda Beauty empire and skincare line WISHFUL. Speaking to GLAMOUR UK, she recalls, “As an adult I started to get a lot of cystic and hormonal acne, particularly on my chin, cheeks, and forehead; the cysts were big and painful and I could just never get rid of them. There was a time when I was so unhappy with my skin that I didn’t want to go out. So I started blogging and experimenting over the last ten years. I’ve literally dedicated my life to beauty and skincare, trying to find the products that work for me and don’t cause a break out. Now I’m in such a good place with my skin and it feels so empowering.”
For Tom Ogden, UK Ambassador for skincare brand Alpha H the perceived lack of emotional care on the NHS for acne-sufferers is something his own team try to compensate for when speaking to customers. “From personal experience with my own acne, as well as that of our founder Michelle, we received very little empathy from the medical profession back in the day. Given the growing awareness in recent years of the links between acne and mental health issues, you would hope that things have changed, but the reality is that our customers still report a lack of empathy from their GPs.”
But for some people, visiting a GP is their only option, particularly if high-end skincare, private dermatologists and alternative holistic therapies are out of their price range and not easily accessible where they live. GP and the founder of One Skin Clinic, Dr. Najia Shaikh agrees that patients can feel frustrated, but it’s not always their doctor’s fault. “Because acne is so distressing for patients and there are no easy solutions, the patient-doctor relationship can be tricky, especially if the patient is feeling low anyway. Most people want to be referred to a dermatologist, but we can’t refer everyone – especially if the acne isn’t particularly severe.”
But she adds, there are options for people who feel sensitive talking to their current GP about their mental health. “Some GPs probably mean well but not everyone is good at showing empathy. If you’re not happy with your GP, then ask for another in the same practise. It’s always important to get a second opinion.”
The more severe cases of depression have been linked to Roaccutane, a brand name of an acne drug called isotretinoin (also known as Accutane) taken by about 30,000 people in the UK each year.
Many people have credited this drug with clearing their acne and changing their lives for the better. Yet last year, data from the Medicines and Healthcare Products Regulatory Agency (MHRA) reported that ten suicides in 2019 have been linked to the drug. However, no direct link has been found – with many arguing that those taking it could already have pre-existing depression due to their acne. But the patient’s leaflet does state depression and suicidal tendencies as a possible side-effect.
“With Roaccutane, there have been a few cases of mood changes, depression and psychosis (hallucinations and hearing voices), even a few reported cases of suicide,” notes Dr. Shaikh. “There probably is a link, but we have no conclusive evidence. Yet a lot of patients are desperate to go on it as it has been proven to work for so many others. We tell them it’s better to use topical treatments or take antibiotics first. Roaccutane is only for severe acne if they have nodules (large painful lumps under the skin), which can leave permanent scarring – for which there are no treatments available on the NHS. In this case, I’d refer them to a dermatologist who can prescribe Roaccutane. I would never prescribe it for mild to moderate acne, but would probably use antibiotics to treat this instead.”
What would she say to someone whose acne is severe enough for Roaccutane, but are worried about the risks? “On the NHS there are strict guidelines we have to follow and the patient’s physical and mental health has to be closely monitored. Especially women in childbearing age, who need to take very strict contraceptive control, as it can affect the foetus.”
“Otherwise, there are forms of contraceptive pills that can also help with acne that I would discuss with patients as a possible option,” she adds. “These also have associated side-effects but not as severe as Roaccutane.”
With most acne treatments taking four to six weeks to have any visible effect, what steps would she take if a patient’s skin was giving them depression in the meantime? “There’s a difference between feeling low and having depression. We look out for symptoms like disrupted sleep, low appetite or overeating, self-harming and suicidal thoughts. These types of cases I would take very seriously and manage the depression first and foremost, perhaps referring them to a specialist. If it’s more a case of low mood, I would start by talking to patients, seeing them regularly and managing their expectations as to how quickly their acne will clear up.”
For those who are currently treating their acne but are mentally struggling, there are other sources of help available. “Find allies – a support group online, for example,” advises Allies of Skin founder and former acne-sufferer Nicolas Travis. “Acne is often lonely but you’re not and won’t be the only one suffering. There are many others that are in a similar situation and you don’t have to go through it alone. Depression is not something that can be treated overnight so the sooner you find help, the better headspace you’ll be in to work towards clearer skin.”
“We are creating a safe space for open dialogue starting with a series on Instagram we call #TransparencyThursday, (TT),” he adds. “TT is a series where we share insights on the skincare industry as well as share personal stories and struggles – starting with mine. Also, in this series, I will be sharing insights on my struggle with depression and what helped. By doing so, I hope it can help others feel more comfortable and less lonely.”
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