Others grow their hair long to cover the face. Girls tend to wear heavy make-up to disguise the pimples, even though they know this sometimes aggravates the condition. Affected individuals frequently avoid socialising and may become withdrawn. They find it hard to form new relationships, especially with the opposite sex. Truncal acne can reduce participation in sport such as swimming or rugby because of the need to disrobe in public changing rooms.
Some people develop social phobia, where the main concern is a fear of negative appraisal by others.
This condition typically starts in early teens and is associated with painful self-consciousness, avoidance and shyness. Acne may reduce career choices, ruling out occupations such as modelling that depend upon personal appearance. More people who have acne are unemployed than people who do not have acne are. Some people with acne become significantly depressed requiring medical attention. Signs of depression include loss of appetite, lethargy, mood disturbance, wakefulness and feelings of unworthiness.