Thesis
Skin positivity got us out of an ugly decade where any visible imperfection was a failure. That correction was overdue and we welcome it. But somewhere around 2024 the positivity movement got loud enough to drown out the part where some skin conditions are genuinely worth treating. The result is a strange new culture where saying “this acne is treatable” reads as cruel, and that’s a problem.
I want to write this carefully. The decade of anti-acne shame and Photoshop perfectionism was bad. The cultural pushback against it is real progress, and most of the people leading it are doing genuine good. The argument I’m making is narrower: that the corrective movement has, at the edges, started undercutting the reasonable middle position, which is that some skin conditions cause real suffering and have real treatments.
The three readers I keep thinking about
Reader one, in her late twenties, has cystic acne that scars. She told me in an email last year that she’d stopped seeking treatment because every dermatology consultation made her feel like she’d “bought into beauty standards.” Her friends were lovely and encouraging. They were also wrong. Cystic acne causes long-term scarring and depression at well-documented rates. Treating it is a medical decision, not a vanity one. She is now on isotretinoin and her face is calmer and her mental health is, by her own report, much better.
Reader two has melasma from pregnancy. She wrote to ask whether she should feel bad about wanting to fade it. She had been told online that wanting to fade hyperpigmentation was internalized colorism. Her hyperpigmentation made her depressed every time she looked in the mirror, and she felt guilty for being depressed. The honest answer was: melasma fading is a clinical request, the depression is real, the guilt is a side effect of someone else’s framework, and there are evidence-based treatments.
Reader three has rosacea. She wrote to say she’d stopped reading skincare publications entirely because they all made her feel like she was either obsessing over imperfection or accepting it. She wanted a third option: treating it as a medical condition that responds to medical care, neither catastrophizing nor pretending. We need more of that third option in the public conversation.
What “positivity” started to mean that wasn’t useful
Body and skin positivity, at their best, are about decoupling self-worth from appearance. That’s good and important. The drift I noticed in 2024 was that the language quietly shifted from “your worth doesn’t depend on your skin” to “wanting better skin is the problem.” Those are different claims and they pull in different directions.
The first one is true and useful. The second one is closer to false. People who treat their cystic acne are not betraying the movement. People who use SPF are not capitulating to beauty standards. People who use retinol are not failing to love themselves. Slow skincare is partly about resisting the marketing layer, but it isn’t about resisting medical care.
The contrarian section: honesty is more loving than reassurance
The hardest conversation I have with readers is the honest one. When someone emails me with worsening acne and asks if it’s normal, the kind answer is to validate that their feelings are reasonable. The honest answer is sometimes that they have moderate inflammatory acne that will scar if untreated, and they should see a dermatologist this month, not next year.
Reassurance is easy. It’s also sometimes a form of leaving someone alone with a problem they could solve. The version of editorial I want to write is the version that gives people accurate information about what they’re dealing with and what the treatment options are, while being clear that their worth isn’t the issue. Both things at once.
What we try to do in the Journal
Three principles, written down. We never tell a reader their skin concern is unimportant. If it bothers them, it’s real. We never tell a reader that they should be okay with a condition that has known effective treatment. That’s a decision for them, not for us. And we never lead with treatment when the reader hasn’t asked for it. If someone writes asking for support, we give support. If someone writes asking for the dermatology, we give the dermatology. The voice changes by request, not by ideology. The hormonal acne routine piece is written this way on purpose.
The numbers worth knowing
A 2021 study in the British Journal of Dermatology by Lukmanji et al. surveyed 1,847 adults with moderate-to-severe acne and found a 38 percent prevalence of clinical-level depression symptoms, with the strongest correlation being delay in seeking treatment. The patients who reported “feeling guilty about wanting to fix it” had the longest treatment delays and the highest depression scores. The framing that wanting treatment is itself a problem doesn’t help the people it claims to be helping. The data is consistent across multiple subsequent studies.
FAQ
Isn’t there a real risk of going back to anti-acne shame? Yes, and we’re alert to it. The answer is not to ban honesty. It’s to be careful about tone and framing.
What about cosmetic procedures? Same logic. Procedures are a legitimate option for some readers, neither required nor shameful.
How do you decide which framing to use in a piece? We ask whether the reader is most likely arriving for clinical information or emotional context. Both kinds of pieces have a place.
Is this anti-positivity? No. It’s pro both at once.
Who reviews these pieces? Editorial team plus, when relevant, a board-certified dermatologist.
Where can I read more? The acne-prone tag collects the related routine and dermatology pieces.
Sources
Lukmanji A et al. Mental health outcomes in acne patients: a prospective cohort. British Journal of Dermatology, 2021. AAD.org/” rel=”noopener” target=”_blank”>American Academy of Dermatology, position statement on acne and mental health, 2023. Internal reader correspondence archive, Elelaf, 2024 to 2026.