Depression and acne can go hand in hand, and one often leads to the other. In cases where acne occurs first, it’s not uncommon for people to want to withdraw from the world. Whether it’s internal embarrassment or external bullying, acne can lead to an extreme loss of confidence and low self-esteem. How to get rid of a pimple may seem impossible, and the emotional toll of acne can impact anyone at any age, and as depression worsens so too does the acne. In some cases, an individual without skincare issues who becomes depressed could incidentally develop acne. Depression can lead to poor hygiene habits, and failing to wash your face contributes to buildups within clogged pores. Depressed people may also experience poor sleep, which can lead to acne by inhibiting your body’s natural, night-time keratinization process.

Recommended therapies for first-line use in acne vulgaris treatment include topical retinoids, benzoyl peroxide, and topical or oral antibiotics.[78] Procedures such as light therapy and laser therapy are not considered to be first-line treatments and typically have an adjunctive role due to their high cost and limited evidence of efficacy.[77] Medications for acne work by targeting the early stages of comedo formation and are generally ineffective for visible skin lesions; improvement in the appearance of acne is typically expected between eight and twelve weeks after starting therapy.[15]


“Sometimes I see people try over-the-counter products just for a couple of weeks, they get frustrated, they say it’s not working, and they discontinue them,” Arthur says. “But it really does take a while to see the effectiveness. So unless you’re having a problem with the medication, like it’s causing severe irritation or dryness, it’s recommended to give it at least 2-3 months before switching to something else.”
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Oral antibiotics are recommended for no longer than three months as antibiotic courses exceeding this duration are associated with the development of antibiotic resistance and show no clear benefit over shorter courses.[87] Furthermore, if long-term oral antibiotics beyond three months are thought to be necessary, it is recommended that benzoyl peroxide and/or a retinoid be used at the same time to limit the risk of C. acnes developing antibiotic resistance.[87]

Atrophic acne scars have lost collagen from the healing response and are the most common type of acne scar (account for approximately 75% of all acne scars).[32][33] They may be further classified as ice-pick scars, boxcar scars, and rolling scars.[31] Ice-pick scars are narrow (less than 2 mm across), deep scars that extend into the dermis.[32] Boxcar scars are round or ovoid indented scars with sharp borders and vary in size from 1.5–4 mm across.[32] Rolling scars are wider than icepick and boxcar scars (4–5 mm across) and have a wave-like pattern of depth in the skin.[32]

Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
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