It did not matter how severe or what kind of blemish she had, whether it was a case of severe acne, a noticeable facial scar or pronounced dark spots covering the face.
"The women who used foundations to cover these kinds of marks reported having a lower health-related quality of life than did the women who didn't wear the same kind of makeup," said Rajesh Balkrishnan, the study's lead author and the Merrell Dow professor of pharmacy at Ohio State University.
While it may seem obvious that anyone with a severe blemish on their face contends with psychological issues, until this study, no one had systematically evaluated how such blemishes affect women psychologically, said Balkrishnan.
"Though they may not have much effect on physical health, severe facial marks may have a significant impact on self-image and over time, that could adversely affect a woman's health," he said. "In this case the psychological impact often outweighs the physical aspects of the problem - the women in our study reported having more problems with social and sexual functioning than with physical functioning."
The study appears in a recent issue of the International Journal of Dermatology.
Of the 73 women in the study, 66 used what Balkrishnan calls "corrective cosmetics" while seven did not. Corrective cosmetics are skin-colored foundations meant to conceal serious blemishes. It's not the kind of makeup that would typically be found in the cosmetics aisle of a drug store, and a dermatologist usually recommends these foundations to her patient.
"The women who used foundation to cover blemishes may have had a tougher time psychologically dealing with their blemishes than did the women who didn't use corrective makeup," Balkrishnan said. "Although it's difficult to say why this is, it may be that the women who didn't wear makeup to cover their blemishes felt more confident in their appearance."
These kinds of cosmetics are also fairly expensive - one company sells a 1-ounce jar of its corrective foundation for $27.50.
The majority of women that Balkrishnan and his colleagues surveyed had severe facial scarring, acne, melasma - a pronounced pigmentation of the upper cheeks, bridge of the nose, forehead and upper lip - or hyperpigmentation, a condition in which patches of facial skin become very dark. Most of the women had only one type of blemish. Participants' average age was 37.
The overwhelming majority of women (90 percent) reported that they used some type of corrective foundation to cover the blemish, although the researchers did not record the brands of makeup that the women wore. Overall, the women were in good physical health.
The researchers used the Blemish Area and Severity Index (BASI) to quantify the area of the face covered by the blemish and to rate the severity of the blemish. Included in the BASI survey were questions that measured health-related quality of life issues, as well as questions that measured each woman's fear of negative evaluation by others.
The researchers asked each woman to rate their health in general - answer choices ranged from excellent to poor. The women were also asked questions about any recent problems with physical or mental health, and how often poor physical or mental health kept them from doing their usual activities.
The survey also asked women to describe what they thought life would be like if they didn't have to contend with the blemishes.
Not surprisingly, having a severe facial blemish negatively affected how most of the women perceived the quality of their lives. But the women who wore foundations to conceal their blemishes reported having a lower health-related quality of life than did the seven women who said that they did not wear this kind of makeup.
The women who didn't wear makeup did not necessarily have less severe blemishes, either, Balkrishnan said.
"Overall, the women who used foundation treatments felt that they were worse off physically and mentally than the women who weren't using these treatments," Balkrishnan said.
Whether or not they wore makeup, participants overwhelmingly felt that without their blemish other people would see them in a less negative light, and that the overall quality of their lives would improve.
Interestingly, the researchers found no difference in health-related quality of life scores based on the type and size of a blemish. For example, a woman with bad acne did not feel any worse or any better than a woman with melasma.
But the more fearful a woman was of being negatively evaluated in public, the lower she rated her health-related quality of life.
Researchers aren't certain exactly how severe blemishes affect a woman's mental health, and a study like this one may help in designing better treatments, including corrective cosmetics, for women, Balkrishnan said.
He conducted the study with researchers from the departments of dermatology, psychiatry and public health services at Wake Forest University School of Medicine in Winston-Salem, N.C.; the division of management and policy sciences at the University of Texas School of Public Health in Houston; and Vichy Laboratoires and Tarnier Hospital, both in Paris.