Adolescent Acne and Disparities in Mental Health

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Abstract

Acne is a hallmark of adolescence, affecting 85% of youth between the ages of 12 and 25 worldwide. Perhaps because of its ubiquity and minimal impact on physical functioning, acne is often dismissed as a time-delimited cosmetic nuisance and has been summarily neglected by developmental scientists. However, emerging evidence suggests that acne is associated with clinically significant psychological adjustment problems, including depression and anxiety. Adopting an interdisciplinary approach that bridges developmental and dermatological science, we reposition acne as a prominent source of psychological maladjustment and health disparities in adolescence. Specifically, we propose that females and youth with darker skin may be disproportionately affected by the pernicious psychological effects of acne. Reconceptualizing adolescent acne as a developmentally and psychologically meaningful dermatologic disease with effects shaped by culture and health care disparities will advance our understanding of youth’s mental health. KEYWORDS—acne; adolescent; gender; health disparities; mental health; skin color Acne is typically viewed as a developmentally normative, peripheral, and functionally neutral correlate of puberty. However, growing evidence suggests that this hallmark of adolescence is, in fact, a developmentally and psychologically meaningful dermatologic disease (Tuchayi et al., 2015). Acne vulgaris, caused by inflammation of hair follicles by Propionibacterium acne (Williams, Dellavalle, & Garner, 2012), ranks among the top 10 most prevalent diseases in the world (Tuchayi et al., 2015). Rates of severe acne increase dramatically across adolescence (Silverberg & Silverberg, 2014), with approximately 20% of teenagers experiencing moderate to severe acne, and 85% of 12to 25-year-olds reporting recurrent bouts of acne (Bhate & Williams, 2013). Perhaps because of its ubiquity and typically minimal impact on physical functioning, acne is often dismissed as a time-delimited cosmetic nuisance (Williams et al., 2012) and has been largely neglected by developmental scientists, including researchers studying puberty. However, as one dermatologist noted, “acne is not a killer, but it can scar people literally and psychologically” (Brody, 2019, p. 5). The persistent exclusion of acne from the lens of developmental science is particularly glaring given emerging evidence that the most immediate and pernicious effects of acne are, in fact, psychological. Acne is associated with clinically significant increases in depression, anxiety, and suicidal ideation (Purvis, Robinson, Merry, & Watson, 2006; Silverberg & Silverberg, 2014), declines in quality of life (Dunn, O’Neill, & Feldman, 2011), and increases in social maladjustment (Halvorsen et al., 2011). Moreover, the psychological ramifications of acne are likely to be distributed nonrandomly as a function of female gender (Hassan, Grogan, Clark-Carter, Richards, & Yates, 2009; Smithard, Glazebrook, & Williams, 2001; Tan et al., 2008) and darker skin (Davis & Callender, 2010; Taylor, CookBolden, Rahman, & Strachan, 2002). Thus, developmental research on acne is urgently needed, particularly among adolescents, for whom both physical appearance and psychopathology take on increased salience, and among diverse groups of youth. In this article, we highlight the opportunity for interdisciplinary research on acne within a developmental science framework to clarify whether, when, how, and for whom acne exerts toxic effects on psychological health. In the first section of the article, we describe the developmental course of acne and its relation to puberty. In the second section, we review empirical evidence on the nature and magnitude of acne’s effects on youth’s mental health. In the third section, we look at health Misaki N. Natsuaki and Tuppett M. Yates, University of California, Riverside. The preparation of this article was supported by a Committee on Research grant from the Academic Senate of University of California, Riverside. We are grateful to Danielle Samuels and Rick Lin for their insights. Correspondence concerning this article should be addressed to Misaki N. Natsuaki, Department of Psychology, University of California, Riverside, 900 University Avenue, Riverside, CA 92521; e-mail: misaki.natsuaki@ucr.edu. © 2021 Society for Research in Child Development. DOI: 10.1111/cdep.12397 Volume 0, Number 0, 2021, Pages 1–7 CHILD DEVELOPMENT PERSPECTIVES