You know the classic nightmare where you’re in school and you have to present to the class, only to stand up and realize you’re naked? When you have adult acne, that’s pretty much what it feels like every day at work—at least emotionally. I personally can’t shake the feeling that everyone is staring at me—judging me—over my constant breakouts, which leaves me feeling anxious and exposed.
I've suffered from acne since middle school, and I have been told I’ll grow out of it my whole life. At 23, I’m not quite what I would consider a grown-up (by dermatologists’ standards, 26 is considered "adult"), but I’m certainly no longer a teen. The thing is, you wouldn’t know it by looking at my face and the smattering of whiteheads and red angry bumps that usually line my jaw, chin, cheeks, and forehead.
I’m not alone. While acne is commonly thought of as a teenage skin problem, acne among adult women has skyrocketed in recent years. According to a 2018 review, anywhere between 12% to 22% of women ages 26 to 44 experience acne, which is a significantly higher percentage than that of adult men (around 3%). Meanwhile, a 2012 study by the American Academy of Dermatology puts that estimate higher for 20-somethings: It found that acne affects more than 50% of women between the ages of 20 to 29.
While dermatologists aren't exactly sure what is causing this epidemic (I’m not the first to call it that), they assume it could be related to anything from diet to increased stress to, most likely, hormones. What experts can confirm, though, is that the disease (yes, it's technically a disease) has an extremely negative effect on all areas of our lives, particularly at work.
Anyone who's had a pimple can tell you that acne impacts self-esteem, but it goes far beyond vanity. “We know there’s a link between acne and depression, specifically with women,” says dermatologist and Proactiv partner Rachel Nazarian, M.D. Case in point: A 2018 study in the British Journal of Dermatology revealed that patients with an acne diagnosis have a 63% higher chance of developing depression compared with those who don’t. “I see a lot of people suffering from acne and psyche issues related to acne," says Matt Traube, a licensed clinical therapist specializing in psychodermatology, a field of psychology that examines the connection between our emotions and our skin. "I can’t tell you how many people call and say, 'I have a little acne, and I feel like I can’t go out for a job interview, a date, or to socialize.'"
The effects of acne can take a huge toll on our overall well-being. “The psychological burden that comes with acne has actually been compared with other systemic diseases including epilepsy, asthma, diabetes, and arthritis, in terms of the kind of burden that it takes on your own quality of life,” says Nazarian. She notes that the severity of the acne has no impact on the intensity of depression, and says these feelings can last much longer than the acne itself, similar to post-traumatic stress disorder (PTSD).
Part of this burden comes from the actual acne itself. “Our self-confidence is intimately connected to our complexion,” says Keira L. Barr, M.D., founder of Resilient Health Institute. “When your skin looks better, your sense of confidence improves exponentially. When it's riddled with red, inflamed, and painful acne lesions, your sense of self and self-esteem can plummet.”
It's something Nicole Watson, a 37-year-old marketing director from Austin, knows intimately. “The worst part about acne is that it's on your face,” she says. “It's the one place you can't hide. It's the first thing you see when you look in the mirror and where people look when they communicate with you.” She adds that when her acne was at its worst, she would often cry because of her skin, and it left her confidence destroyed. "I've always been a confident person, but acne was the one thing that could strip that away with just one bad breakout. I didn't want to bring attention to myself, and I've not wanted to go after promotions because my confidence was lowered due to being so self-conscious about my skin."
While teens with acne also experience depression, it’s particularly difficult for adult women. “Many women feel that their skin is ‘the enemy’ and is sabotaging them when it breaks out or flares up, especially before a big event or presentation,” says Barr. “Viewing their skin from this lens, they feel a sense of helplessness or loss of control because they don’t understand why it’s happening and what to do about it, which can contribute to a sense of shame, feel overwhelming, and add stress.”
This stress often snowballs, and women are left blaming themselves for their skin problems. “It makes me feel like everyone is going to judge me or assume I neglect myself—especially as a plus-size woman with acne, it's like a double whammy," says Kaitlin, a 25-year-old marketing analyst from Columbus, Ohio. "It almost screws your sense of self and self-esteem because you start to question if it is completely your fault or if our bodies are sometimes just complicated.”
Aside from the known effects depression can have on your work life (including a decrease in productivity and loss of interest), lower levels of confidence can affect your career. The experts I spoke to say they've met women in executive positions who already feel more pressure being one of the few females at the C-suite level—when their skin breaks out, it contributes to a feeling of inadequacy. Traube says he's been told things like, "Well, they’re looking at my acne, nobody’s going to take me seriously," or "How am I going to sound smart when I look this way?”
Personally, I experience similar feelings, even at an entry-level position. As someone who is already the youngest in the office, I'm constantly trying to prove I belong in such a competitive field. I get extremely flustered in meetings, even one-on-one with my boss, and manage to convince myself no one cares what I have to say because they're too busy looking at my skin. Of course, I know this isn't the case in reality. But the fact remains that I'm in a job where networking is crucial, and I often hold myself back from making meaningful connections because I’m too embarrassed about my skin.
Randi, a 38-year-old attorney from New York City and patient at Spring Street Dermatology, can commiserate. "You’ve prepared, you have your presentation, you’re really confident in what you’re about to say. You pick out your power suit, but your acne just feels like a distraction," she says. "It's a distraction from the presentation, that, rightly or wrongly, people are focusing on the imperfection on your face as opposed to the material that you're presenting. I think it’s highlighted even more when you’re in a one-on-one meeting and you're close to somebody." She adds that she'll often style her hair in a way to cover breakouts or even make jokes about it, "just so they know I’m aware that it’s distracting."
Megan McIntyre, a 36-year-old freelance writer and former beauty director, says her acne held her back from branding herself as a beauty personality, which, over the past few years, has become a crucial part of getting ahead in media. “There's always this self-doubt in your head about if you belong in [the beauty] industry if you don't look a certain way,” she says. “That only got worse with this expectation of editors to be influencers. I hated showing my face in pictures, and I soon found that I wasn't as visible as my colleagues. Whether it was true or not, I told myself I wasn't being brought to key meetings and events because I wasn't a good representation of my publication—they didn't want people to associate me and my horrible skin with the brand. It made me miss out on the visibility many directors find themselves achieving and furthering their careers.”
She adds that her bad skin also made her feel like a fraud—a thought that has passed through my own head countless times—especially around industry pros. McIntyre says she went from “focusing on totally crushing it" at her job to "being mortified" that her skin was distracting to the experts and execs she was interviewing.
It’s already hard enough to be a woman and taken seriously at work, but many report they feel as if they're being underestimated due to their breakouts. “I've never had anyone say anything about it, but I constantly wonder if some people don’t sign with me because of how I look,” says Stephanie D. McLeester, a 29-year-old attorney in Phoenix. She says she never wore makeup when she was in law school, but her first thought after passing the bar exam was "I should buy some foundation."
Most of the women I spoke to feel like they already look young, and acne gives them a straight-out-of-college appearance that doesn’t line up with their experience. “I tend to be mistaken for an assistant,” says Kaitlin, while Rachel Ridinger, a 25-year-old-hairstylist in Deptford, New Jersey, has had a client insist she was "fresh out of school" and didn't want her touching her hair. (Ridinger has eight years of experience.)
In addition to the shame and missed opportunities, acne takes a lot of time. A 2016 brief by the American Academy of Dermatology revealed that acne has an opportunity cost of $398 a year per person in lost productivity—a figure they totaled based on the amount of working hours spent at the dermatologists’ office, not including the cost of the visit itself. (And that doesn't even begin to figure in the amount of money women with adult acne spend on serums, zit creams, and expensive facials to care for their skin.) Nazarian says she has a list of women she'll fit into her schedule, no matter what, for emergency visits or cortisone injections (to bring down pimples) before big meetings, and she'll often see them during work hours. She also notes many of her patients tell her they will work from home when they're experiencing worse breakouts than usual, which also isn't a great way to further your career. Similarly, a 2014 study on the burden of female acne found that of the women surveyed (between 25 to 45 years old), 12.3% had missed out on going to school or work due to a breakout in the past four weeks alone.
There’s also the simple time suck it takes to cover your acne each morning. Instead of going through my thorough foundation and concealer routine, I could spend that extra 30 minutes sleeping in or getting a jump start on my work for the day. It takes not only my physical time but so much mental energy. The same 2014 study as above found that almost half the women surveyed had difficulty concentrating at work “some” or “all of the time.” Ridinger says, "When I'm with clients, I sometimes catch myself looking in the mirror, fixated on the newest pimple I'm trying to cover up." I often wonder how much time I waste thinking about my skin or checking a zit at my desk, and then spiraling over if I’ll ever look "professional" enough.
I wish I could end this on a more hopeful note, but the reality is, unless a one-size-fits-all miracle cure is invented, acne is something many of us will have to deal with. The good news is, as a movement to embrace acne is starting to rise, women are working to take back the shame from their breakouts.
"Having adult acne has definitely made me feel insecure," says Lisa, a 28-year-old digital marketer from Champaign, Illinois. "But I'll never let my acne hold me back from anything I want to do—whether I have makeup on or not. My acne is not my years of experience, my background, or my work ethic. It doesn't reflect any of that."
It's a good mantra for the rest of us to remember.
Bella Cacciatore is the beauty associate at Glamour. Follow her on Instagram @bellacacciatore_.
