‘I covered the mirrors with dupattas’

Muskaan Kapoor, 21, certified transformation and life coach, and author experienced anxiety attacks and palpitations because of her acne

Acne can be the bane of adolescence. But for some, it continues well into adulthood, permeating other areas of life. For the first time last month, the UK's National Institute for Health and Care Excellence (NICE) recommended mental health support for those who have been affected by acne vulgaris, stating that the scarring it leaves can have a strong psychological effect, potentially causing anxiety or depression. Dr Tanya Bleiker, president of the British Association of Dermatologists, said in a statement, "Acne has a particular effect on appearance, so in addition to depression and anxiety, it can be damaging to self-image, leading to isolation and sometimes to severe mental health disorders. The severity of the acne is not always linked to the severity of the mental health impact, so it is important that there is a better understanding that even mild acne can have severe effects on emotional wellbeing."

Dr Rashmi Shinde, Consultant dermatologist, says seven per cent of her patients suffer from depression due to acne

Muskaan Kapoor, a certified life and transformation coach and author, had a similar experience. The 21-year-old went from having a blemish-free face to experiencing an acne eruption last year. "I've lived with an auto-immune disease since childhood, and as a result, I've been on steroids for most of my life. Last year, I was also diagnosed with PCOS, which affected my hormone levels. All of this culminated in acne." Because she was new to the condition, Kapoor became extremely self-conscious about her face. Being an actor, she routinely began facing rejection at auditions. "A casting director turned me down because he said make-up would not cover my acne." The agony did not end here. She couldn't sleep on her sides as it would lead to acne infection and cause pain. All of this eventually led to Kapoor experiencing anxiety attacks and palpitations. "I ended up covering the mirrors in my house with dupattas. I became aggressive and would snap at those who brought up my acne," she admits. Her mother, who is also a healer and life coach, encouraged her to see psychologists. Although Kapoor felt better after counselling, the feeling did not last long.

Dr Shubhangi Parkar

She eventually took up a life coach certification course titled Coach to Fortune, and later started her Instagram account (@muskaan_), where she began discussing what it's like to live with acne. "When I started talking about and posting pictures [of my acne], people began to respond. It was liberating." She would also post daily affirmations that helped her overcome her anxiety. "Today, if I get another zit on my face, I don't make a big deal out of it. I know that your skin doesn't define you." She has also released her first book, Rewire Your Mindset, where she talks about how to think more positively about your skin.

Premal Mascarenhas is a 22-year-old from Mumbai who has battled acne since puberty.

Muskaan Kapoor suffered a bout of cystic acne after being on steroids for her auto-immune disease and PCOS

She remembers obsessively washing her face, hoping it would help. "At 13, I went to a dermatologist who prescribed creams and told me that it would probably go away once I was out of my adolescence. But, it didn't get any better even after I turned 20." Mascarenhas suffers from cystic acne, an uncommon and severe form of acne, where you have large, red, painful breakouts deep in your skin. Premal lapped up medical literature to figure out what was causing it, and also stopped eating dairy products, which are thought to aggravate acne due to the hormones in them, but it ended up causing her hair loss. "What bothers me is that many people who barely know me feel compelled to comment on my skin. There are times when my face improves, but it quickly deteriorates. I've cried myself to sleep at times. Every day, I struggle to accept my skin," Mascarenhas says.

Dr Shubhangi Parkar is the former head of the Department of Psychiatry at KEM Hospital. While she has treated several patients suffering from anxiety and depression as a result of acne, there is one case that is etched in her memory. "The 15-year-old patient had attempted suicide as a result of being teased about her acne. The entire period of adolescence and youth is a critical stage because people here are at a vulnerable age. In today's world, having a good physical appearance has become a selling point." Acne, she adds, can be very traumatic, especially for young people. "In my practice, seven per cent of patients have low self-esteem and psychological issues associated with even mild acne," says Dr Rashmi Shinde, consultant dermatologist, trichologist, and cosmetologist.

How to combat acne anxiety

. Maintain a healthy lifestyle which includes good diet, well-rested sleep and exercise
. Avoid processed foods, sugar and dairy products
. Always use dermatologist-prescribed medications, and follow proper skin care regime instead of self medication
. Remember, you are not defined by your acne