Acne in Adolescents: Quality of Life, Self-Esteem, Mood and Psychological Disorders
Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood. We performed a MEDLINE search using the terms "acne" and "adolescent" alo...
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| Published in | Dermatology online journal Vol. 17; no. 1; p. 1 |
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| Main Authors | , , |
| Format | Journal Article |
| Language | English |
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United States
University of California Digital Library - eScholarship
01.01.2011
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| ISSN | 1087-2108 1087-2108 |
| DOI | 10.5070/D34HP8N68P |
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| Abstract | Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood.
We performed a MEDLINE search using the terms "acne" and "adolescent" along with "psychological," "depression," or "psychiatric," which yielded 16 reviewed studies.
Qualitative review of the selected articles revealed that the presence of acne has a significant impact on self-esteem and quality of life. Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders.
The reviewed studies were semi-quantitative analyses utilizing various standardized surveys or questionnaires. Therefore, quantitative analysis of selected studies was not possible.
The presence of co-morbid psychological disorders should be considered in the treatment of acne patients and future prospective trials are needed to assess the impact of treatment on psychological outcomes. |
|---|---|
| AbstractList | Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood.INTRODUCTIONAcne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood.We performed a MEDLINE search using the terms "acne" and "adolescent" along with "psychological," "depression," or "psychiatric," which yielded 16 reviewed studies.METHODSWe performed a MEDLINE search using the terms "acne" and "adolescent" along with "psychological," "depression," or "psychiatric," which yielded 16 reviewed studies.Qualitative review of the selected articles revealed that the presence of acne has a significant impact on self-esteem and quality of life. Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders.RESULTSQualitative review of the selected articles revealed that the presence of acne has a significant impact on self-esteem and quality of life. Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders.The reviewed studies were semi-quantitative analyses utilizing various standardized surveys or questionnaires. Therefore, quantitative analysis of selected studies was not possible.LIMITATIONSThe reviewed studies were semi-quantitative analyses utilizing various standardized surveys or questionnaires. Therefore, quantitative analysis of selected studies was not possible.The presence of co-morbid psychological disorders should be considered in the treatment of acne patients and future prospective trials are needed to assess the impact of treatment on psychological outcomes.CONCLUSIONThe presence of co-morbid psychological disorders should be considered in the treatment of acne patients and future prospective trials are needed to assess the impact of treatment on psychological outcomes. Acne in Adolescents: Quality of life, self-esteem, mood, and psychological disordersLauren K Dunn PhD1, Jenna L O’Neill MD1, Steven R Feldman MD PhD1,2,3Dermatology Online Journal 17 (1): 11. Department of Dermatology2. Department of Pathology3. Department of Public Health SciencesCenter for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina. sfeldman@wfubmc.edu---INTRODUCTION: Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood. METHODS: We performed a MEDLINE search using the terms “acne” and “adolescent” along with “psychological,” “depression,” or “psychiatric,” which yielded 16 reviewed studies. RESULTS: Qualitative review of the selected articles revealed that the presence of acne has a significant impact on self-esteem and quality of life. Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders. LIMITATIONS: The reviewed studies were semi-quantitative analyses utilizing various standardized surveys or questionnaires. Therefore, quantitative analysis of selected studies was not possible. CONCLUSION: The presence of co-morbid psychological disorders should be considered in the treatment of acne patients and future prospective trials are needed to assess the impact of treatment on psychological outcomes.---IntroductionAdolescence is a time of physical, emotional, and social development. Acne is a common adolescent problem, affecting more than 85 percent of teenagers, as well as some adults [1]. Although some consider acne to be merely a cosmetic problem, it may have significant and enduring emotional and psychological effects. Acne can negatively impact mood, self-esteem, and interpersonal relationships and may lead to depression and suicidal ideation [2, 3, 4]. Several studies have attempted to qualitatively and quantitatively assess the psychological effects of acne in teenagers. Here we review the current literature to determine the impact of acne on quality of life and effects on self-esteem, mood, and psychological disorders in adolescents.MethodsA Medline search was conducted using the search terms “acne” and “adolescent” which returned 3,400 hits. Studies of adolescents, aged 13 to 18, were included for review. However, non-English language and review articles were excluded. The results were further limited using the search terms “psychological,” “depression,” and “psychiatric,” yielding 192 results. Of these, 16 studies evaluating the effect of acne on quality of life (5 studies), self-esteem (4 studies), personality and mood (2 studies), or psychological disorders (5 studies) were included for review (Figure 1). Nearly all the studies were semi-quantitative analyses of responses to surveys or standardized questionnaires. One study was a qualitative assessment of subjects’ responses to standard interview topics.ResultsImpact of acne on quality of lifeA summary of all reviewed studies is presented in Table 1. Uslu et al performed a cross-sectional analysis of 600 high school students who completed the General Health Questionnaire (GHQ) and the Rosenberg Self-Esteem Scale (RSES) [5]. All participants were examined by a dermatologist who provided an objective assessment of acne severity. A total of 550 out of 600 students completed both the questionnaire and physical examination. The study population consisted of 303 girls and 260 boys, aged 13 through 19, with a mean age of 15.24. Acne was self-reported in 83.4 percent of subjects, with 40.4 percent of subjects rating their acne as mild, 36 percent moderate, and 6.5 percent severe. Self-report of acne and the dermatologist’s objective assessment were positively correlated: the prevalence of acne was 63.6 percent, with 29.2 percent non-inflammatory and 34.4 percent inflammatory acne. Acne was more prevalent and severe in boys than in girls. There was a direct correlation between subjective, but not objective, severity of acne and symptoms of anxiety, depression, and lower self-esteem based on responses to the GHQ and RSES.A cross-sectional survey of 200 adolescents aged 15 to 18 years used two health-related quality of life questionnaires: the Children’s Dermatology Life Quality Index© (CDLQI) and the Cardiff Acne Disability Index© (CADI) [6]. Acne was reported in 83 percent of teenagers, 54 percent of males and 46 percent of females. The overall CDLQI score ranged from 0 to 19 out of a maximum 30, with a mean of 1.7 (CI -1 to 0), representing approximately 6 percent impairment. Nine subjects scored between 5 and 9, suggesting moderate (17 to 30%) impairment, whereas three scored greater than 10, suggesting severe (> 33%) impairment. Similarly, the overall CADI score ranged from 0 to 15 out of 15, with a mean of 1.9 (CI 0 to 1), representing 13 percent impairment. Twelve subjects scored between 5 and 9 (33–60% impairment), one scored 10+ (> 67% impairment), and one scored the maximum, 15 (100% impairment). There was no significant difference in mean scores between sexes for either questionnaire. The authors concluded that acne significantly impacts QOL in some teens.Pawin et al used an adaptation of the CADI to survey 1,566 French adolescents who telephoned a youth helpline between November 2004 and January 2005 [7]. Callers were divided into those who currently had, previously had, or never had acne. Respondents included 79.4 percent females and 20.6 percent males ranging in age from 10 to 37 years, with a mean of 16.1 years. Forty-eight percent of the patients with acne indicated that their daily life was affected, which varied with the perceived acne severity (39% for mild acne, 52% for moderate acne, and 67% for severe acne; p< 0.0001). Perception of acne severity also correlated with ratings given for relationships with friends (p< 0.0001) or significant others (p< 0.0001), and with feelings of anger (p< 0.0001), sadness/anxiousness (p< 0.0001), and shame (p< 0.0001). The percentage of patients with acne who felt lonely (58.2%) or anxious (56.5%) was greater than or equal to that of patients with more serious illnesses such as diabetes, cancer, epilepsy, psychiatric disorders, and cystic fibrosis, further demonstrating the significant psychological impact of acne.Balkrishnan et al studied 73 women, ages 17-45 (mean 37.2) with visible facial skin lesions, including acne, dermatosis papulosis, hypopigmentation, lentigines, melasma, rosacea, vascular proliferations, and other facial scars [8]. They assessed health-related quality of life (HRQOL) by Skindex-16 and fear of negative evaluation to determine whether self-perception characteristics correlated to quality of life. Fear of negative evaluation and the perception of an increased QOL without disease strongly correlated with poorer HRQOL (p< 0.05 and p< 0.01, respectively). There were no differences in HRQOL by type of facial condition. The results suggest that severe facial blemishes of any cause significantly impact women’s QOL in part through psychological effects on patients’ self-perception.Additional measures have been proposed as a means of assessing the effect of acne on patients’ quality of life. The Acne Quality of Life Index (Acne-QOLI) is comprised of twenty-one questions about the perceived effect of acne on daily life and function [9]. The Acne-QOLI has been validated in 480 persons, ages 12 to 62 years, with mild to severe acne and has good validity, internal consistency, and test-retest reliability in the clinical setting.Effects of acne on self-esteemHassan et al selected 132 patients from an acne specialist clinic and compared their responses to questionnaires including the Derriford Appearance Scale (DAS) and self-rated acne severity scales for the face, chest, and back [10]. Women had significantly greater DAS scores than men in the areas of general self-consciousness of appearance (mean score 51.3 vs. 39.7, p< 0.001), social self-consciousness (mean score 39.0 vs. 29.3, p = 0.001), sexual and bodily self-consciousness (mean score 18.0 vs. 14.0, p = 0.01), facial self-consciousness (mean score 7.4 vs. 3.9, p < 0.001), and negative self-concept (mean score 16.4 vs. 13.9, p = 0.004). Facial acne severity rating was significantly associated with social self-consciousness in women (p = 0.038) but not in men. In both men and women, back acne was associated with sexual and bodily self-consciousness of appearance (p = 0.006 and p = 0.002, respectively). The authors noted a trend for DAS scores to vary with ethnicity. Non-white men scored higher in the areas of self-consciousness of sexual and bodily appearance compared to white males and white women scored higher across all DAS subscales. However, these results did not achieve statistical significance.A questionnaire-based survey of 3,775 tenth grade students performed in Oslo, Norway yielded an 80 percent response rate, with 13.5 percent of respondents reporting having acne [11]. The presence of acne correlated with poor self-attitude in boys alone (odds ratio 2.07, confidence interval 1.10-3.88) and poor self-worth in girls alone (odds ratio 1.88, CI 1.23-2.88). These correlations were independent of body mass index and depressive symptoms.In another study, 26 subjects aged 13-72 with acne ranging in severity from 0.1-1.75 according to the Leeds acne grading system were interviewed using a standardized list of themed topics [12]. The authors reviewed interview transcripts, analyzing for common psychological themes among patient responses. Based on their analyses, the authors determined that patients experience immediate psychological consequences of acne including reduced self-esteem, poor self-image, self-consciousness and embarrassment. The effects were common to both men and women and were exacerbated by taunting, stigmatization, and perceptions of s Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood. We performed a MEDLINE search using the terms "acne" and "adolescent" along with "psychological," "depression," or "psychiatric," which yielded 16 reviewed studies. Qualitative review of the selected articles revealed that the presence of acne has a significant impact on self-esteem and quality of life. Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders. The reviewed studies were semi-quantitative analyses utilizing various standardized surveys or questionnaires. Therefore, quantitative analysis of selected studies was not possible. The presence of co-morbid psychological disorders should be considered in the treatment of acne patients and future prospective trials are needed to assess the impact of treatment on psychological outcomes. |
| Author | Dunn, Lauren K O'Neill, Jenna L Feldman, Steven R |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/21272492$$D View this record in MEDLINE/PubMed |
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| Snippet | Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and... Acne in Adolescents: Quality of life, self-esteem, mood, and psychological disordersLauren K Dunn PhD1, Jenna L O’Neill MD1, Steven R Feldman MD... |
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| SubjectTerms | Acne Acne Vulgaris - psychology Adolescent Affect Body dysmorphic disorder Depression - etiology Female Females Humans Male Mental depression Perceptions Personality Psychology, Adolescent Quality of Life Self Concept Self esteem Self image Suicidal Ideation Suicides & suicide attempts Teenagers Womens health |
| Title | Acne in Adolescents: Quality of Life, Self-Esteem, Mood and Psychological Disorders |
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