Acne

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated May 24, 2024by BetterHelp Editorial Team

Acne is a common skin condition— it’s the most common in the United States— and about 85% of people between the ages of 12 and 24 will experience it at some point. If you’re currently living with acne and are looking for treatment advice, see below for general information on this common skin issue. We’ll also cover the ways in which acne can contribute to self-consciousness, low self-esteem, anxiety, and other mental health conditions, plus tips for managing these effects.

A teen girl sits on the couch with a green pillow in her lap and looks at the cellphone in her hand with a worried expression.
Is acne affecting your mental health?

What causes acne?

Acne vulgaris— commonly referred to as pimples or zits— develops when the sebaceous glands or hair follicles become blocked due to a buildup of dead skin cells and an oily substance called sebum. Continued sebum production, while the hair follicle is blocked by these dead skin cells, can clog pores and result in various types of acne. Whiteheads and blackheads are the most common forms of acne and are typically milder, while papules, pustules, and nodules are considered a more severe acne. The most severe form of acne is cystic acne, which is characterized by large, painful, pus-filled lesions on the skin that may lead to scarring and permanent hyperpigmentation.

There are several different risk factors that may contribute to, cause, or trigger acne breakouts. Some of the reasons acne occurs include:

  • Family history and genetics
  • Hormonal changes (such as puberty and pregnancy)
  • Excess production in oil glands
  • Skin irritation or inflammation
  • Bacteria
  • A diet with lots of refined sugars and carbohydrates
  • High-stress levels
  • Certain medications (like birth control and corticosteroids)
  • Use of oil-based cosmetic products
  • Ineffective or insufficient skincare
  • Certain Musculoskeletal and skin diseases
  • Skin cancer

How is acne treated?

For most people, acne can be effectively managed through the use of over-the-counter treatments and simple lifestyle adjustments. This is true for teenage and adult acne. However, in some cases, medical intervention or prescription-grade acne treatments may be necessary to prevent complications from severe acne, such as skin discoloration or acne scars on the surface of the skin from a flare-up.

Topical solutions

Some of the most effective topical medications and skin care products to treat mild to moderate acne contain salicylic acid and benzoyl peroxide. You can usually find all sorts of affordable products for treating acne with these active ingredients at a drugstore. 

Typically, the best skincare routine for mild to moderate acne is to wash away dead skin cells from your face using a gentle cleanser in the morning and to follow up with an oil-free moisturizer. At night, carefully remove any makeup, and then wash your face using the same gentle cleanser. Apply a thin layer of your acne-fighting topical solution of choice (typically one containing salicylic acid or benzoyl peroxide) and complete your skincare routine with an oil-free moisturizer.
Getty/MoMo Productions

If you like to wear makeup, you can still do so and likely avoid triggering a breakout as long as the products are oil-free and non-comedogenic. You might use a helpful resource like cosDNA to check your cosmetics for acne-causing ingredients. Make sure to remove makeup from the surface of your skin every night before bed.

Lifestyle adjustments

Aside from engaging in a quality skincare routine, there are some changes you can make to your lifestyle to support your acne treatment and potentially avoid developing acne. Firstly, change your pillowcase once or twice a week. Bacteria, oil, and dead skin build-up on pillowcases quickly, which can lead to clogged hair follicles. Changing yours regularly is a simple way to help combat acne breakouts. Cleaning your phone on a regular basis—especially if you hold it to your face on calls—can be helpful for the same reason.

Long hair that touches your face should be shampooed regularly, and you may want to tie it back so that any oils from your hair aren’t transferred to your face. You might also try to avoid wearing hats, tight collars, and headbands, which can trap dirt and oil from your hair or skin against your face and neck and lead to breakouts. It’s also generally a good idea to avoid touching your face as much as possible, and don’t pop or pick at your pimples. This can slow down the healing process and lead to scarring, potentially leading you to face the challenge of determining how to get rid of acne scars on the skin surface.
Hydration
Staying hydrated by drinking plenty of water is also often useful in maintaining or achieving clear skin, as it helps to flush out toxins and keep skin cells hydrated. Green tea is another drink that may help with skin health, as it contains antioxidants and may help reduce inflammation.
Nutrition
When it comes to managing acne through nutrition, it's generally important to consume certain foods in moderation, such as sugary and carbohydrate-dense foods that can cause inflammation and trigger an acne breakout. Instead, you might opt for low-glycemic food that includes foods like whole grains and non-starchy vegetables. Additionally, healthy fats found in foods such as eggs and fatty fish can also be beneficial for maintaining healthy skin. Consult your doctor or nutritionist before making significant changes to the way you eat.
Is acne affecting your mental health?
Exercise
Staying active and getting plenty of exercise can also contribute to better health, including skin health. You don’t necessarily need to do hardcore workouts; just taking a walk, shooting hoops, or dancing to your favorite music daily may be enough to result in some benefits. However, if you work up a sweat, try to wash your face immediately afterward so that the sweat doesn’t clog your pores.
Stress management

Managing stress is also typically important while dealing with acne. This can be challenging, however, since a breakout can cause a vicious cycle: You break out, you feel stressed about the developing acne, the stress can worsen acne, and then you become even more stressed. That’s why learning healthy ways to manage emotional distress can be important. Journaling, cognitive reframing, exercising, and meditating are all examples of techniques you might explore for stress management.

Treatments for severe acne

If you feel like you've tried every at-home acne treatment but aren't seeing improvement, there are still options available. The next step is normally seeing a dermatologist who can diagnose acne and help you find the right acne treatment. Dermatologists will often start off with prescription-strength topical creams like adapalene cream, tretinoin, retinoic acid, topical antibiotics, or others with high concentrations of benzoyl peroxide. 

Sometimes, dermatologists will also prescribe oral antibiotics to take over a period of time in addition to using topical solutions to treat acne that’s moderate to severe, such as severe nodular acne. Always speak with your doctor or dermatologist before starting or stopping any medication. For some individuals, dermatologists may also recommend birth control pills or spironolactone, which can help control hormonal acne.

A final option is an isotretinoin, which is often referred to by its previous brand name, Accutane. This is a Vitamin A-based acne medication that can have serious side effects and even make acne worse if used improperly. Skin affected by cysts or other severe forms of acne may be treated with isotretinoin. Again, make sure to speak with your doctor or dermatologist about medications like this and potential side effects.

Acne & mental health

Acne can affect more than just your appearance. Numerous studies have suggested that skin conditions like acne can have effects on mental health as well. These can range from low self-esteem and poor self-image to mental illnesses like depression and anxiety. Many people with acne also report decreased quality of life and feelings of isolation.

Acne doesn’t have to be severe for people to experience mental health effects, either. Even mild to moderately affected skin can cause distress, especially in teenagers. Finding healthy ways to cope with difficult emotions and experiences related to acne can help you support your well-being.

Physical and emotional acne scars

If you’re experiencing acne that's causing mental health challenges, you might seek out the support of a professional. Though it may not be possible to completely prevent acne, a therapist can help you reframe distorted negative thoughts and shift your self-talk in a more positive and realistic direction. They may also offer exercises or techniques that may assist you in building confidence, and discovering healthy coping mechanisms that work for you--and realizing your inherent worth—whether acne appears or not.

Some of those who are experiencing acne feel stressed about leaving the house or meeting new people in person, which can make attending in-person therapy intimidating or even impossible. Others simply have too busy a schedule or live in a rural area and can’t meet with a provider at their office for these reasons. In cases like these, online therapy can represent a more convenient option. Virtual therapy platforms like BetterHelp (18+) and TeenCounseling (13-19 with parental consent) allow you to get matched with a licensed therapist who you can meet with via phone, video call, and/or in-app messaging to address the challenges you may be facing related to acne or other topics. Research suggests that online therapy may be as effective as in-person therapy in many cases. See below for a review of a BetterHelp counselor from a client who faced a similar challenge.
Counselor review
“I got my son a counselor regarding some confidence and social issues he was facing. Every time Quinche’ speaks with my son, I can see how much happier he is. She takes so much weight off his shoulders and gives him the keys to a happier future. I couldn’t be happier with this experience.”

Takeaway

Acne is a common skin condition that affects many people, particularly teenagers and young adults. While some acne can be managed with simple lifestyle changes, other cases may require medical attention. Regardless of the severity of your acne, if you feel that it's impacting your mental health, you might consider speaking with a professional to help you regain your confidence and build your self-esteem.

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The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
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