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Research Report: Teens, Acne, and Quality of Life

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Acne is the Most Common Skin Condition Among Adolescents

“When I was 12, I got my first pimple. It was on the right side of my face, about an inch from my nose, right in the middle of my cheek. I noticed it first thing in the morning. It looked horrible. I was mortified. So I poked it, prodded it, squeezed it, did everything to try to make it go away. It wasn’t ready to pop. It was just a little reddish lump. But all that day, I was one hundred percent sure everyone I saw that day noticed that pimple, and concluded that it was horrible and awful. Further, that one pimple proved that I was the ugliest, unluckiest guy around. When I got home later that night and asked my older sister what to do – who was guaranteed to make fun of me about it – said she didn’t even notice it, could barely see it, and to leave her alone and shut the door on my way out.”

How many of you remember your first experience with acne?

That story above is from one of our staff members, who graciously shared his first experience with acne. And it wasn’t really acne, at all. It was one simple blocked pore, known as a pimple. Nevertheless, its presence caused significant emotional distress for him. We’re not exaggerating he remembers the day, 25 years ago, like it was yesterday.

That’s why a study we found recently got our attention.

Can Acne Impact Quality of Life in Adolescents?

Published in 2022, “The Impact Of Acne Vulgaris On The Quality Of Life In Teen Patients” addresses that short-term experience our friend and staff member had that one day during adolescence.

If you asked him today, he’d confirm that on that day, the presence of that one pimple severely impacted his quality of life. But as we mentioned, what he had was not really clinical acne: it was one blocked pore that was on its way to becoming a pimple.

The study we discuss in this article examines the impact the presence of clinically diagnosed acne vulgaris has on the quality of life and self-esteem in the teenage population. First, let’s talk about acne and its prevalence among adolescents in the U.S.

First, though, let’s define our terms.

What is Acne Vulgaris, Clinically Speaking?

Here’s a definition of acne vulgaris:

Acne vulgaris is the common form of acne, characterized by a mixed eruption of inflammatory and non-inflammatory skin lesions. Types of skin lesions include:

  • Comedones: blackheads and whiteheads
  • Papules: Small red bumps
  • Pustules: White or yellow bumps that are ‘squeezable’
  • Nodules: Large painful red lumps
  • Pseudocysts: Large, cyst-like swellings
  • Excoriations: Scratched or picked-at spots
  • Macules: Red marks for recently healed lesions
  • Scars: Left after severe lesions

There are three types of acne: mild, moderate, and severe:

Mild acne is defined by the presence of:

  • Fewer than 20 comedones
  • Fewer than 15 inflammatory lesions
  • A total of under 30 lesions/comedones

Moderate acne is defined by the presence of:

  • Between 20 and 100 comedones
  • Between 15 and 50 inflammatory lesions
  • A total of 30–125 lesions/comedones

Severe acne is defined by the presence of:

  • More than 5 pseudocysts
  • Over 100 comedones
  • More than 50 inflammatory sites
  • More than 125 lesions

The most common trigger for the onset of acne vulgaris are hormones associated with puberty. Acne most often develops on the face and upper trunk. Data shows that acne affects close to 95 percent of adolescents, with roughly 64 percent reporting mild acne, 30 percent reporting moderate acne, and 6 percent of adolescents with acne reporting severe acne.

Now let’s have a look at that study.

Acne and Quality of Life in Teens

The study we introduce above makes an interesting observation, which we’ll share in a moment. When we read that study, we decided to search for additional data on the relationship between acne and teen self-esteem and/or quality of life. We found more than we expected, but three stood out because their data showed a phenomenon the first study we mentioned did not.

Here’s what we mean.

1. Acne in Teens in India

The study “Impact of Acne Vulgaris on Quality of Life and Self-esteem” showed:

  • The presence of acne correlated with lower quality of life (QoL) a lower self-esteem (SE)
  • The severity of acne – mild, moderate, or severe – corresponded with reductions in Q0L and SE.
    • Teens with mild acne had higher QoL and SE, compared to teens with moderate and severe acne
    • Teens with moderate acne had higher QoL and SE, compared to teens with severe acnes, and lower QoL and SE compared to teens with mild acne
    • Teens with severe acne lower higher QoL and SE, compared to teens with moderate and mild acne

2. Acne in Teens in Greece

The study “The Impact Of Acne Vulgaris On Quality Of Life And Psychosocial Health In Young Adolescents In Greece” showed:

  • The presence of acne correlated with lower QoL and psychosocial health (PH)
  • The severity of acne – mild, moderate, or severe – corresponded with reductions in QoL and PH
    • Teens with mild acne had higher QoL and PH, compared to teens with moderate and severe acne
    • Teens with moderate and severe acne had lower QoL and PH, compared to teens with mild acne
    • Researcher found no difference in QoL and PH between teens with moderate and severe acne

3. Acne in Teens in Egypt

The study “Acne Vulgaris: Prevalence, Severity, And Impact on Quality of Life And Self-Esteem Among Egyptian Adolescents” showed:

  • The presence of acne correlated with lower quality of life (QoL) a lower self-esteem (SE)
  • The severity of acne – mild, moderate, or severe – corresponded with reductions in QoL and SE.
    • Students with mild acne reported limited disability of QoL
    • Students with moderate acne reported increased disability of QoL compared to students with mild acne, and reduced disability of QoL compared to students with severe acne
    • Students with severe acne reported significant disability of QoL

That data tells a story that’s easy to understand. Acne can negatively impact quality of life, psychosocial health, and self-esteem. That negative impact aligns with the severity of the diagnosis. The more severe the acne, the more significant the negative impact.

Now we’re ready to share that interesting observation from the initial study we mentioned.

Mild, Moderate, or Severe: Worst Day Ever

What the first initial study showed was that the presence of acne had a negative impact on quality of life and the severity made no difference at all. Here’s how the study authors described their findings:

“Acne vulgaris has a great potential to precipitate anxiety and affect the quality of life without considering the severity of the disease.”

That brings us back to the anecdote at the beginning of this article. One small – we’ll call it a comedone ­– reduced his quality of life for one day. Simple anecdote, simple outcome. What this study tells us is that he was not overly vain, too concerned with what others think, or extremely sensitive: he felt life the teens in the study: any acne at all impacts self-esteem and detracts from overall quality of life.

We’ll close with a message to parents: when your teenager is sad, agitated, anxious, or moody about their acne, please be compassionate. Help them resolve their acne with medical treatment, and if they show signs of significant emotional or psychological disturbance after their acne clears up, find them professional support. It may seem small to you, but remember: for a teen, whatever is happening right now is the most important thing on earth and even a small outbreak of acne can turn a great day into the worst day ever – just like our colleague had that one day, twenty-five years ago.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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