Acne and One‘s Self Confidence: Cross-sectional study on Malaysian Student population

Abstract

Introduction: Self-confidence of an individual must be motivated by self without the inference of any internal or external consequences. Acne is a common skin defect among adolescents, and even in adults that can cause psychological weakness affecting one’s self-confidence level. The objective of this study is to investigate the effect of acne on the self-esteem of young adults of Malaysian student population. Materials and Method: A cross-sectional survey was done using a newly developed questionnaire having majorly close ended (in 2-point scale) questions. Total of 185 Malaysian MBBS students were randomly chosen, and only 171 valid responses from the victims of acne were analyzed. Results: Among the students with acne problems, 88% of them opine that they lose their self-confidence due to the effect of acne. Out of this, 78% of them were preferred to associated with the people where as 22% of the students do not prefer to be involved with the individuals. Conclusion: From the results, it was found that acne significantly reduces self-confidence of a majority of students whereas a small group of participants does believe that acne does not describe them. Students with acne problems are more self-conscious and perform poorly in social life. It is regardless of the clinical severity of their acne. In conclusion, acne influences students’ ability in public affairs. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.83-86

Full text

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Bangladesh Journal of Medical Science Vol. 18 No. 01 January’19
Original article
Acne and One‘s Self Condence: Cross-sectional study on Malaysian Student population
Abhinitha P1, Ravina Suloshini Gengatharan2, Sarah Zulkiee3, Purveena Ganisan4, Sitharrthen
Arumugam5, Naveen Kumar6
Abstract
Introduction:Self-condenceofanindividualmustbemotivatedbyselfwithouttheinference
ofanyinternalorexternalconsequences.Acneisacommonskindefectamongadolescents,and
eveninadultsthatcancausepsychologicalweaknessaectingone’sself-condencelevel.The
objectiveofthisstudyistoinvestigatetheeectofacneontheself-esteemofyoungadultsof
Malaysianstudentpopulation.Materials and Method: Across-sectionalsurveywasdoneusing
anewlydevelopedquestionnairehavingmajorlycloseended(in2-pointscale)questions.Total
of185MalaysianMBBSstudentswererandomlychosen,andonly171validresponsesfromthe
victimsofacnewereanalyzed.Results:Amongthestudentswithacneproblems,88%ofthem
opinethattheylosetheirself-condenceduetotheeectofacne.Outofthis,78%ofthemwere
preferredtoassociatedwiththepeoplewhereas22%ofthestudentsdonotprefertobeinvolved
withtheindividuals.Conclusion:Fromtheresults,itwasfoundthatacnesignicantlyreduces
self-condenceofamajorityofstudentswhereasasmallgroupofparticipantsdoesbelievethat
acnedoesnotdescribethem.Studentswithacneproblemsaremoreself-consciousandperform
poorlyinsociallife.Itisregardlessoftheclinicalseverityoftheiracne.Inconclusion,acne
inuencesstudents’abilityinpublicaairs.
Keywords:Acne;Self-condence;Malaysian;depression
Correspondence to: Dr.NaveenKumar,DepartmentofAnatomy,MelakaManipalMedicalCollege(Manipal
Campus),ManipalAcademyofHigherEducation(MAHE),Manipal,Manipal,UdupiDistrict,Karnataka,
INDIA576104,email:naveentonse@gmail.com
1. AbhinithaP,Department ofAnatomy,Melaka Manipal MedicalCollege(ManipalCampus), Manipal
AcademyofHigherEducation(MAHE),Manipal,Karnataka,INDIA
2. Ravina Suloshini Gengatharan
3. SarahZulkiee
4. Purveena Ganisan
5. Sitharrthen Arumugam
BachelorofMedicineandBachelorofSurgery(MBBS)Students,MelakaManipalMedicalCollege,
ManipalAcademyofHigherEducation(MAHE),Manipal,Karnataka,INDIA
6. NaveenKumar,DepartmentofAnatomy,MelakaManipalMedicalCollege(ManipalCampus),Manipal
AcademyofHigherEducation(MAHE),Manipal,Karnataka,INDIA
Bangladesh Journal of Medical Science Vol. 18 No. 01 January’19. Page : 83-86
DOI: https://doi.org/10.3329/bjms.v18i1.39555
Introduction
Acneis acommon skindefect amongadolescents,
andeveninadults.Itis caused by inammation of
theskinglandsandhairfollicleswiththeincreased
sebumsecretion.Thepresenceofacnehastheimpact
of being associated with several psychological
distresses, including anxiety, depression, self-
consciousness, lowered self-concept and lack of
self-condence. Scientic literature have described
the negative impact of acne upon one’s mood self
–esteem and interpersonal relationships. Severity
ofacne evencould lead to depression and suicidal
ideation1,2,3
Self-condencerelatestoafeelingorconsciousness
ofone’spowerorofrelianceonone’scircumstances.
Aperson’sself-assurednessisnecessaryforcurbing
depression and depicts how personal achievements
arevalued.Self-condenceisofmuchimportancein
a young adult’s life.
The psychological perspectives of skin diseases
are well studied. However, disease-specic
questionnairesasusedintheformofclinicaltrialsare

84
AcneandOne‘sSelfCondence:Cross-sectionalstudyonMalaysianStudentpopulation
scanty. In this regard, survey-based studies to assess
the impact of facial acne on health-related quality
of life could help in the evaluation of therapeutic
changes4.
The present study was undertaken to understand
the attitude of Malaysian undergraduate students
concerned with the facial acne. The primary
parameters evaluated through this study were the
self-condence pattern of students with acne and
thesocial behaviorof bothacne aectedand non-
aected students. The responses given by these
students might be helpful in drafting a suitable
methodto handleany problemsassociated withit,
for instance, depression and inferiority complex
among students.
Materials and Methods
Sample size:This is a cross-sectional studybased
onrandomsamplingmethod.Atotalof185medical
undergraduate students, comprising of 102 male
students and 83 female students aged 17-19 years
participatedinthis studyandtheresponseratewas
100%. The students belonged to three dierent
Malaysian ethnic races i.e. Malays, Chinese and
Indians(MalaysianIndians)werechosenrandomly.
Data collection:Selfdesignedquestionnaireswere
usedinthestudy.Thequestionsweremostlyclosed-
ended (in 2-point scale) with few optional open-
ended. The questionnaire validated by the expert
faculties of Melaka Manipal Medical College,
ManipalUniversity.Thequestionsweredesignedin
thesimpleformanswerablebythestudentsaccording
to our objectives, and it included questions which
assessthestudent’sperceptionsregardingtheeect
ofacneontheirself-condence.Thisquestionnaire
constitutedof11closed-endedquestionswhichwere
validated by academic faculty.
Data analysis: All the data that obtained after
evaluating the questionnaires was analyzed
percentage wise. The results obtained were
representedastablesandpiechartsusingMicrosoft
Excel2007.
Ethical Clearance: Ethicalclearancewasobtained
from the institutional research committee, before the
study and the students gave their informed consent
before taking part in this study. Participation was
purelyonvoluntarybasis.
Results:
Outof185 studentswhowerevoluntarilyinvolved
in the study through the random selection, only 171
students (92%) responses were validated as they
haveself-declaredthateither they had experienced
the acne related complications or presently being
experiencing.Theremaining14students(8%)ruled
out that they have not been victims of facial acne in
their life (Figure 1).
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Uponanalyzingthesocialbehaviorattitudeof
studentswiththeissuesofacne,133outof171
(78%)studentsarewillingtobeassociatedwiththe
peoples,whileremaining38students(22%)arenot
readytobesocialwiththeindividualsduetotheir
acneproblems(Table1).
Social behaviour attitude
Students with acne
issues
(n=171)
Prefer to associate with
the people 133(78%)
Does not prefer to
associatewith the people 38(22%)
Table1:Socialbehaviorattitudeofstudentswiththe
aectedacneproblems

85
AbhinithaP,RavinaSuloshiniGengatharan,SarahZulkiee,PurveenaGanisan,SitharrthenArumugam,NaveenKumar
Discussion
Acne is a universal problem seen amongst young
adults. More than an apparent skin disease, it can
result in psychosocial distress. It has been widely
experiencedthat,individualwithacnerelatedissues
showlowerself-condencethantheirpeerswithout
acne and multiple studies exhibit a correlation
betweenacneanddiminishedqualityoflife,anxiety,
and suicidality. Based on our assessment of the
subjects,a majority state that acneinuences their
self-consciousness, present-ability, and level of
inferiorityto communicate withothers.Amongthe
subjectswhosuerfromacne,manyofthemresort
toapplyingmethodstoovercometheirproblem.Itis
presupposedthatsubjectsviewacneasanintolerable
entity. According to the outcome, the subject’s
perceptionoftheirconditionisnotparallelwiththe
clinicalseverityof theiracne.Thus,anindividual’s
personal assessment is the crucial determinant of
one’spsychosocialproblems.
Ina previous study by Hassan et alexamined 132
patientsfromaspecialistacneclinicandequatedtheir
response to questionnaires including the Derriford
appearancescaleandself-ratedacnescales5.Subjects
above20yearsofageweremorepronetosuerfrom
appearancedistress due to acne compared to those
between16to19yearsold.Theauthorsnotedthata
personalevaluationoffacialacneseverityincreased
the likeliness of self-consciousness in women, but
not in men.
Uslu et al., done a cross-sectional study with a
populationof563highschoolstudents,agedbetween
13 to 19 years of age. The report documented an
acne prevalence of 63.6% with more lesions seen
inmalesthan females.  Responsesassessed from a
questionnaire about acne, involving both, General
Health Questionnaire (GHQ), and the Rosenberg
Self-EsteemScale(RSES)showed that adolescents
with the improvement of acne due to treatment
subsequentlyhadhigherlevelsofself-esteem6.
An interview-based study by Magin et al., was
conductedfrom randomly selectedpatients visiting
general practices and specialty dermatology
practices in Australia. The study group involved
26patientssueringfromacne.Authorsconcluded
that,withrangingagesandacnestages,participants
had considerable issues with impaired self-image,
embarrassment, frustration, and low self-esteem7.
Smithardetal,conductedacross-sectionalstudywith
317adolescents usingthe Strengthand Diculties
Questionnaire (SDQ) and the Acne Management
Questionnaire (AMQ) to measure psychological
status, acne knowledge, and help-seeking behavior
of the participants. According to their perceptions,
higherSDQscorespresumedtolowself-condence.
Theauthorshavealsoreportedthat,theparticipants
withdenitelesions (morethan12lesions)ofacne
provedtohavehigherlevelsofemotionaldiculties,
and the level of understanding about the cause of
acne was low. However, a prevalence of 77% of
participants had normal SDQ scores8. However,
Srivastavaetal.,reportednocorrelationbetweenacne
andqualityoflifeofpatientseventhoughpresence
ofhigherpsychiatricmorbidityinthe patients with
acne vulgaris9.
Basedontheresultsobtained,despitebeingmedical
students, they not condent with themselves when
they have acne.  However, they do not have a
problem in association with an individual who are
having acne. Some dierent opinions were given
by the participants of these questionnaires. The
majority of them have an opinion that acne does
aect self-condence in one or another way. Most
ofthemgiven theirviewsthattheytendtohave an
uncomfortable or inferior feeling when they have
acneontheirface.Seriousproblemsofbeingvictims
ofacnereducetheirself-condencelevelsasothers
paymoreattentiontotheacneontheface.
Accordingto somestudents, acne reects hygiene.
So,theythinkthatpeoplewithacnedonotmaintain
their cleanliness. Moreover, acne victims assume that
itmakestheirappearanceunaesthetic.Afewofthem
sharetheopinionthathavingacneonthefaceisnot
presentableandmakespeoplejudgethem wrongly.
All these reasons contribute to the fact that acne
reducesanindividual’sself-esteeminaway.
Thepresentstudyinvolvingtheteens,andthefactis
teensgainindependenceduringadolescence.Atthis
stage,theirattitudetowardstheacnecouldadversely
eectontheiracademicactivities and hamper their
socialbehaviors.So,itisimperativetoconsiderthe
presenceofco-morbidpsychologicaldisordersinthe
treatment of acne related issues to attain a successful
impact of therapy on psychological outcomes10.
Timelyguidanceeitherfromtheirparentsorfriends
could overcome these complications, as there is a
positive correlation between treatment adherence
andimprovedqualityoflife11.
Conclusion:
Based on the data collected, the majority of the
studentsofourinvestigationshareasimilaropinion
thatacnediminishestheirself-condencelevel.From
the results, Students with acne problems are more
self-conscious and perform poorly in social life. A

86
AcneandOne‘sSelfCondence:Cross-sectionalstudyonMalaysianStudentpopulation
fewrespondentsgavesubjectiveperspectives,which
acnepresentsas a result ofunhygienic behavior.A
particulargroupofsubjectsperceivedthatfacialacne
becomesaconcentrationpointtoothers,thusmaking
the individual feel inferior of themselves.
Conict of interest: Authors declared that they have
noconictofinterest
Authors’ Contributions:
Data gathering and idea owner of this study:
Abhinitha P
Study design: Abhinitha P, Ravina Suloshini
Gengatharan
Data gathering: Ravina Suloshini Gengatharan,
SarahZulkiee,PurveenaGanisan
Writing and submitting manuscript: Abhinitha P,
Sitharrthen Arumugam, Naveen Kumar
Editing and approval of nal draft: Abhinitha P,
RavinaSuloshiniGengatharan,SarahZulkiee
References:
1. Ayer J, Burrows N. Acne: more than skin
deep. Postgrad Med J 2006;82(970):500-6.
https://doi.org/10.1136/pgmj.2006.045377
2. Fried RG, Gupta MA, Gupta AK. Depression and
skin disease. Dermatol Clin 2005 ;23(4):657-64.
https://doi.org/10.1016/j.det.2005.05.014
3. Fried RG, Wechsler A. Psychological problems in
the acne patient. Dermatol Ther 2006;19(4):237-40
https://doi.org/10.1111/j.1529-8019.2006.00079.x
4. C. J. Girman, S. Hartmaier, D. Thiboutot, J.
Johnson, B. Barber, C. DeMuro-Mercon, J.
Waldstreicher. Evaluating Health-Related Quality
of Life in Patients with Facial Acne: Development
of a Self-Administered Questionnaire for Clinical
Trials. Quality of Life Research 1996; 5: 481-490.
https://doi.org/10.1007/BF00540020
5. HassanJ,GroganS,Clark-CarterD,etal.Theindividual
health burden of acne: appearance-related distress in
maleandfemaleadolescentsandadultswithback,chest
and facial acne. J Health Psychol 2009;14(8):1105-18.
https://doi.org/10.1177/1359105309342470
6. Uslu G, Sendur N, Uslu M, et al. Acne: prevalence,
perceptions and eects on psychological health
among adolescents in Aydin, Turkey. J Eur
Acad Dermatol Venereol 2008;22(4):462-9.
https://doi.org/10.1111/j.1468-3083.2007.02497.x
7. Magin P, Adams J, Heading G, et al. Psychological
sequelaeofacnevulgaris:resultsofaqualitativestudy.
Can Fam Physician2006;52:978-9
8. Smithard A, Glazebrook C, Williams HC. Acne
prevalence, knowledge about acne and psychological
morbidity in mid-adolescence: a community-
based study. Br J Dermatol 2001; 145(2):274-9.
https://doi.org/10.1046/j.1365-2133.2001.04346.x
9. S.Srivastava,ManjeetS.B.,P.Das,S.N.Bhattacharya.A
Cross-sectional Study of Quality of Life and Psychiatric
Morbidity in Patients. Journal of Pakistan Psychiatric
Society2008;5(2):86.
10. Lauren K. D., Jenna L. O., Steven R. F. Acne in
Adolescents: Quality of life, Self-esteem, Mood, and
Psychology Disorders. Dermatology Online Journal
2011;17(1):1.
11. Zaghloul SS, Goodeld MJ. Objective
assessment of compliance with psoriasis
treatment. Arch Dermatol 2004;140(4):408-14
https://doi.org/10.1001/archderm.140.4.408