Genetics also plays a role in determining who is at risk of developing acne. Experts agree that acne seems to run in families and that there seems to be a direct link between the development of severe acne and familial patterns. Experts are unsure why this is so, since an acne gene has not yet been discovered. However, a number of studies have shown that genetics does play a role in determining how likely a person is to develop acne. Various studies of identical twins, for example, found in over 50 percent of all cases that if one twin develops acne so does the other. Correspondingly, other studies have shown similarities among parents and children regarding the types of acne lesions, the severity of acne, and the duration of acne. A patient with acne explains: “I inherited it [acne] from my mother, and she’s always telling me that she had the exact same thing and that it will go away. I am mad that I inherited it from her.”

No matter who gets acne, acne can have a long-lasting physical effect. Acne lesions can leave permanent scars on an acne patient’s skin. When a clogged hair follicle becomes infected, and the body sends white blood cells and powerful chemicals to combat the infection, swelling causes tissue around the infected follicle to be damaged. In many cases, once the infection is gone, the tissue is too damaged to return to its normal state. This damage appears in two distinct types of acne scars, scars caused by increased tissue formation and scars caused by tissue loss.

Scars caused by increased tissue formation are called keloid scars. Keloid scars form when the skin responds to tissue injury by producing an excess of collagen, a substance that helps the skin regenerate. Too much collagen causes the production of excess tissue Page 22 to form over the damaged area. The results are keloid scars, which look like firm, shiny, flesh-colored lumps.

Acne scars that are caused by tissue loss occur when the body is unable to completely rebuild damaged tissue. Often called depressed, ice-pick, or pitted scars, these scars look like the skin has been pushed in, forming a soft depression with puckered edges. Pitted scars can be quite small, or they can be over a centimeter in diameter. Pitted scars are the most common type of acne scar and are commonly found on the face, back, and shoulders.

Fortunately, not every person who has acne develops acne scars. Doctors are unable to predict accurately whether or not a person with acne will develop scars. However, in most cases, as the severity of a person’s acne increases so does the amount of tissue damage. Since acne scars result from damaged tissue, individuals who suffer the most tissue damage are most at risk of developing acne scars. Generally, these are individuals with severe cases of acne.

Even when acne does not cause permanent scars, because acne affects a person’s appearance it can take an emotional toll on a person. People with acne often feel self-conscious about their appearance. Over time, their self-esteem and self-confidence decrease. This makes them feel insecure and anxious in social situations. In fact, many people with acne avoid social situations due to self-consciousness about their appearance. Indeed, many become shy and withdrawn. A young man explains: “I’ve lived with really heavy acne for the last five years. I feel so self-conscious that I don’t even like going out. It’s ruined my confidence.”¹⁶

The combination of low self-esteem, embarrassment, and increasing social isolation leads many people with acne to become depressed. When people are depressed, they often lose interest in daily activities and feel tired, anxious, and unhappy. Some may contemplate suicide. In fact, according to a 2002 survey by the Acne Support Group, a British organization that helps acne sufferers, 15 percent of the acne patients surveyed reported feeling suicidal, and 75 percent reported feeling depressed because of acne. An acne patient describes how acne-caused depression affected her: “I did not Page 23 look in mirrors whatsoever. I walked into a room and immediately shut out the light. Everything I did, I did in darkness because any time I caught a glimpse of myself I felt suicidal.”¹⁷

Truly, many people with acne bear both emotional and physical scars all their lives. A former acne patient explains:

It’s easy to see the scars on my back and neck. What you can’t see is what it did to me inside. I went from a fairly self-confident kid to an angry, withdrawn, and embarrassed teenager. Even today, the memories of the teasing and the embarrassment are quite vivid. It makes me queasy just to think about it. Even when the pimples are gone, acne stays with you a long time.