What Is Self-esteem, and Why Does It Matter?
Self-esteem is a person’s subjective opinion of their own worth. While high self-esteem contributes to a person’s success and quality of life, low self-esteem can make a person feel down and even cause depression. It potentially leads to serious problems, such as an inability to leave destructive relationships or a failure to succeed in school or work.
Acne and Emotional Problems
Doctors generally consider acne a minor health problem compared to chronic conditions like asthma, diabetes, or arthritis. However, over the last two decades, researchers have started to recognize that acne can cause serious psychological and emotional effects, as we can see from the following two studies:1-3
A study published in 1999 in the British Journal of Dermatology compared the quality of life among patients with different diseases by giving them questionnaires. The authors of the study wrote: [A]cne patients…reported levels of social, psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain or arthritis.1
Another study, also published in 1999 in the same journal, looked at the psychological and emotional impact of acne on 34 acne patients by giving them questionnaires. The patients’ answers showed that they were emotionally distressed. In fact, 15 of them had clinical anxiety, and 6 suffered from clinical depression. The researchers concluded that doctors need to stop thinking of acne simply as a skin problem, and to start regarding it as a disorder that can damage a person’s emotional state.2
Acne and Self-esteem
To understand how acne makes people feel about themselves, a group of researchers interviewed 26 acne patients. Quotes from the interviews were published in 2006 in the journal Canadian Family Physician. The patients were between the ages of 13 and 72 years and spoke about the impact of acne on their self-esteem.4 Below are some of the patients’ comments:
You become very focused on the acne. It’s the first thing you see when you look in the mirror, instead of the rest of you. -A 10-year-old girl
I felt it was this real identifying feature of me.…It became part of my persona, and I was a person with acne and that was how others saw me. -A 35-year-old woman
It’s low self-esteem, and your confidence is lacking. You do tend to feel pretty down in your life, and it’s hard to search for things to make you feel good and confident about yourself. -A 32-year-old woman
I guess [acne] made me feel that I was less than acceptable, [that] I wasn’t worthy, that I was cursed. -A 41-year-old man
When I had my acne [badly], I felt quite embarrassed about it, um, at the time, and, ah, it was something that occupied my mind a lot. -A 19-year-old man
It was just embarrassing trying to talk to people and you’ve got pimples and people are looking at you and you are trying to hide [the acne] as well. It makes you feel embarrassed. -A 32-year-old woman
[If] my face was in a bad state, then I was cautious when I was going out … just that you’re aware of [the acne] when you go out and, you know, you don’t want to draw any attention to yourself because of the condition you’re in. -A 15-year-old boy4
However, since this study was based only on interviews with acne patients, it does not provide an idea of how acne patients compare to other people in terms of self-esteem. To compare self-esteem in people with and without acne, another study was published in the Journal of the American Academy of Dermatology in 2008, and found that acne was in fact responsible for the lowered self-esteem:
For this study, 3775 teenagers filled out questionnaires about their self-esteem. Of all the teenagers, 493 had acne. The researchers compared the answers of the teens with acne to those without acne and found that teens with acne had:
- More symptoms of depression
- More feelings of uselessness
- A more negative attitude about themselves
- A lower sense of self-worth
- Lower satisfaction with their bodies5
The researchers also wanted to see whether other factors, like weight, explained why teens with acne felt bad about themselves. To do this, they examined body mass index (BMI), a measure of how a person’s weight compares to his height. They found that, no matter what their BMI was, having more acne correlated positively with lower self-esteem.5In other words, acne was the sole reason for the teens’ low self-esteem. The effect of acne on self-esteem is particularly important for teenagers because they often feel a strong need to be socially accepted.
It's not just teens that experience acne's emotional downsides. Adults can also suffer from low self-esteem due to acne as we can see from this study published in 1989 in the journal Clinical and Experimental Dermatology:
The researchers of this study found that even in adults, acne lowers self-esteem and interferes with common social interactions, such as dating, eating out, and participation in sports.6
Acne Affects Self-esteem More Severely in Women
Even though having acne is apt to damage everyone's self-esteem, it appears to affect women more strongly.
In a study published in 2009 in the Journal of Health Psychology, researchers investigated the effect of acne on self-esteem by analyzing the answers of 132 acne patients to a questionnaire called the DAS (Derriford Appearance Scale). The DAS measures how concerned a person is about her appearance and how it affects her self-esteem. The researchers compared the answers of men to those of women with acne, and found that women with acne were:
- More self-conscious about their appearance
- More self-conscious in social situations
- More self-conscious about their body and sexuality
- More self-conscious about their face
- More negative about themselves7
In addition, the researchers asked all the patients to rate the severity of their acne on the face, chest, and back. They then determined whether the patients’ self-esteem was related to their acne severity. They found that:
- For women, the more severe they considered their facial acne, the more self-conscious they were in social situations.
- For both men and women, the more severe they considered their back acne, the more self-conscious they were about their body and sexuality.7
In other words, both men and women become increasingly self-conscious with more acne. Women, however, are especially sensitive about it, specifically on the face.7
To sum up, many studies have demonstrated that acne causes emotional problems and lowers self-esteem. The main findings of each study are summarized below.8
Treating Acne Improves Self-esteem
The good news is that clearing up the skin will improve self-esteem. We know this based on studies that have been performed on people taking isotretinoin (Accutane). Isotretinoin is a powerful yet controversial acne treatment approved for people with severe acne that dramatically clears the skin, but can also come with severe and potentially lifelong side effects. However, even though the available research focuses on isotretinoin, common sense tells us that any successful method that is used to clear up one's skin will result in improved self-esteem.
A study published in 2014 in the Iranian Journal of Psychiatry looked at 98 patients with severe acne were treated with oral isotretinoin (Accutane) for 16 weeks. The patients included 60 women and 38 men. Before and after the treatment, the patients completed a questionnaire about their quality of life which included questions about how acne affected their level of embarrassment, close relationships, sex, social and leisure activities, study or work, and other aspects of their daily lives.9Based on each person’s answers, he or she was given a quality of life score, which can be interpreted as follows:
- 0–1: Acne had no effect on the patient’s life
- 2–5: Acne had a small effect on the patient’s life
- 6–10: Acne had a moderate effect on the patient’s life
- 11–20: Acne had a very large effect on the patient’s life
- 21–30: Acne had an extremely large effect on the patient’s life
The researchers compared the patients’ scores before and after acne treatment and found that the scores decreased dramatically after treatment for both men and women. It should be noted that the researchers did not look specifically at self-esteem. Rather, self-esteem was only part of what contributed to each person’s quality of life.9
An older study, published in 1987 in the Journal of the American Academy of Dermatology, also looked at whether treating acne reduces emotional problems. The researchers once again studied the effect of isotretinoin treatment on 72 patients with cystic acne. They found that treatment continued improving the patients’ anxiety and depression as their acne subsided.10Again, however, this study did not look directly at self-esteem.
Ironically, one potential side effect of isotretinoin that some researchers have reported is increased depression. For example, in the 2014 study which looked at quality of life before and after isotretinoin therapy, the researchers noted that it actually caused increased depression in some men and women. Since they still found that the overall quality of life and self-esteem of the acne patients improved during treatment, they concluded that the benefits outweigh this side effect.9Other studies have not observed depression as a side effect at all, finding only that isotretinoin reduced depression in acne patients.10
The Bottom Line
There are few surprises here. As one would expect, in both teens and adults, acne lowers self-esteem. Although females are more likely to suffer low self-esteem due to acne, clearing the skin leads to improved self-esteem in general.