Psychiatric Comorbidity in Patients with Acne

Abstract

Acne vulgaris is a chronic inflammatory skin disorder which has a high prevalence among adolescents and young adults and can be associated with emotional and psychological burden on patients. This review aimed to explore psychological factors in patients with acne. Several forms of emotional distress and psychological complications can occur with acne. Such complications may be worse than the physical impact of the skin condition. Current literature suggests that skin changes in acne are associated with changed body image, psychological distress, anxiety, social phobia, suicidal ideation and depression. Population-based studies suggest a significant association between acne and mental distress among both male and female adolescents. Presence of psychological distress is related to severity of acne in some studies. However, other case-controlled studies suggest increased risk for psychological problems in patients with acne regardless of its severity. Stress is suspected to have a role in exacerbations of acne, and the quality of life (QoL) is affected particularly in cases with severe facial acne. Acne treatment can be associated with psychiatric side effects. Isotretinoin may be associated with depression and suicide attempts as shown in several studies but with conflicting results. On the other hand, psychotropic medications (such as antidepressants, antipsychotics and mood stabilizers) can also induce acne. The results of this review indicate the importance of vigilant psychiatric assessment for patients with acne, particularly those receiving isotretinoin, is needed for early diagnosis and treatment of the associated psychiatric co-morbidity.

Blemish on the Body, Scar on the Mind- Psychiatric Aspects of Acne Vulgaris: An Update.

“…Adolescents are extremely sensitive to issues of peer acceptance and have limited coping ability, which makes them vulnerable to develop Social phobia. 10 Acne can significantly interfere Section: Psychiatry in their social interactions, sports activities, academic performance and dating behaviour. 5 The most common fears seen is patients with AV are "fear that acne will never cease(58%) and resultant scarring".…”

“…11 The overall frequency of anxiety disorders, generalised anxiety disorders and social phobia in patients with AV was found to be 12%, 6-50% and 2-45.7% respectively. 9,10,15,22,23 The wide differences in the frequency in these various studies could be because of the use of different diagnostic or screening tools. Patients with AV have demonstrated higher performance avoidance and total avoidance scores which caused significant disability in their occupational, social, and familial lives.…”

“…It affects patient's interpersonal relationships, self-evaluation, and daily performance. 10 Even a mild case of acne can be distressing. 2 Teenagers with acne are perceived by others as being shy, less socially active, more likely to be bullied, and less successful in terms of finding a job.…”

“…2 Teenagers with acne are perceived by others as being shy, less socially active, more likely to be bullied, and less successful in terms of finding a job. 10 Studies on the quality of life in patients with AV suggests that it is at the same level as patients with other chronic medical conditions including asthma, epilepsy, diabetes, back pain and arthritis. 1,10 Various factors influence the suffering in these patients (illustrated in Table 2).…”

“…The possible relationship between acne and psychiatric disorders can take several forms 10 1. Acne can be associated with major psychiatric disorders such as depression and anxiety disorders.…”