Psychosocial Impact of Acne Vulgaris: Evaluating the Evidence

J. K. L. Tan, MD, FRCPC


Skin Therapy Letter. 2004;9(7) 

In This Article

Case-control Surveys

The majority of studies on the psychosocial impact of acne have been case reports and case-control surveys. Although case-control design studies are rapid to perform and relatively inexpensive, disadvantages include potential bias, inability to predict events of precedence, and to provide estimates on prevalence, incidence, or relative risk. The majority of these surveys are based on small samples with responses compared to historical controls or responses from other disease categories (see Table 1 ).

Psychological abnormalities include self-reported depression and anxiety, embarrassment, social inhibition, and psychosomatic symptoms including pain and discomfort. Of particular note is that clinically important depression and anxiety were reported in 18% and 44% of acne patients, respectively.[1]Furthermore, 6% of acne patients in one study reported active suicidal ideation.[2]

Patients with acne had greater impairment in mental health scores compared with those with asthma, epilepsy, diabetes, back pain, arthritis, or coronary artery disease.[3]Furthermore, acne patients reported higher depression and anxiety scores when compared to psoriasis patients and those attending oncology or general dermatology clinics.[1,2]

Longitudinal evaluation of psychometric outcomes has demonstrated that effective treatment of acne was accompanied by improvement in self-esteem, affect, obsessive-compulsiveness, shame, embarrassment, body image, social assertiveness, and self-confidence. The majority of these patients were treated with oral isotretinoin (71%).[1,4,5,6,7]

Unemployment in acne patients was evaluated in 625 patients aged 18-30 years in Leeds, England. Controls were randomly selected patients from general practitioner records and matched for age and gender. This study revealed that unemployment levels were significantly higher among acne patients of both genders compared to controls (16% vs. 9% in males; 14% vs. 9% in females; p<0.001). However, social status, academic background, and intelligence were not included in the analysis.[10]


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