“It can feel like a sign of immaturity. Especially as a senior, [it can feel like] not a lot of other people have acne, so being the only person [among my friends] who still has acne, I sometimes feel behind. Like, ‘why hasn’t mine cleared up?,’” senior Charlie Dickerson said.

Dickerson has struggled with acne since fifth grade. According to the American Academy of Dermatology, he is among the 50 million Americans who have Acne Vulgaris, a skin condition especially common among teenagers. While acne is often associated with pimples, blackheads and other visible blemishes, its psychological effects run much deeper than the surface of the skin. 

Acne is often referred to as one of the most common skin disorders (Yale Medicine). Developing when hair follicles fill with oil, bacteria and dead skin cells, acne is considered a spectrum, ranging from mild cases that clear up in a few days to severe cases that can leave scars from painful nodules under the skin. Dermatologists and doctors categorize cases based on numerous factors, including severity and type of lesions.

Dickerson has experienced various forms of acne on his face and body. 

“It’s kind of always been there,” Dickerson said. “I am always a little insecure about a bunch of red dots all over my face and back or my chest.” 

Beyond being painful and irritating, having acne in high school also causes insecurity and the feeling of extreme isolation. A senior who wishes to remain anonymous, whom we’ll call “Rachel,” has faced issues with comparison due to her acne.

“All the time, I’ll look at people and notice they don’t have any acne or other marks on their skin,” Rachel said. “I get so jealous, and it makes me not want to go out because everyone [seemingly] has perfect skin, and I immediately think everyone’s looking at my [not perfect] skin.” 

Rachel has experienced acne since seventh grade. Not only has Rachel felt an increase in self-consciousness, but she has also faced other psychological effects due to having acne. 

“I know I’m not the only one who struggles with it, but I’ve definitely felt judged [by my acne]. When I’m talking to other people, I’ll look at their eyes and see if they’re looking at where I’m breaking out,” Rachel said. 

Rachel is not alone in her feelings. In an October Bark survey, 76 percent of Redwood students self-reported that they have noticed a significant decrease in confidence or mental health due to acne; six percent of those students said they felt those feelings every single day. 

This is not a Redwood-specific issue: in a study done by the National Institute of Health (NIH), 89.3 percent of teens with severe acne faced decreased self-esteem, and 31.4 percent faced feelings of unworthiness. Self-worth and confidence are already low during adolescence due to the development of the prefrontal cortex (the hub of decision-making and self-esteem), but outside factors like societal and peer pressures, adult expectations and social media can all add to the overwhelming experience of being a teenager.

Rachel can sometimes feel self-conscious enough to the point where she is apologetic to others because of her own acne. 

“I’m so grateful makeup exists, because I feel like I have [to cover my acne up] all the time. It can feel like the polite thing to do,” Rachel said.  

“There have been times where I’ve [thought] ‘I really don’t want to go out [because of my acne],’ but I don’t really have a choice. That’s the other thing about acne; it sits there for a week or two [and]you can’t do anything. It’s something you can’t control,” Dickerson said. 

Not only have Dickerson and Rachel dreaded going out at times, but Rachel has also stayed home from places as important as school. 

“I remember a lot of times I’ve not gone to school because I was so insecure about [my acne]. Especially in middle school and the

beginning of high school, when you feel so judged in that time of your life already, acne just adds to that [insecurity],” Rachel said. 

While missing a few school days or social events may seem harmless, it can lead to larger issues. According to the NIH, 20 percent of teens with severe acne struggled with relationship building. Additionally, during a study also conducted by the NIH, 22 percent of acne cases led to depression and 41.8 percent of cases led to anxiety. 

Pediatrician Julie Bokser, who is also a Marin resident and mom of teenagers, has seen the emotional toll acne can take. 

“Teenage girls in particular suffer significant distress from acne, which [can] make them feel unattractive. Feelings like this can cause some teens to avoid social situations, participating in class, trying out for a sport or getting a job,” Bokser said in a written interview. “[Oftentimes,] the longer acne lasts, the more likely it is to impact a teen’s emotional well-being.”

This raises the question: if so many people are struggling with acne and its severely harmful effects, why isn’t it talked about more? 

One answer may be the plentiful available treatment options. Severe acne cases, such as those of Dickerson and Rachel, can often be the driving factor to seek medical help. Many pursue professional assistance from a dermatologist, who can prescribe various treatments, including Isotretinoin, commonly known as Accutane, topical creams,face washes or other prescribed remedies. 

Bokser has noticed the various treatment options available. As someone who regularly works with teens, she has a protocol she routinely uses with adolescent patients, especially those who might be struggling. 

“When I’m concerned about a teen, I may ask whether they are worried or unhappy with how they look. In particular, in teens with acne, I often let them know that most teens experience acne and then ask whether they are worried about their skin,” Bokser said. “Teens are often embarrassed to bring up their worries about acne, and I find it helpful to bring it up in a non-judgmental way and normalize that acne is part of adolescence.”

Dickerson began seeking help by visiting the dermatologist in eighth grade in hopes of clearing up his skin, but has had little luck so far.

 “I only started Accutane about a month ago, so I haven’t really seen the full effects of it yet. I’ve done all the [prescribed topical medications] they give out, and they’ve never really worked,” Dickerson said.

Accutane is an oral name-brand medication to relieve severe acne. It’s often prescribed as a last resort when other remedies don’t work. Rachel began taking Accutane during her freshman year and was on it for around seven months. 

“It was definitely worth it, but it really tested my patience. It makes you ‘purge,’ so you break out really badly and it makes your skin super dry. It felt like it got worse [before it got better], and it was very frustrating,” Rachel said. 

While treatments can clear some people’s skin, unfortunately for many, acne does not end after meeting with a professional. “I kept going to the dermatologist and they would give me different [prescriptions and] antibiotics. It just never worked, which was the frustrating part,” Dickerson said.

Rachel and Dickerson are not the only ones who have tried multiple treatments for their acne. In the same October Bark survey, 47 percent of students reported that they are currently or have once taken a form of acne medication. However, Rachel feels as though its prevalence often goes unacknowledged. 

“I never hear anyone talking about it. It’s common for girls to have a lot of insecurities, because of how they look or beauty standards or something else,” Rachel said. “To me, acne is the exact same as wanting your body to be different. People talk about [those beauty standards], but nobody really talks about acne, and it [can be] a really deep insecurity.” 

Even though acne isn’t talked about often, Dickerson’s experience has played a large role in his life. 

“It’s kind of become who I am. I [recently realized] that most of my friends have never seen me with clear skin. It’s not a bad thing, but it can just feel weird,” Dickerson said.