In addition to the gut-brain-skin connection and its contribution to acne, stress and depression also have an effect on the immune system which, in turn, can trigger autoimmune skin conditions like vitiligo and immune system mediated skin problems like eczema, psoriasis and dermatitis. Other mental health issues have also recently been found associated with skin conditions, however, with one study even finding a threefold incidence of autism in children with atopic dermatitis.

Acne a Major Psychological Issue

In recent years, psychodermatology and neurodermatology specialists have gained a following as the link between skin conditions such as acne vulgaris and depression, anxiety and other psychological sequelae have been documented. The mental health impairment scores in acne patients have been seen to be higher than in those with other chronic, non-psychiatric medical conditions. Acne sufferers tend to be more depressed, anxious and even have higher levels of schizophrenia and psychosis than those with diabetes and epilepsy, making this skin condition, considered minor by some, a major public health issue.

Does Depression Increase as Acne Worsens?

This psychodermatological connection isn’t, however, as simple as linking depression with more severe acne and Rapp, et al (2004), found that disease severity (in this case it psoriasis) was actually similar in those with high levels of anger but quality of life and skin-related quality of life was reduced. This suggests that people who have issues with anger react poorly to skin disease and feel that they suffer more with acne than those without such angry tendencies.

Psoriasis, Anger and Heart Disease

The same analysis also looked at the relationship between psoriasis and Trait anger, a factor associated with an increased risk of heart disease which could explain the association of heart disease risks with psoriasis. Patients with psoriasis and high scores for Trait anger were, however, no more or less likely to adhere to treatments for their skin condition, meaning that the association appears to be psychological rather than founded in behaviour. Studies looking at the psychosocial effects of psoriasis, including the effect of this skin condition on sexual dysfunction, also noted that disease severity was not the important factor in determining emotional impact.

How Acne Affects Mental Health

Skin problems, such as acne can act as a barrier to engaging in social activities, especially exercise and sport-related activities (Loney, et al, 2008). This kind of inhibition would then have knock-on effects for general health and happiness as those feeling scrutinised over skin health may be less likely to socialise, make friends and have a support network available to them, thus perpetuating the cycle of low self-esteem. Psoriasis sufferers have also been noted to have an increased incidence of sexual dysfunction, with most researchers putting this association down to problems with self-esteem and shunning of social interaction leading to poorer sexual confidence.

Depression Two to Three Times Higher in Patients with Acne

Uhlenhake, et al, also found that the correlation between depression and acne vulgaris was higher in those over the age of thirty-six and is more significant in women than in men (although this could be a result of reporting discrepancies and differences in treatment-seeking behaviour). In a separate analysis by Barrimi, et al (2013), patients over forty were found much more likely to have some kind of psychiatric disorder alongside their skin condition when using long-term corticosteroid therapy. Additionally, Uhlenhake, et al (2010), found that depression was two to three times more common in acne patients than in the general population. Some 8.8% of acne patients reported being clinically depressed, with the highest percentage of these patients in the 36-64 age group. Twice as many women than men with acne reported being depressed (10.6% females vs. 5.3% males).

Acne and Feelings of Inferiority

Doctors were making the connection between acne and mental health problems as far back as the middle of the twentieth century: “There is no single disease which causes more psychic trauma and more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic assessment than does acne vulgaris” (Sulzberger, 1948).

Of course, acne is not the only skin condition linked to depression, anxiety and stress; one skin disorder may actually be regarded as a psychological condition, namely, dermatitis artifacta.

Read More: Psychological factors in skin disease