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The Psychosocial Impact of Acne Vulgaris

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Abstract

Background: Acne vulgaris causes erythematous papulopustular lesions in active stage and often leave behind residual scarring and pigmentation. Its onset in adolescence may add to the emotional and psychological challenges experienced during this period. Aims: To assess the impact of acne on the various psychosocial domains of daily life. Materials and Methods: This was a prospective, cross-sectional study done in the dermatology out-patient department of a tertiary care hospital from January to March 2015. A total of 100 consecutive, newly diagnosed patients of acne vulgaris, aged 15 years and above were included in this study. The relationship between acne vulgaris and its sequelae was analyzed with ten different domains of daily life by using dermatology life quality index (DLQI) questionnaire. Results: Females (56%), 15–20 year olds (61%), facial lesions (60%), and Grade II acne (70%) were most common. Acne scars were noted in 75% patients, whereas 79% cases had post-acne hyperpigmentation. Thirty-seven percent patients had DLQI scores of (6–10) interpreted as moderate effect on patient's life. Statistically significant correlation (P < 0.05) found were as follows: Physical symptoms with grade of acne; embarrassment with site and grade of acne; daily activities with grade of acne and post-acne pigmentation; choice of clothes with site of acne; social activities with gender, site and grade of acne; effect on work/study with grade of acne; interpersonal problems with site and post-acne pigmentation; sexual difficulties with grade of acne. Limitation: It was a hospital-based study with small sample size. Conclusion: Significant impact of acne and its sequelae was noted on emotions, daily activities, social activities, study/work, and interpersonal relationships. Assurance and counseling along with early treatment of acne vulgaris is important to reduce disease-related psychosocial sequelae and increase the efficacy of treatment.
© 2016 Indian Journal of Dermatology | Published by Wolters Kluwer - Medknow 515
Abstract
Background: Acne vulgaris causes erythematous papulopustular lesions in active stage and
often leave behind residual scarring and pigmentation. Its onset in adolescence may add to the
emotional and psychological challenges experienced during this period. Aims: To assess the
impact of acne on the various psychosocial domains of daily life. Materials and Methods: This
was a prospective, cross-sectional study done in the dermatology out-patient department of a
tertiary care hospital from January to March 2015. A total of 100 consecutive, newly diagnosed
patients of acne vulgaris, aged 15 years and above were included in this study. The relationship
between acne vulgaris and its sequelae was analyzed with ten different domains of daily
life by using dermatology life quality index (DLQI) questionnaire. Results: Females (56%),
15–20 year olds (61%), facial lesions (60%), and Grade II acne (70%) were most common.
Acne scars were noted in 75% patients, whereas 79% cases had post-acne hyperpigmentation.
Thirty-seven percent patients had DLQI scores of (6–10) interpreted as moderate effect on
patient’s life. Statistically significant correlation (P < 0.05) found were as follows: Physical
symptoms with grade of acne; embarrassment with site and grade of acne; daily activities with
grade of acne and post-acne pigmentation; choice of clothes with site of acne; social activities
with gender, site and grade of acne; effect on work/study with grade of acne; interpersonal
problems with site and post-acne pigmentation; sexual difficulties with grade of acne.
Limitation: It was a hospital-based study with small sample size. Conclusion: Significant
impact of acne and its sequelae was noted on emotions, daily activities, social activities,
study/work, and interpersonal relationships. Assurance and counseling along with early
treatment of acne vulgaris is important to reduce disease-related psychosocial sequelae and
increase the efficacy of treatment.
Key Words: Acne, dermatology life quality index, psychosocial impact, quality of life
The Psychosocial Impact of Acne Vulgaris
Neirita Hazarika, Archana M
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DOI: 10.4103/0019‑5154.190102
Introduction
Acne vulgaris is a common skin disease with prevalence
reaching up to 80% during adolescence.[1] Major
complications of acne are scarring and psychosocial
distress which persists long after the active lesions
have disappeared.[2] Its onset in adolescence may
add to the emotional and psychological challenges
experienced during this period,[3] and it can lead to the
developmental issues of body image, socialization, and
sexuality.[4] Psychological issues such as dissatisfaction
with appearance, embarrassment, self-consciousness,
lack of self-confidence, and social dysfunction such as
reduced/avoidance of social interactions with peers and
opposite gender, reduced employment opportunities have
been documented.[4-6] Acne can negatively influence the
intension to participate in sports.[7] Moreover, anxiety
and depression are found to be more prevalent among
acne patients than controls.[8-10] Even suicidal ideation
was found in 6–7% of acne patients.[11]
Although acne was earlier considered to be merely a
cosmetic affliction, the psychosocial effects of the disease
have now been scientifically proven. Studies have shown
these effects to improve when acne is treated.[12] Thus, it
is imperative that quality of life (QoL) issues of acne are
taken into consideration for a wholesome management
From the Department of
Dermatology, Venereology and
STD, Tagore Medical College and
Hospital, Chennai, Tamil Nadu,
India
Address for correspondence:
Dr. Neirita Hazarika,
Department of Dermatology,
Venereology and STD,
Tagore Medical College and
Hospital, Rathinamangalam,
Chennai - 600 127,
Tamil Nadu, India.
E-mail: neiritahazarika@yahoo.
com
This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as the
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How to cite this article: Hazarika N, Archana M. The psychosocial impact
of acne vulgaris. Indian J Dermatol 2016;61:515‑20.
Received: February, 2016. Accepted: June, 2016.
ORIGINAL ARTICLE
What was known?
Acne vulgaris commonly causes visible, erythematous, papulopustular lesions in the active stage, often leaving behind residual scarring and pigmentation. This may lead to
psychosocial issues. There is a scarcity of studies on the psychosocial effects of acne among Indian patients.
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Hazarika and Archana: Psychosocial impact of acne vulgaris
516Indian Journal of Dermatology 2016; 61(5)
of the patients. The use of QoL questionnaires can
help us to adequately understand how acne affects the
patient on a day-to-day basis and can aid in assessing
the efficacy of therapy. In this study, the dermatology
life quality index (DLQI) questionnaire,[13] a general
health-related QoL questionnaire, was used as it enquires
into ten different domains of daily life activities. There
is a paucity of studies on the psychosocial impact of
acne vulgaris in the Indian scenario. The aim of this
study was to assess the impact of acne on the various
psychosocial domains of daily life.
Materials and Methods
It was a hospital-based, prospective, cross-sectional
study done in the dermatology and STD out-patient
department of a tertiary care teaching hospital, for a
period of 3 months (January to March 2015). Approval
from the Institutional Research and Ethics Committees
was obtained, and patients were recruited after informed
written consent (Tamil/English).
Inclusion criteria
A total of 100 consecutive patients, newly diagnosed as
acne vulgaris, of age 15 years and above, were included
in the study.
Exclusion criteria
Acne patients with known history of mental disorder,
concurrent physical illnesses and disabilities that can
affect their mental state, patients who used topical
and systemic drugs known to predispose to acne were
excluded from the study.
The parameters collected were divided
into – (1) Clinicodemographic data: Age, sex, duration, site,
grade of acne, post-acne hyperpigmentation, and acne scars.
Acne was graded into four grades (I–IV),[14] whereas acne
scars (all types included) were graded[2] as mild, moderate,
and severe. (2) DLQI questionnaire (Tamil or English) filled
up by the patients without assistance. English version
of the DLQI was translated into Tamil by two bilinguals.
Forward and backward translation was done by different
translators and validated by two other members.
The DLQI questionnaire[13] (used after formal written
permission) grades QoL by assessing the following
domains: (a) Physical symptoms and feelings
(Q1, Q2), (b) daily activities (Q3, Q4), (c) leisure
(Q5, Q6), (d) work/school (Q7), (e) personal relationships
(Q8, Q9), and (f) treatment (Q10). Each question is
scored as four-point Likert scale (score 3-0), keeping in
mind the problems faced the previous week due to the
disease. Final DLQI score is the sum of all scores (range
0–30). DLQI score interpretation is done as follows:
Score (0–1) no effect on patient’s life, (2–5) small effect
(6–10) moderate effect, (11–20) very large effect, and
score (21–30) extremely large effect on patient’s life.
Statistical analysis
The data collected were subjected to Chi-square test and
analysis of variance using IBM SPSS statistics software
version 20 (IBM Corporation, Armonk, New York, USA).
The level of significance was set at P < 0.05.
Results
Among a study population of 100 patients, females
predominated with 56% cases. Sixty-one percent were
in the age group of 15–20 years, whereas 39% patients
had recent onset of acne (0–6 months duration).
Facial acne as single site involvement was the most
common (60%) type encountered, whereas multiple
site involvement (face, chest, and back together) was
seen in 37% cases. Grade II acne with 70% patients
was the most common clinical type found. Seventy-five
percent of cases had varying degree of acne scars,
whereas post-acne hyperpigmentation was seen in 79%
cases. Table 1 shows the clinicodemographic profile of
study population. Thirty-seven percent patients had
a DLQI score in the range of (6–10) interpreted as
moderate effect on patients life, whereas 29% patients
scored (11–20) interpreted as very large impairment of
QoL [Table 2].
Table 3 shows the significance of correlation
between the ten different domains of the DLQI
questionnaire (Q: 1–10) with the each of the following
clinicodemographic factors: Gender, age, site of lesions,
grade of acne, acne scars, and post-acne pigmentation.
Statistically significant correlation (P < 0.05) was seen
between Q1: Physical symptoms and grade of acne. The
domain, Q2: Embarrassment/self-consciousness showed
statistical significant correlation to site and grade
of acne while Q3: Effect on daily activities showed
significant statistical association to the grade of acne
and post-acne pigmentation. Statistically significant
correlation was seen between Q4: Choice of clothes
and site of acne. The domain, Q5: Effect on social
activities showed statistically significant correlation to
gender, site, and grade of acne. Statistically significant
correlation was seen between Q7: Effect on work/study
and grade of acne while the domain, Q8: Problems with
partner/close friends/relatives showed statistically
significant correlation to the site of acne and post-acne
pigmentation. The domain, Q9: Sexual difficulties
showed statistically significant correlation to the
grade of acne. The domains, Q6: Effect on sports and
Q10: Treatment taking up time/making skin messy did
not show statistically significant correlation to any of
the clinicodemographic factors studied (P > 0.05).
Discussion
The present research aimed to study the QoL issues
among acne patients in India. The influence of factors
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Hazarika and Archana: Psychosocial impact of acne vulgaris
517 Indian Journal of Dermatology 2016; 61(5)
such as age, gender, site of lesions, grade of acne, acne
scars, and post-acne pigmentation on ten psychosocial
domains of daily life was analyzed.
Q1: Physical symptoms of itch, soreness,
pain, stinging
Physical symptoms were reported by 78% patients in the
present study. Tasoula et al.[15] reported 25% of cases
of facial acne and 33% cases of acne in the back to be
having itch as a physical symptom while Reich et al.
reported 50% of acne cases to have itch.[16] Enquiry
into the exact nature of physical symptom was however
outside the purview of this study; however, many
patients complained of discomfort/pain in the acne
lesions. In this study, physical symptoms were found to
show statistically significant correlation to the grade of
acne (P < 0.001).
Q2: Embarrassment/self‑consciousness
In this study, 88% cases reported embarrassment/
self-consciousness due to acne which was consistent
to previous studies.[15,17] In the study by Ogedegbe
and Henshaw,[18] 64.4% patients were psychologically
perturbed by the appearance of their skin. Magin et al.[5]
in their qualitative study on the psychological sequelae
of acne stated that acne negatively affected self-image
in all patients, at least to some degree. Embarrassment
and self-consciousness were directly linked to low
self-image and self-esteem; this finally led to decrease
in self-confidence. In the present study, the degree of
embarrassment/self-consciousness showed statistically
significant correlation to the severity of acne (P < 0.001),
which was similar to the findings by Tasoula et al.[15] and
van der Meeren.[19] Moreover, the association between
site of acne and embarrassment/self-consciousness was
found to be statistically significant (P < 0.05) in this
study. Patients with facial acne reported feeling highly
self-consciousness about their acne and this was the
main reason they sought treatment.
Q3: Eect on daily activities‑shopping,
looking after home, garden
In this study, problems in daily activities were
complained by 69% patients. The degree of difficulty
in daily activities showed statistically significant
association (P < 0.05) to the grade of acne and post-acne
hyperpigmentation. Magin et al. established a linear
relationship of appearance to self-image and self-esteem;
unattractive appearance lead to embarrassment and
finally to avoidance of social contact. Moreover, they
could demonstrate a temporal association between
anger, frustrations, and acne.[5] Thus, problems in daily
activities due to acne may be attributed to avoidance
behavior, anger, and frustration.
Q4: Influence on choice of clothes
Appearance is often appraised through dressing[20] and
thus clothes form an important component of social
acceptance. While 25–29% patients in previous studies
reported difficulty in dressing attributable to acne,[15,21] it
was 37% in this study. Site of acne showed statistically
significant correlation (P < 0.05) to choice of clothes
Table 1: Clinicodemographic characteristics of the
study population
n=100 (%)
Gender
Male 44
Female 56
Age (years)
15-20 61
21-25 31
>25 8
Duration of acne (months)
0-6 39
7-12 23
13-24 20
25-36 5
>36 13
Site
Face 60
Chest 0
Back 2
Face and chest 11
Face and back 17
Chest and back 1
Face, chest and back 9
Grade of acne
I 11
II 70
III 17
IV 2
Postinflammatory hyperpigmentation
Present 79
Absent 21
Acne scar
Mild 23
Moderate 25
Severe 27
Absent 25
Table 2: Interpretation of dermatology life quality index scores
Total
patients n
No effect
score (0-1)
Mild effect
score (2-5)
Moderate effect
score (6-10)
Very large effect
score (11-20)
Extreme large
effect score (21-30)
100 (100) 0 34 (34%) 37 (37%) 29 (29%) 0
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Hazarika and Archana: Psychosocial impact of acne vulgaris
518Indian Journal of Dermatology 2016; 61(5)
in this study. Patients with truncal acne consciously
avoided wearing clothes that revealed their acne affected
skin. In the study by Ogedegbe and Henshaw,[18] 14.4%
adolescent avoided wearing costumes that exposed
extrafacial areas affected by acne.
Q5: Eect on social/leisure activities
In this study, 68% patients reported acne affected their
social activities. Negative influence on social/leisure
activities showed statistically significant correlation
(P < 0.05) to gender, site of lesions, and grade of acne.
Patients responded that they especially avoided social
gatherings during an episode of acute acne flare as they
felt other people stared at their acne and this made them
uncomfortable. This was more so in females. A higher
degree of social anxiety, social avoidance/withdrawal
due to acne was also reported by Yolaç et al.[22] and
Fried and Wechsler.[23] Magin et al.[5] stated that many
subjects reported avoidance behavior in response to their
acne and some went on to develop permanent effect on
personality such as avoidant personality trait.
Q6: Diculty in sports
A study among Scottish students found that 10% of acne
sufferers avoided swimming and other sport because of
embarrassment.[24] While Tasoula et al.[15] reported 14.4%
of acne patients having difficulty in sports attributed
to acne, it was 25% in this study. No statistically
significant correlation could be demonstrated between
the clinicodemographic factors and sports in this study.
This could be because the study population was mainly
suburban, where sports may not be an important part of
day-to-day life.
Q7: Eect on work/study
In the present study, 57% patients reported negative
effect of acne on work/study. Twenty-one percent of
pupils felt that acne affected their schoolwork and
personal activities.[15] Similar findings were also reported
by Walker et al.[24] In this study, negative effect on
work/study showed statistically significant correlation
to the grade of acne (P < 0.05). Patients stated that
they were constantly bothered by their acne and facial
appearance, and this affected their ability to concentrate
on study/work.
Q8: Problems with partner/close friends/
relatives
In the present study, 75% patients reported interpersonal
problems. Problems with partner/close friends/relatives
showed statistically significant correlation (P < 0.05) to
the site of acne and post-acne pigmentation. Patients
reported being constantly enquired about their acne,
even teased by peers and relatives. Female patients felt
that acne reduced their prospect in getting alliances for
arranged marriage. Psychosocial research have shown
that physically attractive strangers attribute more
Table 3: Significance of correlation (P) between the clinicodemographic factors and ten domains of dermatology life quality index questionnaire
Clinicodemographic
factors
Domains of DLQI
Q1: Physical
symptoms
Q2: Embarrassment Q3: Daily
activities
Q4: Choice
of clothes
Q5: Social or
leisure activities
Q6: Sports Q7: Work
or study
Q8: Inter-
personal problems
Q9: Sexual
difficulty
Q10: Treatment
difficulties
Gender 0.091 0.595 0.231 0.063 0.050* 0.546 0.143 0.300 0.507 0.997
Age of patient 0.149 0.296 0.118 0.083 0.277 0.475 0.193 0.261 0.463 0.319
Site of lesions 0.469 0.048* 0.614 0.005* 0.005* 0.712 0.458 0.019* 0.794 0.310
Grade of acne <0.001** <0.001** 0.003* 0.921 0.046* 0.782 0.003* 0.851 0.050* 0.082
Acne scars 0.144 0.090 0.405 0.364 0.128 0.629 0.726 0.441 0.511 0.140
Post-acne
pigmentation
0.226 0.329 0.050* 0.441 0.073 0.402 0.230 0.028* 0.859 0.724
*P<0.05, **P<0.001. DLQI: Dermatology life quality index
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Hazarika and Archana: Psychosocial impact of acne vulgaris
519 Indian Journal of Dermatology 2016; 61(5)
positive qualities such as friendliness, intelligence, and
higher social skill levels to each other, compared with
physically unattractive strangers.[25] Adult females with
acne agreed to the advantage of physical attractiveness
in getting jobs and life partners.[26] Magin et al.
stated that primary concern of patients with acne was
appearance which might be, in part, a media generated
ideal of perfect skin. Subjects were acutely aware that
they failed to live up to the ideal of perfect, flawless
skin portrayed in advertising and television. This led
to a self-perceived reduction in sexual attractiveness.
Subjects also had a perception of being judged by others
because of acne while many feared being thought of as
unhealthy or unhygienic.[5]
Q9: Sexual diculties
Only 5% patients in this study reported sexual difficulties
due to acne. Statistically significant association was
observed between sexual difficulties and grade of acne
(P < 0.05). However, enquiry into the exact cause
of sexual difficulty was outside the purview of this
study. Sexual difficulties reported could be secondary
to self-perceived reduction in sexual attractiveness;
disinterest secondary to acne associated anxiety; or
unwillingness to divulge personal information. Kulthanan
et al.[2] reported similar findings and opined that it is a
feature of Asian culture that people became embarrassed
or avoided questions about personal relationships.
Q10: Treatment of acne making home messy/
taking up time
Treatment of acne is probably more time consuming than
generally thought, causing discomfort and annoyance to
many patients.[27] Twenty-five percent of pupils under
the treatment for acne reported that treatment was
unpleasant.[15] In the present study, 45% reported that
treatment/home remedies of acne were taking up time or
making life messy. No statistically significant correlation
could be demonstrated between the clinicodemographic
factors and treatment difficulties in this study. Patients
admitted that their daily routine to hide acne, took a
lot of their grooming time. Adolescents with acne feel
uncomfortable, avoid eye contact, grow their hair long
to cover their faces and girls used makeup to camouflage
their acne.[28] Women found camouflaging their acne with
makeup was effective in decreasing embarrassment and
self-consciousness.[5] More than half of the untreated
pupils with acne brought over the counter products
without prior consulting a dermatologist.[15] Patients
in this study confessed to trying self-remedies in the
form of using creams/medications for acne as suggested
by peers or using turmeric powder paste, which is a
common skin care routine in South India.
Limitations
One limitation of this study was the possibility of
referral bias and overestimation of psychometric
morbidity with hospital-based data. Furthermore, the
sample size was small. There is a need to replicate this
study in community setting to extrapolate the findings
to all acne patients.
Conclusion
The present study showed significant impact of acne
and its sequelae on physical symptoms, emotions, daily
and social activities, study/work, and also interpersonal
relationships. Thus, it is safe to conclude that severity of
acne should not be assessed solely on the physical grade
of acne alone but should include its effect on QoL. The
need of inclusion of QoL questionnaires in evaluating
patients of acne vulgaris at baseline, during, and
after treatment is of utmost importance. Education of
dermatologists and general practitioners alike, about the
psychosocial impairments of acne can help in identifying
cases with QoL issues. There is a need for integration
of psychological intervention in the management of acne
vulgaris, for improvement in the QoL in such patients.
Setting up supportive groups could also be of immense
help for these patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
What is new?
Acne vulgaris and its sequele commonly affects emotions, daily & social activities,
quality of study/work and interpersonal relationships. Identifying acne patients
with QoL issues is important so as to be able to provide a wholesome management
leading to clinical and QoL improvement.
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Cutis 2007;79:110-2.
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... Acne is thought to impact 9.4% of the global population, making it the eighth most common disease on the planet. Acne is most common in postpubescent teens, with males are being affected more than females especially with the severe presentation of the condition [4][5]. According to a Turkish study, acne is more widespread and severe in females, and it is linked to worry and despair [6]. ...
... We have observed that only 0.7% and 9% sustained a very severe or severe impact of acne, respectively, 19% had a moderate impact, while 31% and 40% had small or no impacts, respectively. This finding is concurrent with several other studies [1][2][3][4][5][6][7][8]. Studies conducted in Saudi Arabia reported that 64% of acne cases were mild, 30.1% were moderate, and only 5.9% were severe [12][13][14]. ...
... Acne and its consequences have a substantial impact on physical symptoms, emotions, social activities, study/work, and interpersonal relationships. According to our study, the average impact score of acne was around 4.0 (median = 3) (Figure 2), which is in alignment with other studies conducted in Saudi Arabia [3][4][5]. ...
Article
Background Acne is a chronic inflammatory skin disease caused by bacterial colonization that damages the pilosebaceous gland on the face and other parts of the body. It is one of the most frequent dermatologic diseases in the young population. Acne vulgaris is a devastating disease, and it has a significant impact on a patient's quality of life, influencing their self-esteem as well as their psychosocial development. This study aimed to explore the psychological symptoms associated with patients with acne, its impact on their quality of life according to their personal characteristics, and to raise the importance of observing and managing psychological symptoms during acne treatment. Methods In this cross-sectional study, data were collected through a paper questionnaire. The questionnaire was composed of two parts, the first includes data about demographics and general health while the second has details about the Dermatology Life Quality Index (DQLI); the Arabic validated version was used for data collection. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY). Results According to the impact of acne on respondents' lives, 40.0% have no effect at all, 31.0% have small effects, 19.0% have moderate effects,9.0% have large effects, and 0.7% have extremely large effects. Conclusions Acne is a major problem that affects the quality of life of young patients. Its effect is significantly higher among less educated patients and those with a longer duration of disease.
... In addition to the medical management of AF, the psychological impact of the disease must also be assessed. Hazarika and Archana (2016) suggest acne can adversely affect a patient's physical, emotional, and daily life, resulting in poor self-esteem, poor body image, anxiety, and depression. The disfiguring elements of the lesions can have a profound negative impact on interpersonal relationships in adolescents (Hazarika & Archana, 2016). ...
... Hazarika and Archana (2016) suggest acne can adversely affect a patient's physical, emotional, and daily life, resulting in poor self-esteem, poor body image, anxiety, and depression. The disfiguring elements of the lesions can have a profound negative impact on interpersonal relationships in adolescents (Hazarika & Archana, 2016). Although the literature does not correlate the duration or severity of the acne nor patient age with the severity of adverse effects on the quality of life (Ey€ uboglu, Kalay, & Ey€ uboglu, 2018), it stands to reason that the particularly disfiguring lesions of AF have the potential to significantly affect the psychological outlook of patients with the condition. ...
Article
Acne fulminans (AF) is a rare form of acne vulgaris. The diagnosis can be mistaken for other skin infections and delay treatment, placing patients at risk for scarring and psychological distress. This case report presents a patient previously treated for COVID-19 and subsequent pneumonia. COVID-19 restrictions in the clinic setting, including mask-wearing and isolation protocols, accounted for the suboptimal assessment of the patient's skin, which ultimately prolonged the diagnosis. This case report reviews AF from a primary care perspective and highlights clinical manifestations, physical examination findings, and management of AF.
... After >5 weeks of treatment, the median DLQI score was 5.0 (min = 0; Q1 = 2.0; Q3 = 8.0; max = 25.0; n = 113) for females and (Table 4) [30]. The proportion of females who reported a great (n = 33, 29.2%) or extreme impact (n = 6, 5.3%) of acne on their lives dropped from 34.5% (n = 39) to 15.0% (n = 17) at the final visit. ...
... If classified according to Hazarika and Archana [30], as described above for the adult collective, only 2 and 4 males (n = 6, 20.7%), and 1 and 8 females (n = 9, 39.1%) at baseline were classified as having an extreme or very great effect of the disease on the HRQoL, respectively (data not shown). At the final visit, no male presented with an extreme effect; but 1 female (4.35%). ...
Article
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Introduction: Daily parallel application of adapalene and nadifloxacin has been determined to be effective and well tolerated in patients with acne vulgaris in randomized, controlled clinical studies. Here, the authors report the results from a large, prospective, uncontrolled, multicentric, noninterventional study under real-life conditions in Germany. The effect of treatment on acne severity, safety, and, for the first time, health-related quality of life (HRQoL) was investigated. Methods: Of the 292 patients (safety collective: 231 adults, 61 adolescents) who had at least grade 4 acne vulgaris on the face as per the Leeds Revised Acne Grading (LRAG), 273 (efficacy collective: 213 adults, 60 adolescents) were treated with adapalene 0.1% cream or gel and nadifloxacin 1% cream for the defined minimum of 28 days. Patients were evaluated for acne severity, acne-related facial symptoms, HRQoL, overall assessment of therapy, and safety. Results: After the median treatment duration of 37 and 38 days (adults and adolescents, respectively), 93.4% and 85.0% of adults and adolescents, respectively, exhibited a sustained decrease in acne severity. The LRAG decreased by at least 3 scores in 29.1% and 24.6% of female and male adults, respectively. HRQoL improved in 67.9% and 63.5% of adults and adolescents, respectively (median improvement in the Dermatology Life Quality Index scores per patient of 3.0 [female adults], 1.0 [male adults], and 2.0 for all adolescents in the Children's Dermatology Life Quality Index). Female adults were more impaired in terms of HRQoL compared to male adults. The 2 best overall efficacy ratings were provided by physicians in 79.3% and 69.5% and by patients in 68.5% and 58.3% of adult and adolescent cases, respectively. The treatment was well tolerated, as reflected in the low number of 9 mild adverse events (AEs), all of which resolved without treatment. However, 4 patients terminated the study prematurely due to AEs. Conclusion: In this study, the parallel use of adapalene and nadifloxacin for at least 5 weeks resulted in a rapid improvement in acne severity, an increase in HRQoL, and a good safety profile. Therefore, it represents a promising treatment option that offers the possibility of flexible therapy adjustment.
... In Poland, acne is diagnosed in about 75% of adolescents, without any difference of frequency between female and male individuals, and it decreases the quality of life in both genders [4]. Taking this into account, the psychosocial impact of acne is significant, and it may influence emotions, everyday activities, social life, study, as well as interpersonal relationships of adolescents [5]. The aetiology of acne is indicated to be multifactorial, as increased sebum secretion, endocrinological factors (including androgens), abnormal keratinization of the follicular infundibulum, bacterial proliferation, and subsequent inflammation are considered [6]. ...
Article
Full-text available
Acne vulgaris is diagnosed in the majority of adolescents, decreasing their quality of life, while the diet may influence its aetiology in a gender-dependent manner. The aim of the study was to analyse associations between nutritional behaviours and acne-related quality of life in a population of Polish male adolescents. The study was conducted on a population of Polish secondary school adolescents (a studied sample of 925 adolescents), while the random quota sampling procedure of secondary schools was applied. To assess acne-related quality of life, the Acne Quality of Life (AQoL) Scale and Acne Disability Questionnaire (ADQ) were applied, while the Social Quality of Life (SOCQOL) Score and Cardiff Acne Disability Index (CADI) were calculated. To assess the diet, an Acne-specific Food Frequency Questionnaire (Acne-FFQ) was applied. Neither for the ADQ results, nor for the CADI calculated on the basis of ADQ, was there an association with dietary intake (p > 0.05). The results of the SOCQOL Score (calculated on the basis of AQoL) were positively correlated with the intake of fish (p = 0.0085; R = 0.1144), salty snacks (p = 0.0495; R = 0.0854), and non-chocolate confectionary (p = 0.0078; R = 0.1156). In a group of respondents declaring any acne-related quality of life problems in AQoL, while compared with those declaring no such problems, higher intakes of dairy beverages other than milk (p = 0.0063), white bread (p < 0.0001), other white cereal products (p < 0.0001), fast foods (p = 0.0006), salty snacks (p < 0.0001), chocolate confectionary (p < 0.0001), and other confectionary (p < 0.0001), but lower intake of wholegrain bread (p = 0.0084) were observed. It may be concluded that acne-related quality of life is associated with dietary intake in a population of Polish male adolescents. In the studied population, the most prominent influencing factors were salty snacks and non-chocolate confectionary, with both of them having a proacnegenic effect.
... Dermatological disorders are prevalent worldwide and regarded as one of the major global burdens among various diseases [16]. Severe skin damage from burns or wounds as well as acne (i.e., often causes erythematous papulopustular lesions such as rash consisting of papules and pustules) can also lead to trauma and further psychosocial stresses besides possible pain or other aggravations caused by the disorder itself [17,18]. Dermatological disorders can be atopic dermatitis, alopecia (androgenic alopecia and alopecia areata, both indicating hair loss), hirsutism (growth of excess coarse body hair usually in women in places where hair is not supposed to grow), hyperhidrosis (excessive sweating), hidradenitis suppurativa (chronic and progressive inflammatory skin condition affecting groin, buttocks, and perineal and perianal regions), vitiligo, psoriasis, and melanoma [19]. ...
Article
Nanomedicines emerged from nanotechnology and have been introduced to bring advancements in treating multiple diseases. Nano-phytomedicines are synthesized from active phytoconstituents or plant extracts. Advancements in nanotechnology also help in the diagnosis, monitoring, control, and prevention of various diseases. The field of nanomedicine and the improvements of nanoparticles has been of keen interest in multiple industries, including pharmaceutics, diagnostics, electronics, communications, and cosmetics. In herbal medicines, these nanoparticles have several attractive properties that have brought them to the forefront in searching for novel drug delivery systems by enhancing efficacy, bioavailability, and target specificity. The current review investigated various therapeutic applications of different nano-phytopharmaceuticals in locomotor, dermal, reproductive, and urinary tract disorders to enhance bioavailability and efficacy of phytochemicals and herbal extracts in preclinical and in vitro studies. There is a lack of clinical and extensive preclinical studies. The research in this field is expanding but strong evidence on the efficacy of these nano-phytopharmaceuticals for human use is still limited. The long-term efficacy and safety of nano-phytopharmaceuticals must be ensured with priority before these materials emerge as common human therapeutics. Overall, this review provides up-to-date information on related contemporary research on nano-phytopharmaceuticals and nano-extracts in the fields of dermatological, urogenital, and locomotor disorders.
... The scars at the level of the skin represent a normal and inevitable process of healing of traumatic or surgical lesions, but except for the appearance of the skin, they also have a profound psychological impact [1,2]. Thus, people with scars try to integrate them into their own sense of self to gain psychological acceptance [3]. ...
Article
Full-text available
(1) Background: Scars are the consequence of physiological inherent healing processes of post-traumatic and surgical lesions with a psychological impact. Post-traumatic scarring may induce emotional and behavioral changes through social stigma. In this study we analyze the internalization of scars and their impact on hopelessness, depression, or the perception of social support in subjects with post-traumatic scars compared to people with surgical scars. (2) Methods: to research this suggested model, we analyzed data collected from 110 participants 61 women and 49 men, aged between 18 and 64 years; 55 participants had post-traumatically and 55 surgically acquired scars. They all were examined to assess the characteristics of scars, were asked to complete four psycho-social scales, and the results were compared. (3) Results: our results indicate that people with post-traumatic scars are oriented toward the internalization of scars, depending on their shape and size. We argue that hopelessness, appreciation of scars, age, and how scars are produced are important predictors of internalization. (4) Conclusions: the patient’s attitude toward the appearance of a scar is an indicator of how he/she will react in the future and it could predict the vulnerability to hopelessness. Finally, we nuance the impact of objective bodily harm on the psychological and moral suffering.
... Skin disorders are associated with various factors like age, gender, nutritional status and stress [6,7,8]. Similar to our findings, a study done by Neirita et al, reported that acne vulgaris affects the emotional status, interpersonal, personal and social activities [9]. ...
Article
Full-text available
Relevance. Acne vulgaris is chronic inflammatory disorder which is known to have major psychological impact on adolescents which results in residual scarring and pigmentation. Acne is devastating disease and have significant negative psychosocial impact as their faces being checked by others leading social anxiety. Objective: this study was conducted with objectives to study psychosocial impact due to acne vulgaris. Materials and methods. This study includes 200 patients of 15 years and above of acne vulgaris patients. Global Acne Grading System was used to grade severity of acne and dermatology life quality index (DLQI) was used to measure psychosocial quality of life. Data collected was entered into MS excel sheet and statistical analysis was done by SPSS software. Results. Majority of patients (58%) were localised mostly on face and with grade – II. 39.5% were mildly affected 47% were moderately affected with quality of life in the study. Conclusions. Significant impact of acne vulgaris was noted on emotional, social, study was noted in adolescent population.
... Before the onset of dementia symptoms, pellagra patients have clear minds, but they are accompanied by adverse emotional and psychological changes such as depression, apathy, despair, irritability, anorexia, poor appetite, distress and sadness, insomnia, anxiety, fear, memory decline, inability of logical thinking and so on [13][14][15][16][17]. Patients with chronic acne have negative psychological symptoms. Acne vulgaris is associated with social isolation, employment difficulties, depression, and suicide [8,[18][19][20]. With time, the inflammation of acne vulgaris disappeared, while depression might still exist. ...
Article
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Background: Acne, the most common skin disease characterized by comedones, papules, pustules, nodules, and/or cysts, has a prevalence of 90% during adolescence. The pathogenesis of acne vulgaris requires further study based on the pathological and pathophysiological changes in acne. Recent findings and evidence: Adolescence is the period when teenagers have very high nutritional demands. The occurrence of acne during adolescence suggests that the patient is nutritionally deficient or has increased nutritional requirements. Malnutrition of vitamins (niacin) is the most important cause of abnormal metabolism and inflammation. A pellagra diagnosis should focus on the presence of the "3 D's" (diarrhea, dermatitis and dementia). The clinical features of acne include "3 D's": dermatitis (acne, seborrheic dermatitis), dyspepsia, and depression. Patients with acne are frequently associated with abnormal serum lipid profiles and elevated sebum secretion. Foam cells are an important pathological change in acne lesions. Niacin is the only vitamin that promotes the efflux of cholesterol and other lipids from cells and prevents foam cell formation. Foam cells in acne lesions suggest that patients with acne are deficient in niacin. Recently, several studies have reported the efficacy and safety of nicotinamide and niacin for acne treatment. Summary: Based on an analysis of the clinical feature of acne patients, pathological changes in acne lesions and the therapeutic effects of niacin on acne, we propose that acne can be diagnosed as a specific clinical type of pellagra, and niacin is the first choice for the treatment of acne vulgaris.
Article
Background. Acne is the most common inflammatory skin disease in adolescence. It is also prevalent in adults, especially females. The disease has a considerable impact on health-related quality of life. Many studies have reported the negative impact of acne on patients due to skin disfigurement, ineffective treatment, and adverse effects of the treatment. Numerous factors contribute towards nonadherence to therapy. Summary. This review discusses the various factors that are related to treatment nonadherence such as ineffective therapy, adverse effects with topical pharmacotherapy such as skin irritation and erythema as well as patient-related factors such as lack of knowledge of disease and a poor patient-physician relationship. Various methods are being adopted to increase adherence to treatments. Increased adherence to acne therapy has been associated with the use of dermocosmetics, such as moisturizers and cleansers. Encouraging the use of dermocosmetics in synergy with pharmacological regimens could support improved treatment adherence resulting in better clinical outcomes for acne patients. Conclusion. Dermocosmetics as an adjunct to pharmacological regimens has the potential to improve clinical outcomes by increasing treatment adherence in patients with acne.
Article
Background. The postacne symptom complex occurs in the outcome of vulgar acne in 40% of cases. Recently, there has been a tendency to grow up acne. Currently, there are many methods in the arsenal of a dermatologist and a cosmetologist for correcting post-acne elements, but most of the procedures for correcting postacne elements have age restrictions, some of the procedures are accompanied by severe pain and the presence of a rehabilitation period, and the economic component of these procedures is also of great importance. Therefore, for the treatment of the post-acne symptom complex, there should be methods that are highly effective and accessible to patients. In most cases, the assessment of the clinical effectiveness of treatment is subjective, both for the doctor and for the patient. Photo documentation is also not in all cases a reliable way to represent the quality and effectiveness of treatment. Consequently, the use of hardware methods for quantifying the severity of disease indicators to confirm the effectiveness of treatment increases the patient's compliance. Aims. Evaluation of the effectiveness of Postacnetin gel in the treatment of postacne symptom complex, using the ANTERA 3D device. Materials and methods. 12 patients aged 18 to 28 years with the presence of postacne symptoms were under observation. The study was conducted on the basis of the Department of Dermatovenereology of SibSMU and the medical center Estetik in Tomsk. During the entire study period, patients applied Postacnetin gel to one half of the face. Treatment regimen: Postaknetin gel was applied in a thin layer, point-by-point on the postakne elements 2 times a day. The duration of treatment was 28 days. To assess the clinical effectiveness, photo documentation, three-dimensional analysis of the skin surface on the ANTERA 3D device and statistical analysis were performed. Results. The average level of redness in 12 patients on the side of using Postacnetin gel before the study was 117.200 0.424, 1 month after using the gel, there was a significant decrease in the level of the indicator to 95.900 0.849 (р 0.05). The average value of the pigmentation level before using the Postacnetin gel and 1 month after use was 56.950 0.919 and 46.600 0.424, respectively (р 0.05). This indicates a significant decrease in the level of pigmentation. The average value of the volume index before the study was 9.350 0.212, after 28 days the volume index decreased to 6.750 0.071, respectively (р 0.05). Conclusions. As a result of the conducted research, it was established with the help of the ANTERA 3D device that the use of Postacne gel for 28 days leads to a regression of the indicators of postacne elements.
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Acne is the most common skin disease and isotretinoin is the most powerful drug among the various drugs used for its treatment, but it has some adverse effects. The aim of this study was to evaluate the effect of isotretinoin on depression and quality of life of a group of patients undergoing isotretinoin therapy before and after the treatment course. In this prospective study, 98 patients with severe acne were enrolled consecutively and underwent isotretinoin therapy receiving 0.5 mg/kg/d of isotretinoin for 16 weeks. Isotretinoin effects on quality of life and depression were evaluated using Dermatology Life Quality Index (DLQI) and Beck Depression Inventory (BDI) questionnaires, respectively. In this study, 98 patients suffering from severe acne (38 males and 60 females) were enrolled. Treatment of acne was associated with improvement of quality of life scores in both male and female patients (p = 0.001). Considering the cutoff value of 13 for mild depressive mood in the BDI score, in total, 48 (49%) of the enrolled patients (21 males and 33 females) had a mild depressive mood before the commencement of the treatment in this study. The analysis of before and after treatment BDI scores showed that the number of patients and also the mean score of BDI were increased in both male and female patients after the treatment (p<0.05). Isotretinoin therapy improved the quality of life of patients suffering from acne, but depression was accentuated in the patients to some extent.
Article
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Acne vulgaris is a common skin condition, which affects most adolescents at some point in their lives. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicide ideation. Many studies have assessed the impact of acne vulgaris on the quality of life (QoL) in different population subgroups around the world, but there is a dearth of reports from the African subcontinent. This study thus seeks to assess the severity of acne vulgaris and determine its effect on the QoL of adolescents in Lagos, Nigeria. In a cross-sectional survey employing a two-stage sampling method, the severity of acne vulgaris and its impact on the QoL of adolescents attending a senior secondary school in Lagos, Nigeria was assessed using the Global Acne Grading Scale (GAGS) and the Cardiff Acne Disability Index (CADI), respectively. The correlation between the results of the GAGS and CADI was also determined. One hundred and sixty adolescent students with acne were recruited, with males accounting for 51.9% and females 48.1%. The mean and standard deviation of the GAGS severity scores were 11.3±5.4 for males and 11.9±5.4 for females. Only one student had severe acne vulgaris (GAGS, 31-38), 10% moderate (GAGS, 19-30), and 89.4% mild (GAGS, 1-18). The overall CADI score was 3.4±3.0, which suggests mild impairment in QoL; however, the solitary student with severe acne had severe QoL impairment. There was a weak positive correlation between the GAGS and the CADI score. Most adolescents in our study had mild acne vulgaris, and the overall impact on their QoL was mild. However, the correlation between the psychosocial impact and acne severity was weak. There is a need for similar studies in other parts of the country and for further studies to determine the adequacy of the existing instruments in assessing the impact of acne vulgaris in Nigerian adolescents.
Article
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Acne vulgaris can severely affect social and psychological functioning. The aim of this study was to investigate the impact of acne vulgaris and its severity on Quality of Life of young adolescents in Greece. We conducted a questionnaire based survey among 1560 adolescent between the ages of 11 and 19 years old and 1531 of these were completed. Adolescents with acne filled all the questions including the Children Dermatology Life Quality Index. Adolescents without acne filled the questions about age, family history of acne, stress and smoking. Data were analyzed with Pearson Chi Square test. Acne prevalence was 51.2% affecting both sexes equally. Self reported mild acne was present in 71.2% and moderate-severe acne in 28.8% of the study population. The mean age of the study population was 15.77y. The median score of Children Dermatology Life Quality Index was 4.02. The impact of acne on quality of life is associated with the severity of the acne (p<0.0001). Patients with moderate/severe acne experience greater psychosocial and emotional impairment (p<0.0001). Body image is modified proportionally to the severity of acne (p<0.0001). Symptoms and treatment of acne are factors that also influence their quality of life. Girls and boys are equally affected. Stress and heredity are correlated with acne and its severity (p<0.0001). We didn't find any correlation between smoking and acne. Acne affects Quality of Life of young adolescents in Greece. The impact is proportional to the severity of acne. More severe acne is associated with greater effect on quality of life with implications for self esteem, body image and relationships with others.
Article
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Acne may cause psychological distress that is associated with many psychiatric disorders. In this issue, Halvorsen et al. report suicidal ideation, mental health problems, and affective isolation to be relatively frequent in adolescents with acne. This report suggests that adverse events that have been attributed to therapies for acne, including suicidal ideation and depression, may reflect the burden of substantial acne rather than the effect of medications.
Book
The late Arthur Rook established the Textbook of Dermatology as the most comprehensive work of reference available to the dermatologist. Covering all aspects of skin disease from basic science through pathology and epidemiology to clinical practice, the text is recognized for its unparalleled coverage of diagnosis. Hailed by reviewers as 'a thorough, modern masterpiece' and 'the best textbook of dermatology in the world', and trusted by dermatologists around the world for accurate and comprehensive coverage, this clinical classic is the definitive source of information for all dermatologists. The new edition of this venerable classic extends the standard of excellence to include: All-new coverage of cosmetic dermatology and sexually transmitted diseases. More material on evidence-based dermatology. Increased coverage of dermoscopy. More emphasis on therapeutics throughout the set. More contributions from a greater variety of international experts. New page design with larger illustrations for more immediate recognition. The 8th Edition marks the debut of the online edition of Rook's Textbook of Dermatology, allowing users the fastest possible access to the full range of knowledge on all known dermatological conditions. With fully searchable text and a fully searchable bank of more than 3,300 downloadable images, this online version puts specific information at your fingertips - when and where you need it - and is free with purchase of the four-volume set. The person-specific access code travels with you, not your computer, so you can check with Rook from any location. With the online version, you can: Search across all four volumes simultaneously. Search all images separately. Download images into presentations. Link directly to references via a range of sources. Rook's Textbook of Dermatology, in print and now online, provides a reliable, constant companion for all dermatologists.
Article
Objective: Acne is an inflammatory disease of pilosebaceous units. Major complications of acne are scarring and psychosocial effects. When compared to other chronic illnesses, patients with acne have been shown to have levels of social, psychological, and emotional impairments similar to those with serious diseases. This study is aimed to assess the effects of acne, including acne severity and acne scar on the patientûs quality of life using a Thai version of the Dermatology Life Quality Index (DLQI). Methods: One hundred and ten patients with acne who attended the Dermatology Outpatient Clinic, Siriraj Hospital, were asked to complete the Thai version of the DLQI questionnaires by themselves. Clinical severity of acne and acne scars were assessed. Results: Of 110 patients, 80 (72.7%) were females with a mean (SD) age of 26.0 (6.6) years and a range of 16-52 years. Most of the patients were students. The mean total DLQI score was 8.95 (range 0-24). Questions concerning embarrassment had the highest mean DLQI score, which meant the greatest impairment of the quality of life. The others that also had high mean DLQI scores were questions which represented social activities, itchy/sore/painful/stinging skin, and treatment difficulties, respectively. Concerning personal relationship problems, female patients had significant higher mean DLQI scores than male patients (p
Article
Summary Background: The relationship between acne and psychological well-being has been a subject of controversy. There is paucity of data on the role of anger in acne vulgaris. The present study was designed to delineate the relevant psychometric characteristics of acne vulgaris and specifically to shed light on the role of anger in acne vulgaris. Patients and Methods: 31 acne vulgaris patients and 25 controls with healthy skins were recruited in the study. The subjects were assessed by Beck Depression Inventory, State-Trait Anxiety Inventory, Rosenberg Self-Esteem Scale, and Spielberger State-Trait Anger Expression Inventory. Results: The acne group had significantly higher scores on depression and trait anxiety scales and their self-esteem was significantly lower than controls. No significant difference was detected on anger-related subscales between the acne and control groups. Conclusions: Our data indicate that acne has a serious impact on the patients’ lives. We also conclude that no association exists between anger and acne vulgaris.
Article
Meta-analysis was used to examine findings in 2 related areas: experimental research on the physical attractiveness stereotype and correlational studies of characteristics associated with physical attractiveness. The experimental literature found that physically attractive people were perceived as more sociable, dominant, sexually warm, mentally healthy, intelligent, and socially skilled than physically unattractive people. Yet, the correlational literature indicated generally trivial relationships between physical attractiveness and measures of personality and mental ability, although good-looking people were less lonely, less socially anxious, more popular, more socially skilled, and more sexually experienced than unattractive people. Self-ratings of physical attractiveness were positively correlated with a wider range of attributes than was actual physical attractiveness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Acne, the most common problem that presents to dermatologists, can persist beyond teen years. Although its physical and psychosocial impact is studied in teen years, it is poorly understood in the Indian adult population. To study the physical and psychosocial impact of acne in adult females. This exploratory study was done in the university setting. Eleven adult, unmarried females, between the age group of 18 and 25 years, having (mild-to-moderate), acne, for two consecutive years, were interviewed using a semi-structured clinical interview of the Skindex, a quality-of-life measure for patients with skin disease, developed by Chren et al., along with some open-ended questions. Both qualitative and quantitative analysis was done to analyze the data. The results indicated a higher level of emotional and social impairment, in terms of the feelings of physical discomfort, anger, and the intermingling impact of these, among the participants. Acne is a common problem among adults and appears to have a considerable impact on the mental health, therefore, for the treatment to be successful, a sympathetic approach by doctors and significant others, with the basic psychosomatic treatment, are necessary.