Ep 8: Dermatologist's Take on Acne Positivity

Описание: Dermatology Weekly Flash Briefing - The acne positivity skincare movement has taken social media by storm, but should we be glorifying a medical skin condition? Here's what accredited dermatologist, Dr. Teo Wan Lin has to say about #acnepositivity.

The acne positivity movement has been making it rounds on social media since early 2018, when activists such as #freethepimple founder Lou Northcote started building a movement online to destigmatize acne, and empower others to embrace their skin. Acne positivity is in some ways, an extension of the body positivity movement, in which it promotes acceptance of all skin regardless of its state.The hallmarks of the movement are unfiltered, make-up free photos that showcase their natural skin, encouraging others to do the same.

Dr. Teo, as a dermatologist who’s probably seen countless acne cases in your practice, what do you think of acne positivity? Is it something that we should glorify?

Acne positivity, while probably coming from good intentions, unfortunately, is not a sound movement. From a dermatologist’s perspective, acne is not a cosmetic issue. The cause of acne is truly medical, and it has to do with genetically induced inflammation in the skin. Besides the fact that it can be very distressing and painful, especially with severe forms of cystic acne, it can also lead to psychosocial problems such as affecting one’s self esteem, or even conditions like depression and anxiety.

This has nothing to do with being positive about acne or not, though it may be easy to ride the trend that it is ok to have acne, it is not something that is going in the right direction. This is because the severity of acne can be graded. If you have moderate to severe acne, it is very likely you started with mild acne, and would not have developed severe acne overnight. Moderate to severe acne tends to be cystic in nature, and can lead to bleeding, pus, abscess formation (which is a collection of pus under the skin), and in very severe acne, Acne Fulminans.

A lot of the dramatic cases that I have seen on social media, and under the #acnepositivity movement, are really semi-dermatologic emergencies; especially those who look like they have abscess under their skin. It can potentially be life threatening because it starts with infection. The abscesses start with infection, and if uncontrolled, can lead to systemic inflammation and sepsis, causing fever. Additionally, the pus and the blood can also be very distressing.

The key thing here is that it is timely for us to remind the public that acne is not cosmetic, and hence it should not be treated by beauticians and non-medical evidence-based therapies. It is important for us to emphasize the relevance of evidence-based medical treatment for acne. Acne is 100% treatable, so there is no need to be positive about something that can be treated. In severe cases of cystic acne, isotretinoin - which should be used under medical supervision - is a very effective treatment, and it is certainly necessary to advocate this.

In my opinion, what’s more important, beyond acne positivity, is positivity in general. This should apply to individuals who are suffering from all types of skin conditions. As dermatologists, we are acutely aware of the psychosocial effects of visible skin and hair disorders on the psyche of an individual who has a dermatological condition. The key here is that we do not advocate ignoring the condition, or pretending that everything is okay, as this can have disastrous and dangerous results. This is because the skin is a barrier against the external environment, and you have to ensure it is healthy.

But shaming individuals with skin conditions is certainly inappropriate, and this goes for body shaming and all other types of humiliation and bullying. Nevertheless, I feel that it is important to draw the line at recommending appropriate medical treatment - as acne is imminently treatable with medications. I have personally never encountered acne that could not be treated and was not treated successfully, and I can speak for the rest of my dermatologist colleagues as well. The key here is that we have to acknowledge the significant amount of psychosocial distress that acne patients undergo, and focus more on educating people who don’t have acne who can sometimes pass very insensitive comments. I personally have heard these testimonies form my patients who feel terrible, simply because of these insensitive comments. And this applies for anybody with any sort of visible imperfection and disability.

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DR. TEO WAN LIN
  / drteowanlin