Inquiro Volume 13

Prachi Patel

Introduction

Acne vulgaris is a common skin condition that impacts millions of adolescents (ages 10 to 19) worldwide. Szepietowska et al. (2022) explain that over 90% of adolescents and young adults suffer from acne at some point in their life (p. 6816). While acne most commonly localizes to the face, it often also occurs throughout the body in regions such as the back, chest, and trunk (p. 6816). Although acne is oftentimes considered a temporary and cosmetic condition, it can have substantial psychological and social impacts (p. 6818). Adolescence is a developmental period in which one’s appearance and social belonging plays an important role in identity formation (p. 6816). As a result, while acne may be common among adolescents, many studies indicate that adolescents feel discouraged or embarrassed as they begin to develop acne.

Adolescents also use social media platforms that heavily emphasize appearance and unrealistic beauty standards (Baloglu & Akin, 2024, p. 1). Increased exposure to filtered images may further increase appearance-based comparisons and feelings of insecurity for adolescents suffering skin conditions such as acne (p. 2). Therefore, understanding how acne-related stigmatization relates to adolescents’ social media usage is an important topic of study.

The research question guiding this review is: How does stigmatization associated with acne influence social media usage and psychosocial experiences among adolescents?

This paper is a narrative review intended to synthesize emerging literature to examine the relationship between acne, adolescent mental health, and social media usage. This study aims to integrate findings to identify common themes regarding stigmatization, treatment-seeking behaviors, and the role of digital environments in shaping adolescents’ perception of acne.

Acne and Mental Health in Adolescents

Szepietowska et al. (2022) defines “stigmatization” to be a “discrediting mark” that isolates individuals and “hinders interpersonal relationships” (p. 6815). Szepietowska et al. found that in a cross-sectional study of 730 high school students, 58% of the adolescents questioned faced feelings of stigmatization regarding the subject of acne and felt uncomfortable staring at their peers’ imperfect skin and not feeling attracted to acne students (p. 6817). The adolescents with acne reported notably higher levels of stigmatization as they were most concerned regarding their peers’ opinions of their skin (p. 6818). There was also a notable gender difference between feelings of males and females as 65.7% of females reported feelings of stigmatization compared to 44.8% in males (p. 6817).

While research regarding the mental health of adolescents facing acne is still limited, studies have found that acne can not only lead to feelings of stigma, but also adversely affect how they view themselves as individuals and thus act out in response. For instance, a quantitative correlational study was conducted by researchers at the University of Maragheh in Iran where adolescents with varying levels of acne severity completed assessments that measured self-concept, self-esteem, and perfectionism (Afshari et al., 2017, p. 433). Statistical analysis found that adolescents with more severe acne had a lower self-concept, lower self-esteem, and more perfectionistic behaviors, suggesting that acne severity can contribute to increased psychological distress (p. 433). The researchers stated that these behaviors can lead to those with severe acne having high self-expectations regarding their body image and may face difficulties asking for help, secluding themselves from their loved ones (p. 434). Therefore, pediatricians can recognize that as patients begin developing acne, they may feel poorly about their appearance. Hence, while assessing them, they can establish realistic expectations to ensure adolescents do not feel worse about themselves and help to prevent perfectionistic standards that may lead to eventual harm. Additionally, if patients express depressive or anxious behaviors from their acne, referrals to therapists can be made to help adolescents grapple with these changes.

A 2020 survey-based, observational Albanian study found that one of the major causes of acne stigmatization is the lack of education and discussion surrounding it (Savo et al., 2020, p. 2). The study used structured questionnaires to investigate adolescents’ understanding of acne and found that 21.3% adolescents do not understand whether acne is contagious or not with males being notably less educated than females (p. 2). The study also discovered that less than 18.5% of these adolescents tried seeking professional help from a dermatologist, using their friends as treatment resources instead (p. 2). It is important to keep this research in mind when assessing patients because they likely do not have a complete understanding of the root causes of their acne. However, they may also not be a blank slate because they may have consulted non-professional sources that influence their skin treatment approach. As a result, the impact of the stigmatization surrounding acne on adolescents suffering from acne and their treatment sources is a significant topic.

Adolescents are the primary age group that suffer from acne and are facing significant body image issues that negatively impact their mental health and overall development (Poli et al., 2011, p. 534). An observational study conducted by Poli et al. studies how adolescents perceive and are impacted by acne (p. 534). The study finds that many adolescents consider acne to be a “physiological event of adolescence” that they face due to puberty but still let it suppress their daily relations with others until they find a cure (p. 534). Overall, this study highlights that acne influences adolescents’ perception of themselves and their urgency to treat their skin. However, there remains a notable gap in research regarding how social media information impacts adolescents’ skin treatments.

Rise of Social Media

According to a 2024 large-scale population data study in the Journal of Health, Population, and Nutrition, over 5.16 billion (64.4%) individuals worldwide use the Internet or other social networking sites (Toklu Baloglu & Caferoglu Akin, 2024, p. 1). Researchers saw that with technological access being increasingly widespread, most people can use their personal or public devices to easily access the Internet (p. 1). Social media is notably more prevalent in adversely affecting the mental and physical health of users, especially as they get more addicted to it (p. 2). While the Internet and social networks can be used for entertainment purposes or to connect with others, they are increasingly becoming many individuals’ primary source of information (p. 2).

Influence of Social Media on Patients Suffering from Acne

Physicians and non-physicians alike share informative videos on social media with varying levels of credibility that can influence acne patients to pursue certain treatments. A 2022 cross-sectional content analysis Turkish study systematically reviewed YouTube videos made by both physicians and non-physicians using standardized quality metrics and engagement indicators to determine the correlation between credibility and video quality and viewer count (Kaya & Solak, 2022, p. 167). The study found that the videos made by non-physicians consistently had larger viewer count, likes, and viewing rate than physicians, despite the lower score in quality of information they contained (p. 167). Kaya and Solak hypothesized that this is likely due to the frequency of video uploading and personal relatability being greater in the non-physician-produced videos than the physician-produced videos (p. 168). Additionally, the content discussed in these videos somewhat differed as the physicians primarily focused on medical methods for treating acne while the non-physicians incorporated temporary, costly cosmetic procedures that made skin seemingly flawless (p.170). The study also found that women watched these viewers at a substantially greater rate than men, which correlates to their expected outcome of women having a generally lower self-concept than men with regards to body image (p. 168). Overall, this study establishes the concept for doctors to realize that their patients may be gaining sources of information with less credibility and may not have the best understanding of their skin condition.

Furthermore, the literature published in a 2021 survey-based observational Turkish study published by the Journal of Cosmetic Dermatology found that patients’ socioeconomic status can influence their social media usage to gain treatment information (Aslan Kayiran et al., 2021, p. 2558). Patients completed questionnaires regarding their income levels, social media usage, and sources of treatment information (p. 2558). The study showed that most patients using social media sites to learn about acne vulgaris (one of the eight most searched dermatological conditions on social media) had a monthly middle-class family income ranging from $350 to $1300 (p. 2558). Approximately 72.96% of the patients in this study comprised this economic range, corresponding with societal structures having a vast middle class (p. 2558). This middle-class economic range is logical as individuals making less than $350 may not have access to social media and may prioritize necessities over their skin condition (p. 2562). Furthermore, researchers in the study argue that those making over $1300 have a higher tendency to visit healthcare professionals and seek personalized care instead of relying on others’ experiences on social media (p. 2562). As a result, this study highlights that most patients who gain acne information from social media belong to the vast middle-range socioeconomic class.

While some of the patients in the 2021 Turkish study contacted dermatologists or other healthcare professionals, the majority of these patients tried to self-diagnose their treatments via one of these sites to see if that could fix their skin before seeking professional help (Aslan Kayiran et al., 2021, p. 2559). A noteworthy result in this study was that the social media accounts of dermatologists offering personalized skincare recommendations were trusted by 16.2% of patients, and more than 44.5% of patients reported to feel more comfortable with an in-person consultation (p. 2561). The researchers indicated that the patients believe digital information to be less credible than physical appointments regardless of the credibility of the influencer; therefore, having physicians share credible information online might not be the optimal solution to promote skin well-being (p. 2562). As Kaya and Solak (2022) found bright, misleading advertising to be more popular among individuals seeking treatment information, dermatologists offering skincare recommendations may seem less promising (p. 167). Researchers conclude that patients trust others sharing their acne journeys online more than unfamiliar dermatologists because they believe the acne patients can empathize with them better and provide effective feedback (p. 167). Thus, when providing acne care to patients, in-person discussions may be more beneficial for doctors to connect with the patient and provide quality care.

A 2019 qualitative content analysis study in the Journal of Communication of Healthcare found that social media posts can also influence patients to purchase products that may not be suitable for their skin (Chansiri et al., 2019, p. 73). Researchers found that recommended search algorithms favored overly positive or negative posts, leading the cautious ones that discuss potential side effects to get overshadowed (p. 73). The study examined discussions surrounding isotretinoin – an acne prescription drug that bears severe side effects for mental health and pregnancy – to analyze misinformation trends on Acne.org and Reddit.com (p. 71). A total of 50 posts were studied to find that 76.3% of discussions made claims of self-efficacy with only 23.7% of these posts having some hesitancy in their ability to use isotretinoin (p. 73). The study indicated that this might be due to acne sufferers already facing large societal stigma and not wanting to seem weak for being unable to make certain treatments work for them (p. 75). As a result, these misleading posts serve as a form of misinformation that can influence patients to believe in unsuitable medications for their skin.

Approximately 22.6% of discussion posts also expressed dissatisfaction with isotretinoin regulation and prescription in the United States as many dermatologists can be hesitant to prescribe it (Chansiri et al., 2019, p. 73). However, these posts claimed that isotretinoin would be the only cure for their acne and placed blame on the dermatologists for advising against it, making healthcare professionals seem dismissive of skin-related concerns (p. 73). Posts claimed a need to take matters into their own hands by “buying it online” (p. 73) instead of getting a safe, regulated prescription from their dermatologist. The researchers explained that these types of posts can lead media-browsing patients to perceive isotretinoin as the optimal cure for their acne with users constantly promoting it, avoiding discussion of its potential side effects (p. 75). As a result, when patients come for wellness check-ups, encouraging them to avoid misinformation from these posts can be beneficial to their overall health, extending beyond skin-related concerns. Additionally, the researchers suggest that if patients do request medications like isotretinoin that have serious side effects, doctors can inform patients of these effects prior to prescribing the medication to counter any misinformation spread from the posts that may have encouraged them to come ask for it (p. 75). Overall, misinformation from videos and posts can spread and mislead acne patients to believe in a treatment that may be ineffective for them; however, doctors can play a role in reducing the spread of misinformation by explaining potential effects of medications and providing more personalized alternatives for their patients.

Focusing on Adolescents

Toklu Baloglu and Caferoglu Akin (2024) analyzed population-level data on the Internet and social media usage and found that while social media can influence patients of all ages to pursue a certain treatment, it has more adverse impacts on adolescents (p. 1). The researchers explained that adolescents’ extensive technological usage has led them to be more prone to social media addiction than other age groups, leading to detrimental consequences such as mental health issues and depressive behaviors (p. 2). Hence, the constant social media usage coupled with the mental health issues adolescents face from the stigmatization of acne makes adolescents the most impacted demographic to study as they suffer from acne (Poli et al, 2011, p. 534). Since acne education is not commonly taught and the stigma surrounding it is so large, adolescents often desire to immediately fix their skin using the most convenient treatment source available to them: social media.

Figure 1: Information-seeking Behaviors and Acne Management before Visiting Skin Clinic

This figure depicts various treatment-seeking behaviors displayed by patients suffering from acne in a 2020 Journal of Cosmetic Dermatology study (Wisuthsarewong et al., 2020, p. 1194).

Figure 1 shows that 36.8% of patients used digital media sources and 54.6% tried to manage their acne with over-the-counter drugs and vitamins (Wisuthsarewong et al., 2020, p. 1194). The study recorded that websites were the most frequently recorded source of information when patients used digital media (p. 1194). Wisuthsarewong et al. emphasize that adolescents rely greatly on external sources that influence their skin treatment like public data (p. 1194). However, this information can be “erroneous” (p. 1194) and lead patients to procure ineffective treatments that at best provide a temporary solution. Figure 1 is important for pediatricians to keep in mind as many of their patients may have sought out forms of acne management from various sources of information beforehand that could frustrate them as they may not work. Hence, when prescribing skin treatments (in milder cases) or referring to skin specialists (in more severe cases), pediatricians can ask their patients which treatments they have already tried to gain a more complete understanding of the patient’s history.

Social and digital media usage was also correlated to the severity of acne that adolescents faced. A 2023 observational study in the Journal of Cosmetic Dermatology found that 73.5% of parents of adolescents with severe acne were likely to take them to seek professional treatment and contribute financially as opposed to the 56.8% of parents whose adolescents faced mild or moderate acne (Ballanger et al., 2023, p. 4). The researchers found that younger adolescents are also the most likely age group to use digital media to search for acne treatments and indicated that this may be accredited to their lack of knowledge regarding acne as they are in the early stages of it being mild (p. 3). This study differs from the rest in that it specifically examined the effects of truncal acne on adolescents – a form of acne that presents mainly in women on the back and chest and can be more severe in terms of appearance and pain (p. 1). The researchers found that female adolescents disproportionately used social media sources more than male adolescents, due to their findings of women being more likely to seek “beauty and health-related information from ‘influencers’” (p. 6). These female participants emphasized their mental health issues from truncal acne as they faced significant discomfort, discouragement, and even “selected their clothing accordingly” (p. 6). It is important that pediatricians understand how adolescents respond to societal pressures so that their patients are not emotionally or physically distressed and could refer the adolescent to psychological professionals along with the skin treatment. It is easier to pursue preventative care than have a larger issue develop and have to treat it afterwards, so pediatricians can contribute by implementing consistent mental health check-ins with their patients to ensure overall well-being when assessing them.

Overall, while limited research exists regarding the impact of stigmatization of acne on adolescents’ treatment sources, the existing literature discussed previously have outlined that social media has become increasingly used as a treatment source especially in younger adolescents and females over healthcare professionals. While socioeconomic status and parental support have been found to be external factors that influence treatment sources, the mental health of adolescents due to the societal stigmas surrounding acne are still a leading cause for increased digital media usage as adolescents are desperate to fix their appearance.

Methodology

A total of 22 major searches were conducted for this review. While databases such as Dermatology AccessDxRxand PubMed were searched, they yielded mostly generic dermatology textbooks and isotretinoin-based articles. Instead, Academic Search Premier served to be the only and optimal database to delve specifically into the intersection of acne in adolescents and social media influence. The most common relevant journals related to this topic included the Journal of Cosmetic Dermatology, Acta Dermato-Venereologica, Journal of Health, Population, and Nutrition, Dermatologic Therapy, Journal of the Fundamentals of Mental Health, and Journal of Communication in Healthcare. Key terms like “acne,” “social media,” “adolescents,” “treatment,” and “mental health” found the most relevant sources. Searches were then further refined using more targeted combinations such as “acne AND adolescents AND social media,” “adolescents AND isotretinoin,” and “gender AND acne.” These narrower searches were used to explore psychosocial and treatment-related factors that can influence adolescent experiences with acne.

Selection criteria required the source to be from a peer-reviewed academic journal with full-text access at UAB, if not already in pdf form. Sources were not directly filtered by date as existing research regarding the intersection of adolescents, acne, stigmatization, and treatment sources is already very limited, but sources prior to 2010 were not included. Because limited research directly addresses the intersection of acne, stigmatization, and social media usage, inclusion criteria were intentionally broad. Articles were included if they addressed at least two of the following themes: acne, adolescents, or social media usage. Particular attention was given to identifying each study’s research design, sample population, and reported statistical findings (including percentages, correlations, and significance levels when possible) to better evaluate the strength of evidence discussed in the review. An intersection of acne and mental health-related research began getting researched from 2005 onwards. However, an intersection of social media and acne primarily had significant research from 2019 onwards, likely due to its increased usage during the COVID-19 pandemic.

Because there were only a couple of sources centered around adolescents, a broad-to-narrow clustering approach was adapted to first focus on the impact of stigmatization on acne patients of all ages on their treatment sources to then focus on only adolescents. Additionally, an external source that broadly described the impact of social media on adolescents’ perception of body image was used to broadly contextualize why adolescents are the most affected age group from social media. A total of 10 sources were used, with the other nine pertaining directly to acne patients and their perception of acne or possible treatment sources. The dates of publication for the articles used ranged from 2011 to 2024.

Discussion

Societal stigma dissuades many individuals from deviating or even discussing deviations from established norms. Because issues like mental health and acne have been stigmatized for hundreds of years, there is limited research regarding both, making examination of the intersection of both topics even more limited. Mental health research regarding body image and acne began taking off over the last couple of decades. The rise of digital media played a key role in influencing this research as many individuals began sharing their stories via these global platforms, demonstrating a need for research in this field to potentially find solutions.

Most of the studies employ methodologies that analyze adolescents’ self-reported perceptions of acne to understand what they believe regarding acne and how it impacts their lives. While their self-reported nature led them to be slightly biased and subjective, the majority of mental health research regarding their understanding of a topic is self-reported. Despite their subjectivity, this self-reported data was still effective as they measured the adolescents’ direct opinions regarding acne in surveys, tests, and phone calls, finding that many adolescents do not have a true understanding of their acne, leading them to turn to social media for information. These findings highlight a significant need for future research in these fields. A couple of the studies used a unique methodology and examined videos and discussion posts instead of people to directly analyze viewer rates and misinformation trends, so these results were more objective and credible. However, while these studies were stronger in their analysis than the self-reported perception studies, these objective studies are not specifically focused on adolescent viewers and cannot definitively determine why the viewer trends exist and how many viewers are impacted by misinformation.

Therefore, the existing literature has depicted a great need for more acne education, especially among adolescents who are vulnerable to social media tactics. While a few programs have begun implementing acne education, it is still very limited, especially in the United States. A French study examining the self-reported perception of adolescents with acne found that adolescents themselves wished for more treatment information from their doctors, even if in the form of “practical leaflets” (Poli et al., 2011, p. 537). This study shows that adolescents are confused regarding how best to treat their skin and need more education regarding the subject from their doctors. Longitudinal studies regarding acne education programs can be established and used to understand whether educating adolescents of the causes and treatments for their acne will combat the effects of social media advertisements. Additionally, various forms of education can be tested to see if open doctor-to-patient discussions are more effective than only handing out educational brochures or if another form of education proves to be more effective.

Another direction future research could take is by measuring more precisely how many adolescents are influenced by social media and purchased products. The existing studies primarily measure adolescent perception of acne and different forms of misinformation that could exist from videos and posts. Hence, future research could investigate how different forms of misinformation can lead adolescents to become susceptible to social media tactics. Additionally, understanding which advertisements are the most misleading could benefit doctors when they examine patient history so that they can watch out for those products when assessing patient history to better understand their skin condition. While the study conducted by Wisuthsarewong et al. (2020) revealed that patients were using social media as a treatment source and seeking forms of acne management through supplements and over-the-counter drugs, it did not quantify how many patients pursued these treatments only due to social media influence. As a result, further research can be done in this field to better understand the direct impact that social media has on which products adolescents purchase for their skin.

Additionally, gender differences affected how adolescents perceived acne and sought treatment in four of the studies (Ballanger et al., 2023; Kaya & Solak, 2022; Szepiotawska et al., 2022; Savo et al., 2020). Females were recorded to be more adversely impacted by acne and sought out more digital sources of treatment than males, but none of the studies deeply examined why this may be (even though some hypothesized females to be more interested in maintaining body image). Hence, further research should be done in the field to examine why females react differently and the impact of societal stigmatization in their response.

While this review examined multiple peer-reviewed studies to explain the impact of stigmatization on adolescents’ acne treatment sources, it also has some limitations. Most research reviews are more extensive and examine over 40 sources whereas this one was limited to 10 studies as it is still a developing topic. Furthermore, because research regarding the intersection of adolescents, acne, and social media was so limited, only two studies were found to study that age group, particularly. Instead, three other studies were used to examine the effects of patients of all ages to see the research done with them before narrowing specifically into those adolescent-based studies. Because the research surrounding adolescents was limited, other studies should be conducted to have increased research in the field as adolescents are the most impacted age group from both acne and social media. Regardless of these limitations, the existing literature has established that stigmatization (along with other factors like financial status and parental support) influence adolescents’ acne treatment sources.

Conclusion

This narrative review examined existing literature on acne-related stigmatization in adolescents and its relationship with social media usage. Overall, the studies suggest that acne can contribute to feelings of embarrassment, lower self-esteem, and social comparisons. These feelings worsen in online environments where appearance is especially emphasized. Social media platforms thereby amplify the psychological impact of visible skin conditions by increasing exposure to idealized beauty standards and viewer judgment.

The current literature remains limited, and few studies directly examine the intersection between adolescents with acne, stigmatization, and social media usage. As a result, future research should further investigate how digital environments such as social media shape adolescents’ perception of skin health and their treatment-seeking behaviors. This information could then be used to explore interventions that promote accurate acne information and promote positive self-image among adolescents with acne.

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