Metrics details. The purpose of the current survey was to evaluate how teenagers and adults view teens with acne as compared to those with smooth, clear skin. We also surveyed teens and adults about their experiences with acne. We hypothesized that teens with acne would be perceived in a more negative fashion as compared to teens with smooth, clear skin. We presented digitally altered photographs to our responders and asked how they perceived the two groups. No mention was made of acne. Survey 1. Survey 2. Teens with smooth, clear skin were rated higher on every favorable characteristic and lower on every unfavorable characteristic by both teens and adults. In most cases, the first thing that respondents noticed was the skin of teens with acne.
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Teenagers and adults alike perceived other teens with acne as generally being shy, less socially active, more likely to be bullied, and less successful in terms of finding a job. Overall, these results show that acne has a negative effect on the way people are perceived by others. We all know that how you look affects how you feel. This survey took a unique look at how outer beauty impacts the way others view you [ 1 ]. Our ancestors recognized that being attractive was important for survival [ 1 ]. Beautiful skin, nails, hair and teeth were indicators of youth, good health and even reproductive capability. Attractiveness equated to good health and perpetuation of the species.
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This is one reason why men still find women in their late teens and early twenties so alluring. At this age, young women are most loudly broadcasting signals of their vitality and fertility through their faces and bodies. Conversely, any change from the ideal appearance ie unhealthy skin, asymmetric facial or body features, being underweight or overweight is perceived negatively. Etcoff, in Survival of the Prettiest, stated, "Our extreme sensitivity to beauty is hard-wired, that is, governed by circuits in the brain shaped by natural selection [ 2 ]. We love to look at smooth skin, thick shiny hair, curved waists, and symmetrical bodies because in the course of evolution the people who noticed these signals and desired their possessors had more reproductive success. The skin can be thought of as the most aesthetic organ of the body. One of the first things we notice about another person is their skin. On the average adult, skin weighs lbs and covers about 22 square ft of surface area on the body [ 3 ]. Clear, healthy skin that is free of diseases such as acne is an important factor that contributes to our positive perceptions toward others.
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Acne vulgaris acne is a common skin disease involving the pilosebaceous unit, including the follicular canal, hair follicle and sebaceous glands [ 4 ]. Microcomedones, caused by hyperproliferation and hyperkeratinization in the follicular canal, constitute the initial lesions in this disease [ 5 ]. The bacterial species Propionibacterium acnes colonizes the follicular channel. This stimulates cytokine production, which eventually leads to the formation of inflammatory lesions. Upon rupture of the follicular walls, granulomatous lesions and scarring often occurs [ 5 ]. The prevalence of acne is particularly high among teenagers and young adults. Ghodsi and colleagues found, in a study of 1, adolescents, that the prevalence of acne was Collier et al.
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The prevalence of acne was higher in women than it was in men [ 8 ]. The Global Alliance to Improve Outcomes in Acne Group recently published their update on the management of acne [ 6 ]. The group described acne as a chronic disease due to its prolonged course, pattern of recurrence, acute outbreaks, and slow onset. Due to the negative psychological and social effects of the disease, early and aggressive treatments were considered by the panel to be warranted. The physical and emotional scars of acne can extend from adolescence and beyond. Many adolescents experience considerable psychological distress as a result of their acne [ 10 ]. Severe acne can cause extensive physical scarring, and can last well into the fourth and fifth decades [ 11 ]. This scarring can cause despair and other negative psychosocial effects. It is apparent that acne is a disease that causes many challenges to the psychological resources of a patient and these effects can last up to several decades. Evidence abounds that teen acne leads to distress, higher rates of depression and in extreme cases treatment with isotretinoin has been associated with suicidal ideation and actions [ 12 — 15 ].
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Antidepressants are used to combat the psychological symptoms of skin diseases such as acne [ 16 ]. Uhlenhake et al. Most cases of depression and antidepressant therapy utilization were observed in acne patients aged 18 and over. Previously, it has been reported that people with acne suffer from a lack of confidence and self-esteem [ 17 , 18 ]. This survey attempted to assess whether acne changes how others perceive you. Both groups of participants took the same survey.Quotas were set to ensure reliable and accurate representation of each audience. Each respondent answered questions about several pictures of teens males and females of Caucasian, African American, or Hispanic ethnicity with or without acne Figure 1 and 2. Each respondent reacted to 3 randomly selected pictures, with the only condition being that it was a combination of either a 1 clear and 2 acne pictures or b 2 clear and 1 acne picture. This design allowed the respondents to focus in-depth on specific stimuli and kept the survey at a reasonable length. In an effort not to 'lead' the responses, acne was not specifically mentioned during the perception survey Table 1. Respondents then answered questions about their own experiences with acne in the second survey Table 2. Results of any sample are subject to sampling variation. The magnitude of the variation is measurable and is affected by the number of responses and the level of the percentages expressing the results. Representative photos of a teen with and without acne are shown in Figures 1 and 2.
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When the results were analyzed by gender, the skin was the first thing that both female and male teens noticed from photos the most Figure 4. Responses to the question: If you had to choose one, what's the first thing you noticed about this person's face? Responses by gender from teenagers: If you had to choose one, what's the first thing you noticed about this person's face? Teenagers' and adults' perceptions when asked: Which of the following words or traits describe this person? Positive traits. Negative traits.Responses by gender from teenagers: Which of the following words or traits describe this person? Responses to the survey question: Which of the following are effect of having acne? Survey results clearly show and confirmed the hypothesis that acne affected how people were perceived. Both the adults and teenagers were more likely to first notice the skin of teens with acne. In contrast, when shown images of teens with clear skin, a variety of physical features were noticed first ie shape of mouth, eye color, nose. Teenagers with clear skin were more commonly described as being happy, intelligent, self-confident, healthy, and fun. Interestingly, those with acne were most often perceived as being shy, stressed, unkempt, lonely, boring, nerdy, and introverted.
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Therefore, one might imply from these results that how you look affects how others view you. Greater acne severity has been shown to be associated with poorer social outcomes and quality of life [ 19 ]. Among seven facial disfigurements, acne had the largest negative impact on finding a partner [ 20 ]. In the current survey people with acne were thought less likely to be currently dating someone. Murray and Rhodes found that 5 themes were revealed in interviews with acne patients: powerlessness and the variable nature of acne; comparisons, self-image and identity; the experience of general social interaction; relationships with family and friends; and gender, sexuality, and romantic relationships [ 21 ]. Many of the negative psychological effects on those individuals who are afflicted by acne relate to a diminished perception of attractiveness [ 22 ]. Acne has been termed by some investigators to be a biopsycosocial skin condition [ 19 ]. Motley and Finlay reported that patients with facial acne felt that they were unattractive, reluctant to engage in dating activities, and were socially isolated [ 23 ]. There was a sense among adults and teenagers in the current survey that the lives of teens with acne are less fulfilling, with more weekend time spent alone. Adolescents with acne have reported lower scores for total body esteem, sexual attractiveness, and weight concerns than their clear-skinned colleagues [ 17 ].
Introduction
Rubinow and colleagues conducted a survey of 55 acne patients to evaluate psychiatric morbidity and mood characteristics [ 14 ]. The most frequently reported adverse psychological effects of a severe form of acne called cystic acne included embarrassment, self-consciousness, social isolation, decreased physical activity, anxiety with the opposite sex, decreased self-confidence, preoccupation with acne, sleep disturbances, nuisance, feeling ill at ease, frustration, and decreased self-esteem. In our survey, a higher percentage of teens with clear skin were perceived as being self-confident. Magin and colleagues also found skin diseases like acne to be a cause for embarrassment and impaired self-esteem [ 24 ]. Acne caused so must frustration that nearly three in five teenagers would stay off Facebook for an entire year if they could get rid of their acne forever. These responses underscore the value that teenagers place on their appearance and the lengths they would go to treat their acne. Our survey suggests that acne can have a negative effect on relationships and social life. A smaller percentage of teenagers admitted that they would be friends with someone who had acne. More than 3-fold more teenagers than parents believe acne can cause difficulty for teens in regards to finding dates.
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