If you have liver disease or heart disease, it's between you, your doctor, and your god. But skin disease is out there for the world to know about. You live with a constant reminder that there's something not quite right. Kids use body language to express their feelings. They might wear caps or have their collars turned up. Putting their hands on their face or covering their face is also common. I think those are clues that the acne is bothering them.
Appearance is a huge issue. Our culture worships beautiful people. You don't ever pick up a magazine and see someone with acne or rosacea unless it's a medical journal and it is in the context of diagnosis or treatment. We have many good drugs and products that can help kids with acne. And not only do we know more about the drugs, we also know more about the pathophysiology of acne, thanks to giants in the field such as Peter Pochi, John Strauss, Alan Shalita, and Jim Leyden. These are people who devoted their careers to better understanding acne and its treatments. I see kids with bad acne in the malls and in the grocery stores, working as clerks or carryout. I wish I could let them know, somehow, that we've got really good treatment for them, especially if they are obviously trying to cover up their acne. You look at all the body signals. Some of these kids are not depressed, but they still don't like their acne.
I have yet to have a teenager say "Yeah, I have acne and I like it!" I've never had one say that he or she wants to keep it. The best thing about acne is that it is a disease about which we can now say, with confidence, "We can get you better." We can't say that about every disease, but with acne we can almost always get the patient better. In some of these kids, there will be improvement within a month, but they never complain if they get better quicker.
This avoids disappointment. We dermatologists and our patients really are blessed with effective medicines for treating acne. The psychological impact of acne can be devastating, particularly for the young patients who are most susceptible to this extremely visible disease. Dr. Jan Hornets has lectured nationwide on the effects that acne can have on self-confidence and self-esteem. I educate them about basic skin care, explain how their medications work, and try to impress upon them the importance of compliance. I usually tell them, "It doesn't matter what I do. If you don't help, we can't get you better." I have them share responsibility. It is particularly important for teenagers to agree to a shared responsibility. The agreement must be between the patient and the doctor, not the doctor and a parent.