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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.
References
1. Rzany B, Kahl C. Epidemiology of acne vulgaris. J Dtsch
Dermatol Ges 2006;4:8-9.
2. Kulthanan K, Jiamton S, Kittisarapong R. Dermatology
life quality index in Thai patients with acne. Siriraj Med J
2007;59:3-7.
3. Misery L. Consequences of psychological distress in adolescents
with acne. J Invest Dermatol 2011;131:290-2.
4. Tan JK. Psychosocial impact of acne vulgaris: Evaluating the
evidence. Skin Therapy Lett 2004;9:1-3, 9.
5. Magin P, Adams J, Heading G, Pond D, Smith W. Psychological
sequelae of acne vulgaris: Results of a qualitative study. Can
Fam Physician 2006;52:978-9.
6. Purvis D, Robinson E, Merry S, Watson P. Acne, anxiety,
depression and suicide in teenagers: A cross-sectional survey
of New Zealand secondary school students. J Paediatr Child
Health 2006;42:793-6.
7. Loney T, Standage M, Lewis S. Not just ‘skin deep’:
Psychosocial effects of dermatological-related social anxiety in
a sample of acne patients. J Health Psychol 2008;13:47-54.
8. Yazici K, Baz K, Yazici AE, Köktürk A, Tot S, Demirseren D,
et al. Disease-specific quality of life is associated with anxiety
and depression in patients with acne. J Eur Acad Dermatol
Venereol 2004;18:435-9.
9. Sayar K, Ugurad I, Kural Y, Acar B. The psychometric
[Downloaded free from http://www.e-ijd.org on Tuesday, May 9, 2017, IP: 59.97.82.233]
Hazarika and Archana: Psychosocial impact of acne vulgaris
520Indian Journal of Dermatology 2016; 61(5)
assessment of acne vulgaris patients. Dermatol Psychosom
2001;1:62-5.
10. Khan MZ, Naeem A, Mufti KA. Prevalence of mental health
problems in acne patients. J Ayub Med Coll Abbottabad
2001;13:7-8.
11. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of
suicidal ideation among patients with skin disease. J Am Acad
Dermatol 2006;54:420-6.
12. Fakour Y, Noormohammadpour P, Ameri H, Ehsani AH,
Mokhtari L, Khosrovanmehr N, et al. The effect of
isotretinoin (roaccutane) therapy on depression and quality
of life of patients with severe acne. Iran J Psychiatry
2014;9:237-40.
13. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) – A
simple practical measure for routine clinical use. Clin Exp
Dermatol 1994;19:210-6.
14. Adityan B, Kumari R, Thappa DM. Scoring systems in acne
vulgaris. Indian J Dermatol Venereol Leprol 2009;75:323-6.
15. Tasoula E, Gregoriou S, Chalikias J, Lazarou D, Danopoulou I,
Katsambas A, et al. The impact of acne vulgaris on quality of
life and psychic health in young adolescents in Greece. Results
of a population survey. An Bras Dermatol 2012;87:862-9.
16. Reich A, Trybucka K, Tracinska A, Samotij D, Jasiuk B,
Srama M, et al. Acne itch: Do acne patients suffer from
itching? Acta Derm Venereol 2008;88:38-42.
17. Wu SF, Kinder BN, Trunnell TN, Fulton JE. Role of anxiety and
anger in acne patients: A relationship with the severity of the
disorder. J Am Acad Dermatol 1988;18(2 Pt 1):325-33.
18. Ogedegbe EE, Henshaw EB. Severity and impact of acne
vulgaris on the quality of life of adolescents in Nigeria. Clin
Cosmet Investig Dermatol 2014;7:329-34.
19. van der Meeren HL, van der Schaar WW, van den Hurk CM.
The psychological impact of severe acne. Cutis 1985;36:84-6.
20. Feingold A. Good-looking people are not what we think.
Psychol Bull 1992;111:304-41.
21. Motley RJ, Finlay AY. How much disability is caused by acne?
Clin Exp Dermatol 1989;14:194-8.
22. Yolaç Yarpuz A, Demirci Saadet E, Erdi Sanli H,
Devrimci Ozgüven H. Social anxiety level in acne vulgaris
patients and its relationship to clinical variables. Turk
Psikiyatri Derg 2008;19:29-37.
23. Fried RG, Wechsler A. Psychological problems in the acne
patient. Dermatol Ther 2006;19:237-40.
24. Walker N, Lewis-Jones MS. Quality of life and acne in Scottish
adolescent schoolchildren: Use of the Children’s Dermatology
Life Quality Index (CDLQI) and the Cardiff Acne Disability
Index (CADI). J Eur Acad Dermatol Venereol 2006;20:45-50.
25. Layton AM. Disorders of sebaceous glands. In: Burns T,
Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook
of Dermatology. 8th ed., Vol. 42. Oxford: Wiley-Blackwell
Publication; 2010. p. 1-89.
26. Pruthi GK, Babu N. Physical and psychosocial impact of acne
in adult females. Indian J Dermatol 2012;57:26-9.
27. Rubinow DR, Peck GL, Squillace KM, Gantt GG. Reduced
anxiety and depression in cystic acne patients after successful
treatment with oral isotretinoin. J Am Acad Dermatol
1987;17:25-32.
28. Tedeschi A, Dall’Oglio F, Micali G, Schwartz RA,
Janniger CK. Corrective camoufl age in paediatric dermatology.
Cutis 2007;79:110-2.
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... For DLQI scores, there were five groups such as DLQI group 0: normal (0-1), group 1: mild [2][3][4][5], group 2: moderate [6][7][8][9][10], group 3: severe [11][12][13][14][15][16][17][18][19][20], and group 4: very severe (21-30) quality of life impairment. For BDI scores, there were six groups: group 1: normal [1-10], group 2: mild impairment [11][12][13][14][15][16], group 3: clinical depression [17][18][19][20], group 4: moderate [21][22][23][24][25][26][27][28][29][30], group 5: severe (31-40), and group 6: very severe depression (41-63). According to LSAS scores, there were five groups, including group 0: < 55 points, group 1: mild (55-65 p), group 2: moderate (65-80 p), group 3: severe (80-95 p), and group 4: very severe (> 95 p) anxiety and social phobia. ...
... In their study, which included 100 AV cases, Hazarika and Archana reported that AV had a significant psychosocial impact [24]. Similarly, Vilar, Santos, and Sobral Filho [4] compared the QoL scores of adolescents with AV to adolescents without AV and noted apparent quality of life impairment within the AV cohort. ...
Article
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Background Acne vulgaris, a common dermatological condition, has physical manifestations and significant emotional and social implications for those affected. This study aims to assess the stigma experienced by acne vulgaris patients and identify relevant physical, social, and psychological factors. Methods The research involved individuals aged 12–45 diagnosed with acne vulgaris. The authors recorded each patient's demographic information, global acne severity, and acne scar severity. Additionally, each patient completed the Dermatologic Life Quality Index, Beck Depression Inventory, Liebowitz Social Anxiety Scale, and 6‐item stigmatization scale. Using the scale scores, the authors categorized the severity into subgroups and compared the results within these subgroups. Results The severity of acne was positively correlated with DLQI scores (r = 0.196, p = 0.004) and stigmatization scores (r = 0.156, p = 0.024). Higher stigmatization scores were associated with increased levels of depression (r = 0.461, p < 0.001) and anxiety (r = 0.336, p < 0.001), as well as a significant impact on quality of life (r = 0.472, p < 0.001). Upon stratification of patients into three age groups (adolescence, late adolescence, and adulthood), the comparisons between these groups did not reach statistical significance. Conclusion The results of the current study reveal a clear connection between the severity of acne and psychosocial disturbances, irrespective of age. The authors advise incorporating psychosocial screening, especially for severe acne vulgaris patients of all ages.
... In terms of affected sites, a study revealed that facial acne as a singularly involved site was the most prevalent type, occurring in 60% of cases. Conversely, multiple site involvement, encompassing the face, chest, and back concurrently-was observed in 37% of cases (23). Furthermore, it was observed that acne predominantly manifested on the facial region in 82.5% of cases, with the back (34.8%) and chest (14.8%) being less commonly affected areas. ...
... The stigma associated with acne can lead to social withdrawal, which perpetuates emotional distress. Addressing both the clinical and psychological aspects of acne can improve patient satisfaction and treatment adherence [7,8]. With the limitations of pharmacological therapies, device-based treatments have become increasingly important in providing targeted, non-systemic solutions. ...
Article
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Objective: This case series aims to evaluate the efficacy, patient satisfaction, and safety of combined needle radiofrequency (RF) and topical exosome therapy for moderate to severe acne. Methods: This study involved 22 patients (12 females and 10 males, ages 18–35) with moderate to severe acne who underwent combined needle RF and topical exosome (Xomage, Zishel Bio Inc., Seoul, Republic of Korea) treatments. Each patient completed between 6 and 10 sessions, conducted weekly over three-week intervals. Acne severity was assessed using the Investigator’s Global Assessment (IGA) scale, while patient satisfaction was measured on a 5-point Likert scale. Clinical photographs were taken at baseline and after the final treatment session. Results: All patients showed improvement in acne severity with a mean decrease in IGA score of 2.5 points from baseline to the final assessment. Patient satisfaction was high, with the majority expressing satisfaction in skin texture and acne reduction. Conclusion: Needle RF combined with topical exosome therapy appears to be an effective treatment for reducing acne lesions and improving skin quality, demonstrating a strong safety profile and high patient satisfaction.
... Указанный возрастной период в отечественной психологии принято относить к ранней юности, именно данный критический этап становления личности, в первую очередь, опреде-ляется социальными условиями, и именно от него будут зависеть последующее положение человека в обществе и его жизненный путь, включая выбор профессиональной деятельности [6]. Вместе с этим крайне важно понимать, что ВА оказывает выраженное негативное влияние как на качество жизни, так и на психосоциальное благополучие, приводя к формированию ряда психических расстройств и физическому дискомфорту [7,8]. Даже легкие формы заболевания имеют значительное отрицательное воздействие на самооценку и самовосприятие человека, поскольку приводят к ошибочным суждениям окружающих, оценивающих пациентов с ВА легкой степени тяжести как «менее надежных», ...
Article
Acne vulgaris (AV) is a common skin pathology in adolescents, it is characterized by chronic recurrent inflammatory process affecting the pilosebaceous units. This disease has significant negative effect on both quality of life and psychosocial well-being, resulting in development of various mental disorders and physical discomfort, including not only typical clinical signs, but also post-acne symptom complex. Nowadays, the paramount importance in disease pathophysiology are changes in the skin microbiome caused by interactions between genetic and exposomal factors leading to increased cutaneous fatty secretion by sebocytes and concomitant dysfunction of the epidermal barrier due to ongoing inflammatory process. Current AV treatment options include topical and systemic therapies with various clinical and pharmacological groups. However, most available options (for dermatovenerologists) can provoke dry skin and irritate sensitive adolescent skin due to additional disruption of epidermal barrier and microbiome composition. All together it significantly reduces patient compliance, and, therefore, reduces the treatment success rate. We have to mention that AV management should be carried out for a long time to prevent the recurrence observed in one third of all cases. It emphasizes the topicality of adequate optimization of treatment regimens used in wide clinical practice. In this context, guidelines for skin care have the leading role. It is crucial part of AV management, and it can not only improve compliance, but also increase the efficacy of prescribed drugs through synergistic interactions. Though, the comprehensive analysis of the available core care products, their composition and the effect of their ingredients on the structural and functional integrity of the skin, is required to ensure such effect.
Article
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Background Topical retinoids, while renowned for their efficacy in treating acne vulgaris, are often hampered by inter‐individual variability in tolerability. This challenge, primarily driven by side effects like erythema, scaling, and dryness, significantly impacts patient adherence and, ultimately, treatment outcomes. Aims This prospective, multi‐center, observational study investigated the novel role of a specific dermocosmetic regimen as adjunctive therapy, focusing on its ability to mitigate retinoid‐induced side effects and enhance the overall tolerability of acne treatment regimens in a Korean population. Patients and Methods We enrolled 304 patients receiving conventional acne therapies and integrated a standardized dermocosmetic regimen (foaming facial wash and moisturizer) for 12 weeks. Our primary endpoint assessed changes in skin sensitivity scores in both retinoid and non‐retinoid users. We incorporated a patient‐reported outcome measure evaluating acne's impact on quality of life across different facial areas as a secondary endpoint. Results Our results revealed a significant improvement in skin sensitivity across both patient groups, effectively mitigating the anticipated heightened sensitivity in retinoid users. This finding suggests that dermocosmetics may hold the key to unlocking consistent, age‐independent tolerance to retinoid therapy. Furthermore, we observed a compelling correlation between improvements in cheek acne and enhanced quality of life, highlighting the profound psychological impact of this specific facial area. Conclusions This study pioneers a new understanding of holistic acne management, emphasizing the synergistic potential of dermocosmetics in enhancing treatment adherence, improving long‐term outcomes, and ultimately transforming patients' lives.
Article
Background Acne vulgaris is a common disorder of the pilosebaceous unit seen primarily in adolescents. There is still a paucity on understanding about acne. Although nonlife-threatening, acne has a significant impact on social, psychological, and emotional well-being. Materials and Methods Ananalytical cross-sectional study was conducted among high school students using constructed, self-administered questionnaires adapted from previous studies. Results Among 416 respondents, 340 (81.73%) have acne. Acne is not considered contagious which was believed by 154 (45.26%) students with acne and 28/76 (36.84%) of those without. Despite controversial findings, diet, hormones, genetics, emotional stress, lifestyle, menstruation, and cosmetics are thought to play roles in acne. Students believed lack of sleep, hormones, stress, oily/fatty foods, menstruation, cosmetics, sunlight, and poor hygiene aggravate acne. There were significant differences in responses of those with and without acne to food/diet and hormones ( P 0.000 and 0.006, respectively). There were also significant differences in the distribution of answers between those with and without acne on sweets ( P 0.002) and heat/sun exposure ( P 0.004). The students’ quality of life (QOL) assessed using teenagers’ QOL and Cardiff Acne Disability Index showed weak positive and statistically significant correlation between scores and acne severity indicating that as the severity of acne increases, the greater the impairment in their QOL. Conclusion Beliefs and perceptions about acne play an important part in management and compliance. The results generally equate from evidence-based data. Few misconceptions may be brought by misleading information and different opinions. The physical, social, and psychological morbidity associated with acne can be profound and the QOL can be impaired.
Article
Acne is an inflammatory condition in the pilosebaceous glands due to many factors, including colonization of Propionibacterium acnes. White tea and pomegranate seed oil (PSO) contain many phytochemical constituents with antibacterial properties. This study aims to develop emulgel preparations containing white tea extract and PSO with good physical characteristics and stability. The study was also conducted to determine the antibacterial activity of extracts and emulgel preparation against the acne-causing bacteria P. acnes. White tea was extracted using 70% ethanol by ultrasonic extraction method. Antibacterial activity tests were conducted using agar well diffusion. Emulgels were prepared using PSO as the oil phase, stearic acid and triethanolamine (TEA) as the emulsifier agent, and viscolam mac 10 as a gelling agent. The emulgels were evaluated by organoleptic, pH, viscosity, spreadability, centrifugation, and freeze-thaw tests. The white tea extract has potent antibacterial activity against P. acnes with a MIC value of 0.05%. The extract at 1% and 2% concentrations has been successfully developed into an emulgel system with good physical characteristics based on organoleptic, pH, viscosity, and spreadability tests. The emulgel was stable base on the centrifugation and freeze-thaw tests. Emulgel containing 2% white tea extract has optimum antibacterial activity with an inhibition zone of 12.80 ± 0.20 mm, The white tea emulgel has potent antibacterial activity and can be further developed as anti-acne product
Article
Acne vulgaris is a common dermatological condition requiring individualized management. Teledermatology provides convenience and accessibility that is highly suitable for this dermatological condition. Herein, our review aimed to describe the current state of teledermatology in the context of acne management and to assess patient satisfaction, adherence to virtual care, and the experiences of health care providers in delivering remote dermatological services. A systematic search for articles was conducted in Medline, Embase, and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Title, abstract, full-text screening, and data abstraction were carried out in duplicate. One thousand one hundred three nonduplicate articles were screened based on title and abstract review. A total of 21 studies were included in the review. It was found that teledermatology is well-suited to the effective management of acne vulgaris. When compared to in-person care, teledermatology resulted in similar outcomes on several acne-grading scales. Additionally, patient satisfaction was comparable, with a large proportion of patients preferring virtual care to traditional in-person visits. However, compliance was found to be lower for virtual care. There are several secondary benefits to telemedicine, including time savings and greater accessibility to care for rural patients. Teledermatology is an evolving, promising medium for acne management for both clinicians and patients. Future research comparing the effectiveness of different teledermatology platforms, its limitations and pitfalls, and integration of patient and physician preferences to improve treatment outcomes is warranted.
Article
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Backgrounds Acne vulgaris is one of the most common skin conditions worldwide among adolescents. Beyond its physical manifestations, acne can leave invisible psychological scars. Objectives We aimed to examine the protective and risk factors of acne-related quality of life, and its association with mental health outcomes. Methods The analysis included data collected in 2023 from adolescents enrolled in the SEROCoV-KIDS population-based cohort. By combining the Acne Severity and Acne-Quality of Life (Acne-QoL) scales, three groups were established: Acne-LowAQoL (adolescents with acne and low Acne-related Quality of Life), Acne-HighAQoL, and NoAcne-HighAQoL. We used multinomial and logistic regression to assess the association between health behaviours, these groups, and mental health outcomes. Results Among 335 adolescents (mean age 16.1 years [SD 1.8], 56% female), 65 (19.4%) reported experiencing acne while maintaining a high Acne-QoL, 26 (7.7%) reported having acne and a low Acne-QoL and 244 (72.9%) reported having nearly no acne. Low engagement in physical activity (aOR: 0.30, 95% CI: 0.12-0.77), addictive use of social media (aOR: 3.78, 95%CI: 1.60-8.96), and prolonged screen time (aOR: 2.99, 95%CI: 1.26-7.08) were independently associated with Acne-LowAQoL. Conversely, those from the group Acne-HighAQoL reported higher social support (aOR: 1.95, 95%CI: 1.07-3.54). Adolescents with Acne-LowAQoL showed lower levels of self-esteem, resilience, and increased psychological distress. Conclusions Among adolescents with acne, physical activity and social support were positively associated with good acne-related quality of life, which translated into better mental health. In contrast, screen time and social media use notably reduced it. Dermatologists should incorporate these considerations into clinical practice to ensure effective patient care.
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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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Background 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. Methods 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. Results 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. Conclusion 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.
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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.
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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)
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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
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.