Dr. Amy Wechsler: The Relationship between Skin and Self-esteem

Dr. Amy Wechsler is a board-certified dermatologist and psychiatrist.

Self-esteem forms during childhood, especially throughout our adolescent and teenage years. This phase is also when we form things like skin conditions. And that’s difficult because given the society we live in, there’s no easy way to separate how we perceive ourselves physically from self-esteem. From everything to the media to social situations, we are inundated with cultural and social messages about appearance and worth. When I was a kid, that type of pressure was just in magazines or billboards, but now there’s TikTok, Instagram, and Facebook. No matter how hard you try, it’s just there. I think skin positivity is good, but the thing about our journeys with self-esteem is that it’s so individualized.

For example, I can see two patients with the same gender, same age, and with the same amount of acne. One will be distraught, not leaving the house, and socially withdrawn while the other one will not let it keep them from their social interactions. Sometimes, they will even remain extroverted. Although these people have the same condition, self-esteem has so much to do with the personality we’re born with, the environment we’re brought up in, and how the two have interconnected to form our identities. For example, if we’re brought up to deeply value our physical appearance, appearance may have a higher weight on our self-esteem.

Our journeys with skin positivity are all so individualized, and for some people, skin positivity is wonderful, but for others, it makes them feel left out. They may think - “I want to feel good about myself, and I don’t want to feel down because of my skin, but I do feel bad.” Then, they feel guilty about feeling bad. We just have to understand that self-image is different for everyone. When it comes to feeling confident, I think we should allow for shades of gray and nuances. If someone has depression, anxiety, or BDD, and they’re being told to feel good about themselves - but because of their mental condition, they aren’t able to at the moment, social ideas around confidence might make them feel worse.

This is one way that social media can be deeply problematic for self-esteem and body-image. Another is how we are constantly inundated with it. As I said earlier, I can remember flipping through Vogue as a kid and feeling bad because I didn’t look like the models in the pictures. I didn’t know anything about photoshop, but I never looked liked them so it made me feel bad. So, I made a conscious choice not to read them, and therefore, I didn’t have to look at it. This lack of exposure helped a lot. But now, social media is everywhere. So, we’re just constantly fed these unreal images. It’s too much, and it’s really affecting self-esteem. I see it all the time. I have kids come in and tell me that their lips are too small, their bodies aren’t curvy enough, and they want lip filler. And I’m just thinking to myself - “You’re 14…”

It’s really impacted this generation. Social media has now become something that largely forms self-esteem, self-confidence, and perception. Self-esteem is the way one views their own worth, and self-confidence is the ability to feel positive about oneself. Whereas self-esteem is a little more fixed, self-confidence is not stable over time. For example, if someone is having a hard day with their skin, they might feel horribly about themselves. On the other hand, when they have clear skin, they feel better about themselves.

The appearance of skin is very impactful because the world interacts with it. When something is on the outside, you have to worry about how you feel looking at it in the mirror. You’re also concerned with how the world is reacting to it. And while the world isn’t always great, you have to be critical about the comments people make as well as the things you’re seeing on social media. What people say isn’t always true, and a lot of things on social media have been changed and altered. Photoshopped images on Instagram might look real, but they’re not. And if something on social media has impacted your confidence, you can always talk to a friend or a parent. Don’t keep it inside because that leads to isolation and loneliness. And when you’re on social media, be intuitive. If something makes you feel bad, it’s not good for you.