How Your Skin Affects Your Self-Esteem

HS is a chronic inflammatory condition that affects 1% to 4% of adults in the United States, according to Cleveland Clinic. It mainly impacts the skin, causing painful symptoms, particularly in sensitive areas where hair grows, such as the groin, underarms, or buttocks. Feeling down on yourself because of these symptoms is quite common. “Most patients with skin conditions, including HS, suffer from the emotional implications of the skin condition in addition to the physical pain,” says Mina Guirguis, Psy.D, a licensed clinical psychologist and psychodermatologist in La Mirada, CA, and member of the Association for Psychoneurocutaneous Medicine of North America.

The symptoms of HS, along with the many myths that persist about the condition—for example, that it’s contagious or an STI—can contribute to the emotional burden, says Steve Daveluy, M.D., associate professor and program director at Wayne State Dermatology in Dearborn, MI. “HS often causes a lot of shame for patients, shame in fearing that someone will see or smell your HS and will be disgusted, and shame that your body is betraying you in a way,” he says. But HS does not make you “less than,” adds Dr. Daveluy. “If you have HS, know that it's not your fault and you're not alone.”

That shame, along with the difficulty of managing a painful chronic illness, can add up to mental health struggles for people with HS: Those with HS are at increased risk of mental health conditions like depression and anxiety, according to a study in JAMA Dermatology. “Depression and anxiety will often manifest in social isolation, negative thoughts, increased sleeping or sleeping disturbances, difficulty concentrating, and at times suicidal ideations,” says Guirguis. “Patients will also develop difficulties with relaxing and increased stress.” Thankfully, you can—and should—get help for the emotional challenges of HS.

Did you know there are therapists who specialize in helping people with skin disorders? These “psychodermatologists” can provide a nonjudgmental space to share your experience and strategies to help improve self-esteem. You can search the Association for Psychoneurocutaneous Medicine of North America website to find one. A therapist can also help you work toward acceptance around HS: “Acceptance of one’s condition doesn’t mean that a patient should give up on seeking treatment—but it may help the patient free their minds of worrying how others will perceive them and whether they will be accepted by others or not,” Guirguis says.

It’s also important to share any emotional difficulties related to your HS with your dermatologist, Dr. Daveluy says. They may be able to connect you with mental-health care providers they trust, and they can definitely work with you to better manage any HS symptoms that may be contributing to distress or low self-esteem. For example, many people feel embarrassed by the odor that comes from their HS flare-ups—your dermatologist can help find the best way to control this odor so that you don’t feel the need to isolate from others, says the American Academy of Dermatology.

Another great way to get support and increase self-esteem with HS is to speak with others who understand what you’re going through. “HS is also a hidden disease, so patients often don't know anyone else affected by it and are forced to struggle alone,” says Dr. Daveluy. Support groups are a great solution: “Finding online support networks and going to in-person events and meetings with others who experience similar skin conditions will often provide social support and a sense of being connected with others,” Guirguis explains. For example, the nonprofit Hope for HS provides support groups around the country and online.

Self-compassion is an important tool to fight shame with HS, Dr. Daveluy says. “There are many self-compassion exercises that can help stop negative feelings of shame. They focus on the feelings that the shame causes you and help break the vicious cycle and negative thoughts.” A study in The Journal of Affective Disorders found that practicing such skills can help reduce depression—it’s powerful stuff. You can find many guided meditations on YouTube or apps that focus on self-compassion, or work with a therapist specializing in mindfulness. Engaging in activities that bring you a sense of peace, like yoga or spending time in nature, can also help, Guirguis says.

It can feel scary to talk to friends or family about your HS. You might feel afraid that they will judge you. But your loved ones can be a valuable source of support. “Engaging in an honest conversation is always a start. Share with others how your skin condition impacts your emotional as well as physical health,” suggests Guirguis. “You are not going to succeed with having every loved one truly understand what you are experiencing, but you are opening their mind to understand your struggles.” The HS Foundation also offers helpful tips on how to talk to others about HS.

Because of all the misinformation around HS, sometimes even doctors may perpetuate harmful myths that contribute to your feelings of shame. But arming yourself with facts about HS and helping to break down the myths and stigma can help—both on a personal level and on a larger scale. “Some patients even find it empowering to fight HS by becoming active in spreading awareness and research on HS, including supporting organizations like the HS Foundation,” Dr. Daveluy says. The HS Foundation has tools to help you best talk to medical providers about HS, including this handy patient card.

You don’t have to suffer in silence due to HS—you deserve to feel confident in yourself, inside and out. New meds offer more hope for fewer symptoms, and the resources and strategies here are all excellent tools you can add to your toolbox to battle the emotional challenges you may be experiencing. “Patients are encouraged to seek help when their skin condition affects their daily functioning—for example, finding it difficult to go to work, leave the house, or connect with loved ones,” Guirguis says. If you’re experiencing excessive worry, anxiety, difficulty relaxing, or feeling sad most days—and especially if you are feeling suicidal—seek help immediately. We promise: You are not alone.