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Adolescent acne and disparities in mental health

Researchers at the University of California, Riverside, are calling for a more aggressive approach to the treatment of acne that combines psychology and dermatology. Further, research published online ahead of print in the journal Child Development Perspectives (Jan. 9, 2021) found the psychological impacts of acne affect women and patients with darker skin disproportionately.

The study’s investigators note that acne affects 85% of youth worldwide, most between the ages of 12 and 25 years. They said that because of its ubiquity and minimal impact on physical functioning, acne is often dismissed as a time‐delimited cosmetic nuisance, adding that acne has been neglected by developmental scientists.

However, emerging evidence suggests that acne is associated with clinically significant psychological adjustment problems, including depression and anxiety, the authors said.

“Acne is pervasive, physically harmless, and painless, so we all-too-often underestimate its impacts as the quintessential nuisance of adolescence and puberty,” said Misaki Natsuaki, PhD, in a press release. Dr. Natsuaki, a co-author of the study, is a developmental psychologist at UC Riverside.

The psychological effects of acne among adolescents are often “toxic,” the researchers wrote. To support their recommendation of a change in treatment habits, the investigators alluded to the prevalence of acne among adolescents20% encounter moderate to severe acne and 85% experience recurrent bouts of acne.

“Acne can leave psychological scars, especially during adolescence when physical appearance becomes more salient for self-esteem, and internalizing psychopathology such as depression gains prominence,” said Dr.Natsuaki.

The researchers cited numerous studies which have shown direct links between acne and depression, anxiety, and suicidal thoughts. Teens with acne have more difficulty forming friendships, finding romantic partners and feeling connected to school, they wrote.

Previous research published in the journal BioPsychoSocial Medicine (Aug 2011;5(1):11) found that when shown a photo of a teenager with facial acne, 65% of adolescents said skin was the first thing they notice. In a photo of a clear-skinned teen, youth said they noticed the skin first only 14% of the time.

Young people attribute traits such “nerdy,” “stressed,” and “lonely” to adolescents with acne, the authors said.

Additionally, research has shown females experience negative psychological impacts at a rate higher than males.

“Aesthetic ideals of clear and unblemished skin are held by both sexes,” the researchers wrote. “But females experience greater social pressure to attain these ideals than males.”

Adolescents with darker skin colour are likely to have disproportionate effects of acne because of the heightened incidence of post-acne scarring and hyperpigmentation, according to the authors.

The investigators added that the structural systems of inequality, which fuel healthcare disparities in the U.S., further exacerbate acne and related psychosocial distress among individuals receiving public health insurance. These individuals are more likely to belong to one or more ethnic-racial minority groups.

The complex infrastructure of the health insurance system in the U.S., the uneven geographical density of healthcare providers, and reluctance to provide dermatology appointments to children with public insurance all contribute to these disparities, the researchers wrote.

“According to dermatology research, the psychological burden of acne is on par with that of other serious illnesses, such as diabetes,” said Tuppett Yates, a UC Riverside psychology professor, and co-author of the study.

“Acne is a medical condition with clear psychological effects—effects that are non-randomly distributed as a function of gender, skin colour, and socioeconomic status. So effective acne treatment rests at the intersection of medicine, psychology, and sociology.”

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