Aesthetics investigates the recent concerns with the psychological implications that acne can have on patients
Charities worried about the potential psychological implications of skin conditions on patients have recently voiced concerns in the media about the way acne is perceived in society by not only the public, but by medical practitioners as well.1,2
According to statistics from research conducted in 2015 by the British Skin Foundation (BSF), a charity that aims to help people living with skin diseases in the UK, 95% of people say acne has an impact on their daily lives, with 63% reporting a decrease in self-confidence.3 The BSF and Changing Faces, a charity that represents and supports people with disfigurements to the face and body, including skin conditions, argue that statistics like these highlight the psychological implications that could present in patients suffering from acne. The charities also stress that, due to the potential underlying psychological effects, the condition is not taken seriously enough by some medical practitioners. Approximately 85% of people between the ages of 12 and 24 experience at least minor acne,4 and the condition can expand far into adulthood with studies indicating around 70% of people over 20 experience acne at one time or another.5
So what implications does acne have on a patient’s mental health, confidence and self-worth, and are aesthetic practitioners taking these implications seriously enough?
“I have come across some people who have gone to the extreme to self harm and attempt to end their lives because of the effect scarring has had” Dr Vishal Madan
Studies have suggested that acne can cause a number of psychological abnormalities, including depression, anxiety, embarrassment, and lack of self-confidence.6
“People with acne can feel unsupported, socially isolated and become withdrawn, which can affect all aspects of their life including relationships at work, with family and friends,” says Dr Anjali Mahto, consultant dermatologist and BSF spokesperson.
Psychological effects of acne can result from two possible areas, according to consultant dermatologist Dr Vishal Madan; the visible disease itself, which includes painful acne lesions, papules, pustules and nodules, and the scarring that may be a result of the improper treatment of acne. Cosmetic dermatologist Dr Sam Bunting says that the level of psychological impact acne has depends very much on the patient, “With any dermatological condition you always need to factor in the individual’s subjective response to the condition, at the same time as objectively assessing its severity – it can be surprising how diverse the impact of skin disease can be.”
Dr Madan has seen how severe the psychological long-term affects of acne scarring can be, explaining, “People who develop scars on their faces get deeper scars on the psyche somewhere. I see people experiencing subclinical and clinical depression as a result of acne scarring; I have come across some people who have gone to the extreme to self harm and attempt to end their lives because of the effect scarring has had on their lives.”
Ivon Van Heugten, policy adviser in health at Changing Faces, says the charity often sees acne sufferers feeling as though they have not been taken seriously enough, which can be concerning. “Acne is often a temporary condition and only sometimes a lifelong condition, and because of that people think that it’s just a stage that you go through – this is a common attitude not only amongst the public but also amongst health professionals – skin conditions are often underestimated in terms of the treatment and the psychological care that is needed.” Dr Mahto agrees with these concerns, and says,
“In a health system that is bursting at the seams, often conditions that are not life-threatening do not get the priority that they need. The growing field of psychodermatology recognises this and places emphasis on the often-unmet need for patients with skin disease to get the psychological support they require. Dr Mahto explains that the results from studies such as the one from the BSF do not surprise her, “People do underestimate acne and the impact it has on those suffering with it; I think these results highlight that acne should be taken far more seriously.”
Dr Bunting suggests that the main issues lie at the general practice level where, due to the limitation of resources, many patients who need the next level of help are not being referred to a dermatologist. “Almost everyone that I have seen with acne has had the experience of not being taken as seriously as they would like to be by the medical profession, in terms of how their skin condition are affecting them,” she explains, adding that, in her experience, patients are only being referred by the GP if their acne is severe enough to warrant Roaccutane. Dr Jane Leonard is a GP and an aesthetic practitioner who believes that GPs probably do not get the sufficient dermatological training that patients may need. She says, “At the end of the day we are generalists, in some areas, particularly related to skin. People only know the basics, so even simple things like making the differentiation between mild, moderate and severe acne can be challenging and some practitioners may not have had that experience or insight to know what they need to do.”
Dr Madan believes that non-specialist medical professionals need more education to not only recognise the severity of acne on the outside, but to deal with the emotional factors that surround acne, “There’s a lack of education, and a lack of awareness of the long-term sequela of acne. You cannot address this issue if there is not enough education to the clinicians who are diagnosing the condition.”
Dr Bunting agrees, “GPs face a big challenge when it comes to managing dermatological patients. Skin disease is terribly common and many of them won’t have had a huge amount of dermatology exposure during their GP training. It’s important to keep dialogue with patients suffering from common conditions like acne as open as possible to ensure the best possible standard of care and seek secondary care input in complex cases.”
Dr Mahto says it is crucial that GPs and medical professionals know when to treat acne and the deeper issues that surround the condition, as well as when to refer, “Healthcare and allied professionals need to be trained in recognising acne, assessing severity adequately and knowing when a specialist opinion from a dermatologist is required. Otherwise, patients will always be done a disservice.”
Dr Leonard suggests that skin specialists and dermatologists can do more to support other medical professionals who might not have as much experience, and recommends a multidisciplinary approach, saying that they, “Need to pick up the phone and ask for advice if necessary, rather than relying on a watch and wait approach.” She says this can go both ways, and practitioners with strong dermatology experience can help GPs, nurses and other medical professionals by letting them know their knowledge is available if they need it, or letting them know that if the GP’s patients are interested in going private, then they are there to help. Dr Leonard concludes, “At the end of the day everybody is good at the things they are good at, but sharing information and sharing support is always a good thing.”