Acne can cause emotional scarring.

People suffering from severe outbreaks and blemishes are at a high risk for depression, a new study from the British Journal of Dermatology suggests.

Researchers looked at a database of 134,427 men and women with acne and 1,731,608 people without acne over the course of a 15-year period. Many of the subjects were under age 19 at the beginning of the study, while others ranged in age from 7 to 50. The probability of developing depression was a staggering. Nearly one in five (18.5%) of those with acne developed depression compared to just 12% in those without. What’s more, females made up the majority, particularly nonsmokers and of a higher socioeconomic status. Those women were also less prone to use alcohol or be overweight.

The findings suggested that the greater risk for depression happened following the first five years after the acne diagnosis. The risk for developing the disease was the highest in the first years when there was a 63% increased risk of depression in someone with acne verses someone without it. The reason why acne can cause depression is unclear.
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A whopping 60 million Americans in the U.S. suffer from acne, 20% of whom are adults while 85% are teens and college-aged young adults between ages 12 and 24. What’s more, 25% will have permanent scarring, according to anti-aging company Nu Skin. And young women are at a greater risk. During their 20s, around 60% of women report experiencing acne compared to 42.5% of men.

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Treating the skin condition doesn’t come cheap. Topical, over-the-counter daily cleansers, toners and non-prescription medicated lotion can cost between $30 to $60 per month. And prescription antibiotics and topical creams and ointments for hormone therapy can range from $45 to $200 per month.