How does acne affect self-esteem, and why might a teenager refuse to go to school? The thoughts behind the shame, the family role, dermatology and useful steps.
Seven in the morning. A fifteen-year-old is looking in the bathroom mirror at a red bump that has appeared on their forehead. They comb their hair forward, then push it back again. When the school bus sounds its horn at the door, they still have not come out of the bathroom: "Can't I just not go today?" Acne, which looks like a minor skin problem to adults, can carry a completely different meaning for a teenager's self-esteem. The link between acne and self-esteem can affect how a young person looks in the mirror, talks with friends, puts their hand up in class and has their photo taken. In this article we look at why acne takes up so much room in young people's inner worlds, which sentences families use without realising that deepen the wound, and what both the young person and the parent can do.
Why Does Acne Affect Self-Esteem So Much?
Acne is very common in adolescence and is largely linked to hormonal changes. In other words, it is not the young person's fault. But being common does not mean the young person experiences it more lightly. There are several reasons for this.
The sense of an imaginary audience. In adolescence, young people tend to feel that everyone is looking at them and notices every detail of their appearance. A spot an adult would never notice can, for a young person, turn into a point everyone in the class is staring at.
Identity is still forming. A teenager is in the process of discovering who they are and how others see them. In this process, appearance is the most visible and most easily judged part of identity. And because the face is the most central part of appearance, a change on the face feels as if it touches identity itself.
A filtered world. Most of the faces encountered on social media have passed through filters, lighting adjustments and editing apps. A young person who compares these smooth, flawless-looking faces with the real skin in their own mirror perceives themselves as far more "flawed" than they are.
Lack of control. Spots appearing suddenly, whatever the young person does, can create a sense of helplessness. They can raise their grades by studying and improve their fitness by training; but they cannot know what will be on their face tomorrow morning.
Unfortunate timing. The years when acne is at its most intense often coincide with preparing for the LGS or YKS (Turkey's national high-school and university entrance exams), starting a new school, first crushes and friendship groups reshaping themselves. Plenty of young people also notice that their skin becomes more sensitive during periods of sleeplessness and exam stress. So acne becomes an extra burden piled on top of an already loaded period.
For these reasons acne can become not just a skin matter but an emotional burden that affects the young person's view of themselves, their social relationships and their daily life.
Where Shame Turns Into Behaviour
Shame about acne often shows itself through small but repeated changes in a young person's behaviour. Some examples parents can look out for:
- Constantly covering part of the face with hair, a cap, a hood or a mask
- Avoiding having their photo taken, school photo day or family photos
- Shying away from speaking in class, going up to the board or giving presentations
- Cancelling meet-ups with friends at the last minute, not going to birthday invitations
- Avoiding eye contact, lowering their head while talking
- Spending a very long time in front of the mirror or, on the contrary, never looking in the mirror at all
- Constantly picking at, squeezing or pulling at spots
What these behaviours have in common is that they bring relief in the short term. When the young person does not have their photo taken or does not go to the meet-up, they avoid the embarrassment of that moment. In the long term, however, these avoidances strengthen the belief "I can't be around people looking like this", and the young person's world gradually shrinks.
Picking at spots is a subject that needs separate attention. For some young people, it can turn into a hard-to-stop behaviour done without awareness in moments of anxiety or tension, and it can leave marks on the skin. We have covered repetitive behaviours of this kind in more detail in our article on skin picking.
Sentences Families Say Without Realising
Parents often comment on a young person's spots with good intentions. But some sentences can unwittingly deepen the young person's shame:
- "It's not even noticeable; you're exaggerating." This sentence is meant as comfort, but it can make the young person feel their feelings are not being taken seriously.
- "I told you not to eat chocolate." Linking acne to a mistake on the young person's part adds guilt on top of shame.
- "You can't be washing your face properly." Comments implying poor hygiene can lead the young person to feel "dirty" or "careless".
- "Come here, let me squeeze that." Touching a young person's face without permission can both damage the skin and violate their bodily boundaries.
- "We had it in our day too; it'll pass." This sentence is true, but it can belittle what the young person is going through today.
Beyond parents, comments from relatives and acquaintances also add to the young person's burden. A neighbour met in the lift asking "Oh, what's happened to your face?" may stay on the young person's mind all day. A parent standing by the young person in such situations, for example by politely changing the subject, shows them they are not alone.
Then there is the parent's own history. A mother or father who had a hard time with acne in their own adolescence may feel their own shame again when they see the same picture on their child's face, and may intervene too much out of that anxiety. Conversely, a parent who never had such a problem may find it hard to truly understand what the young person is going through. Noticing your own experience makes it easier to tailor your reactions to the young person's needs.
How Can You Support Them as a Parent?
Listen without belittling the feeling
Saying "This is really upsetting you, isn't it?" instead of "You're exaggerating" lets the young person feel their emotion has been seen. Often a young person wants to be understood before the problem is solved.
Stop commenting
Commenting on a young person's skin every day, even with good intentions, makes them feel constantly watched. Not talking about their skin unless they raise it themselves shows them that they are in control of this matter.
Plan specialist support according to the young person's wishes
If the acne is noticeable, leaving marks or affecting the young person's life, it is appropriate to see a dermatologist. Treatment options are decided by the doctor according to the young person's skin and situation; products found online or recommended by friends can damage the skin. Planning the appointment for a time the young person wants, and asking their opinion too, makes them part of the process.
Make their non-appearance qualities visible
Noticing and naming the young person's effort, their sense of humour, their loyalty to friends, a picture they made or their determination in a match reminds them that their worth is not limited to their face. Feedback of this kind widens the way the young person sees themselves.
Talk about social media
Talking with the young person about filters, editing apps and lighting helps them notice that the faces they see on screen do not reflect reality. Asking how the accounts they follow make them feel supports them in consciously curating their own feed.
Keep daily skincare simple and in the young person's hands
Once the care routine recommended by the doctor is clear, it is important to leave keeping track of it to the young person. A parent asking every evening "Did you put your cream on?" turns skincare into the parent's project rather than the young person's. Practical arrangements such as a shelf in the bathroom where the young person can keep their own products, or changing pillowcases often, are quiet but concrete support. Keeping the routine simple matters too; trying lots of products one after another can both irritate the skin and keep the young person's mind constantly occupied with their skin.
Instead of telling a young person "You can hardly see your spots", saying "Spots or not, you're still you" is the first step in making their worth independent of their appearance.
For the Young Person: When Acne Shakes Your Self-Esteem
This section is also written for young people reading this article. If you too are finding it hard to look in the mirror, it may help to try the following:
Notice what you are avoiding. What have you stopped doing lately because of your spots? Having your photo taken, meeting friends, speaking in class? Writing these down lets you see how much room acne has taken up in your life.
Take it back in small steps. Start with the easiest of the things you have been avoiding. Perhaps first meeting a close friend, then putting your hand up once in class. Each step strengthens the feeling "I can do this" a little more.
Pay attention to the way you talk to yourself. What sentences go through your mind when you look in the mirror? When thoughts such as "I look disgusting" or "Everyone is staring at me" come up, think about whether you would say this to a friend. Try not saying to yourself something you would not say to a friend.
Balance your mirror time. Staying in front of the mirror for a long time, examining your spots and assessing each one individually makes them even bigger in your mind. Keeping mirror time short while getting ready in the morning, and not checking frequently throughout the day, may help.
Tell someone you trust. When acne weighs this heavily on your self-esteem, keeping it inside makes the load heavier. Telling a friend, your sister, your brother, your mum or the school counsellor how you feel lets you realise you are not alone. Finding out that many people, perhaps even the person you are talking to, went through the same stage can be surprisingly comforting.
Remember: what is most visible to you is often a detail others do not notice. Your friends are most likely so busy with their own appearance that they do not notice yours as much as you think.
If you feel that your feelings about your body are not limited to acne, our article on body image may offer you new perspectives.
When Should You Seek Professional Support?
Shame about acne usually fades as the skin improves and the young person grows older. However, consulting a professional may be useful in the following situations:
- If the young person refuses to go to school or is frequently absent because of their acne
- If they have markedly withdrawn from friends and social activities
- If they spend hours in front of the mirror, or thoughts about their appearance take up most of their day
- If, although the skin condition is mild, the thought of a "flaw" in their appearance has become intense and unshakeable
- If picking at spots has reached a level that causes wounds and scars on the skin
- If there is marked low mood, hopelessness or an increase in negative things said about themselves
These signs do not on their own mean a diagnosis; but they show that what the young person is going through is heavy enough to deserve a conversation with a professional.
How Are Acne-Related Self-Esteem Difficulties Addressed in Therapy?
In therapy, the aim is not to get rid of the acne but to loosen the link between the young person's view of themselves and their appearance. In the counselling for teenagers process, work may focus on the following areas:
Avoidance and safety behaviours: In the Cognitive Behavioural Therapy approach, the avoidances the young person uses to cope with shame, and safety behaviours such as covering their face, are identified. These behaviours are reduced gradually, at a pace the young person is ready for; in this way the young person experiences that the situations they fear do not turn out as badly as they expected.
Examining thoughts: How far thoughts such as "Everyone is looking at my spots" or "Nobody will want to be friends with me looking like this" match reality is assessed together.
Deeper beliefs: In some young people, shame about appearance is connected to beliefs formed earlier on, such as "There is something defective about me" or "I won't be accepted as I am". From a schema therapy perspective, the origins of these beliefs and their effect on the young person's life today can be addressed.
Self-compassion: The young person learns to develop a gentler, more understanding inner voice. This helps them support rather than judge themselves at difficult moments related to their appearance.
Working with the parents: With the parents, work focuses on comments about the young person's skin, conversations about appearance at home and how the young person can be supported.
Frequently Asked Questions
Will self-esteem recover by itself once the acne clears?
In many young people, shame decreases as the skin improves. However, avoidances and negative thoughts that became established during the acne period can continue after the skin has healed. That is why it is important to see the young person's emotional burden alongside the skin treatment.
Should I let my daughter wear make-up to cover her spots?
For some young people, make-up is a tool that helps them feel more comfortable. It is important to choose skin-appropriate products in consultation with a dermatologist. However, if the young person reaches the point where they cannot go anywhere without make-up, this may indicate that the shame is deepening.
Can my son be affected by his acne this much too?
Boys can be affected by their acne at least as much as girls; but they may find it harder to put it into words. Sentences such as "A real man doesn't care about that" lead a young person to hide their feelings. It is important that your son knows he too can talk about this.
They don't want to go to school because of their acne. Should I let them stay home?
A single day off may be a relief in the short term; but when it is repeated, it strengthens the cycle of avoidance. Taking the young person's feelings seriously while planning small steps together that support them in going to school, and working with the school guidance service and a professional if the problem continues, is more helpful.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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