The effectiveness of acne treatment: an assessment by patients of the outcome of therapy

Abstract

The impact of acne on quality of life can be profound. Although treatment improves the clinical features of acne, there is little information on its benefit from the patients' point of view. In this study, patients with acne referred to a dermatology clinic were sent questionnaires before being seen, and 4 and 12 months afterwards. Clinical severity was assessed by a dermatologist at baseline and at 4 months. Quality of life was assessed by patients using the Short Form 36 instrument (SF-36), the Dermatology Life Quality Index (DLQI), Rosenberg's measure of self-esteem and the General Health Questionnaire (GHQ-28). Of 90 available patients, 79 (89%) returned at least one follow-up questionnaire. The clinical acne grade improved substantially with treatment. There were also significant improvements either at 4 or 12 months in the DLQI, self-esteem. GHQ-28 and all five dimensions of the SF-36 that were impaired at baseline. Quality of life continued to improve between the 4- and 12-month follow-up questionnaires. Clinical and patient-assessed outcomes were significantly better in patients treated with isotretinoin. The study showed that disability caused by acne can be largely reversed by effective treatment. It also showed that patient-assessed measures of outcome can respond to changes over time and discriminate between treatments differing in effectiveness.

Primary Focal Hyperhidrosis: Disease Characteristics and Functional Impairment

“…The mean DLQI total score in patients in this study (9.2) was of the same magnitude as those reported in other skin conditions that are assumed to impose a physical or psychological burden, such as inpatient or outpatient psoriasis (13.9–4.5) [18,19,20,21,22,23,24], Hailey-Hailey disease (6.1) [25], rosacea (7.8) [20], acne (9.3–4.3) [13, 20, 21, 23, 26], pruritus (10.5–10) [13, 20], contact dermatitis (10.8) [21] and atopic dermatitis (12.5–5.8) [13,21,22,23,24, 27]. On the basis of a comparative literature analysis, the HRQOL impairment associated with hyperhidrosis can exceed that of the severest dermatological diseases as measured by the DLQI.…”

Psychosocial Impact of Acne vulgaris

“…Since the 1960s there is an increasing interest in the psychosocial impact of acne vulgaris [3]. In most research, a combination of generic and dermatology-specific questionnaires has been used [4, 5, 6, 7, 8, 9]. In the last decade multiple dermatology-specific questionnaires were developed in order to evalute the patients’ perceived benefits of treatment [2, 10, 11, 12, 13, 14, 15, 16].…”

“…Moreover, in some studies females seemed to be more impaired than males, despite higher total acne severity scores in males [8]. Clinical improvement after treatment with isotretinoin gave parallel improvements in self-esteem and other patient-assessed outcomes [6]. An impaired emotional state (depression; social anxiety; anger) in patients with longstanding acne appeared to be more resistant to clinical improvements than an impaired psychological state (e.g.…”

Isotretinoin Use and Risk of Depression, Psychotic Symptoms, Suicide, and Attempted Suicide

“…3 Successful acne therapy significantly reduces anxiety and depression in patients with acne. [11][12][13] However, isolated patients developing depression months after therapy suggest that clearing of a disfiguring disease may make it more difficult for some individuals to accept difficulties previously attributed to appearance alone. 14,15 Isotretinoin therapy and alleged adverse psychiatric effects received considerable media attention during the past years.…”