My Dermatologist Pile on the Acne Shame: Personal Essay

I could’ve avoided some deep scars (and a serious self-confidence knock) if I had trusted the dermatologist who initially prescribed spironolactone for my cystic acne. But instead of planting that seed of trust, she recoiled in horror at my swollen breakouts, leaving the air in that little exam room thick with judgment.

That was years ago. But recently, when a friend left her acne consultation defeated from being told, “You’re too pretty to have pimples.”

Dermatologists can offer invaluable guidance when over-the-counter acne remedies aren’t cutting it, but how providers talk about skin conditions can have sizable mental health consequences, and we all deserve a dermatologist who leaves us feeling empowered, not judged.

Experts Featured in This Article

Lavinia Rusanda is a skin-positive content creator and host of the podcast “LoudTalk with Lavi.”

Rachel Nazarian, MD, FAAD, is a board-certified dermatologist.

Amanda Doyle, MD, is a board-certified dermatologist at Russak Dermatology.

When Acne Care Feels Like Acne Judgment

I’ve experienced two distinct eras of acne: One in my teenage years and another soon after my 20th birthday. Both were marked by dismissive or judgmental episodes at the dermatologist’s office.

In my teens, I spent hours in facial extractions prescribed by a dermatologist who refused to adjust my treatment plan, even when months of it yielded no visible improvement. One day, mid-extraction, an aesthetician quietly recommended a different provider, whose thoughtful approach cleared my skin in the next month.

The second coming of my acne was far more painful and destructive: Scarlet and tender to the lightest touch, I still remember the day I noticed the first inflamed cyst in the mirror, opening the floodgate for months of breakouts to follow.

As it does to many who struggle with acne, scheduling a dermatology appointment already felt like a failure. My acne had reached a point of such severity that drugstore remedies for “normal” skin were no longer for me. And as if to amplify my self-consciousness, strangers commented on my breakouts, offering up unsolicited treatment suggestions in the grocery store. God forbid I have a peaceful Trader Joe’s run.

In the face of these upsetting facts, I hoped a dermatologist could take the wheel and quell my concerns with the hope of healing. But honestly, I just needed to be told that everything would be alright by someone with authority.

Spironolactone, an oral diuretic often prescribed for hormonal acne, eventually cleared my cystic breakouts, paving the way for healing in more ways than one. But the process was stunted by a dermatologist who appeared horrified by my skin, emphatically repeating “it’s so bad,” enough to make me feel like I had done something wrong. While I’m glad she didn’t dismiss my concerns, her evident shock also cemented my worst fears: My skin was particularly bad; this was not normal, and my acne was problematic.

I left the office utterly defeated, without a clear explanation of how the prescribed spironolactone would work. Not wanting to take any medication unnecessarily, I chose to hold off until I found a dermatologist I trusted. My search for a new provider delayed the treatment process as new, deep lesions formed. I often think of the scars (and unpleasant grocery store run-ins) I could’ve avoided had that dermatologist softened their delivery.

Lavinia Rusanda, a skin-positive content creator, had a similarly discouraging experience with a physician. “I remember walking in, talking to the doctor, and immediately, he saw my face and was scared, almost. He was like, ‘We need to get you on Accutane immediately.’ I expressed to him the side effects I was worried about with Accutane, and [he said], ‘If you want to have nice skin, you’re going to have to take on the side effects.'”

“I was, at that point, already so vulnerable in my skin, but to go into a place where you’re reaching out for help, and to be told that, I was fighting back tears in that moment. . . already you feel like everyone is looking at your skin,” says Rusanda.

After this experience, Rusanda waded through a sea of dermatologists to find a provider who would accept her concerns about Accutane’s harsh side effects, which can include depression and suicidal ideation.

“I’ve always found [it] interesting that when I express my concerns about Accutane, it almost feels like the dermatologists I’ve talked to are more worried about my skin scarring than I am. It’s like, is that the worst possible thing that could happen to me? I think especially as women, we’re held to this beauty standard . . . It’s not just us, but also the people around us, that are like, OK, you need to fix this issue right away because you don’t want to ruin your face.'”

Experiences like these can be confusing, disappointing, and frankly baffling. Considering that acne is the country’s most common skin condition according to the American Academy of Dermatology, severe acne can’t be shocking, especially to the medical professionals who treat it. But handling it with empathy takes considerable perspective.

Board-certified dermatologist Rachel Nazarian, MD, FAAD, says, “I have learned in all these years of practicing that you have to validate that what they’re experiencing is an issue. You never want to minimize it because it is a big deal to many. But at the same time, I’ve also learned that when you express too intensely how bad the acne is, it actually can backfire [and] make them feel worse. So it’s a delicate little walk.”

Understanding Acne Shame (And How Pros Can Help or Hurt)

Acne’s mental health impact isn’t an emerging concept: It’s widely recognized and documented by clinical research. A study by The Indian Journal of Dermatology of 100 people with acne vulgaris found that 88 percent of them experienced embarrassment or self-consciousness due to their skin. A meta-analysis of 42 studies published in the Journal of the American Academy of Dermatology found that acne vulgaris is strongly associated with an increased risk for anxiety and depression.

Considering the mental health impact of acne, feeling judged by your dermatologist can have lasting consequences. It can undermine your willingness to return or, as in my case, your trust in the prescribed treatment plan. It can obstruct your skin’s path to healing, leaving you more vulnerable to lasting scars and ongoing stress.

Board-certified dermatologist Amanda Doyle, MD, addresses these concerns with a collaborative approach. “No one asks for acne or any skin condition. If it’s something that one wants to address, they should feel good about discussing it with their provider. I try to foster an environment where patients can talk to me about their lives and their insecurities…we work through it together.”

Dr. Nazarian encourages anyone who’s felt shame at the dermatologist’s office to give it another try. “I would never encourage anyone to return to the same physician if they felt uncomfortable for any reason. There are just too many options out there, but not every dermatologist is the same. Many of us have also suffered with acne ourselves, which really encouraged us to enter the field of dermatology.”

Dr. Nazarian recommends leading with the story of why you’re there to give your new doctor helpful context. “That opening line is going to set you up for success with whoever you’re seeing next.”

The bottom line? From dermatologists to grocery store strangers, we can all be a little kinder about skin conditions. And if you just don’t click with your dermatologist, know you deserve a provider who makes you feel cared for.

Megan Foley is a New York City-based freelance writer with over nine years of experience specializing in beauty, skin care, and wellness. She has written for a range of brands and publications, most recently for Verywell Fit and Omnilux LED.