The relationship between the severity of acne and the emotional distress it causes is poorly understood. A student study showed that acne patients experienced a worsening of their disease during exams. An increase in acne severity was significantly associated with increased levels of stress (p < 0.01). A recent questionnaire-based study of 1,560 adolescents in Greece found a positive correlation between acne and self-reported stress. respondents themselves (P <0.0001) .
It is generally considered that there is a linear relationship between the clinical severity of acne and the deterioration of quality of life. However, this worsening also depends on a person's ability to cope with the various problems as there are people with an objectively minor acne problem who may experience severe subjective dysfunction, greatly affecting their quality of life.17 Thus, acne can to have a major impact on patients' lives, often independent of its severity.
THE heavy acne it is associated with increased depression, anxiety, poor self-confidence, and poor self-esteem.19,20 Psychiatric symptoms are more common in more severe acne and in the advanced stages of adolescence.
THE acne it is associated with an increased risk of depression, anxiety and suicidal tendencies, and there are some interesting gender differences.
It has been suggested that patients with moderate to severe acne suffer from poor body image, low self-esteem, social isolation and activity limitation. As an emotional impact, increased levels of anxiety, anger, depression and frustration are also reported. In a study of 615 school-age children with acne, adolescent girls were found to be more vulnerable than boys to the negative psychological effects of acne, and stress levels were higher.27 Considering the fact that acne causes psychological distress, it may also affect the social, professional and academic performance of adolescents.
In addition, suicidal ideation (about 6% -7% in acne patients) and suicide attempts related to the negative psychosocial effects of acne have also been recorded. A study involving 480 patients with various skin diseases revealed that the highest incidence of depression and suicidal ideation was found in patients with severe forms of acne and severe psoriasis, while patients with mild and moderate forms of acne were at the same levels as people suffering from atopic dermatitis, moderately severe forms of psoriasis and alopecia areata.
Acne negatively affects quality of life, and there is not always a correlation between the severity of acne and its impact on quality of life. The magnitude of anxiety and depression is proportional to the degree of deterioration of quality of life due to acne. Patients with greater social sensitivity experience poorer quality of life compared to other patients with the same severity of acne. Anger, similarly, was associated with poorer quality of life and less satisfaction with treatment, independent of other variables.
Studies on the psychosocial impact of acne have documented dissatisfaction with appearance, embarrassment, self-esteem, and lack of self-confidence in acne patients. Social dysfunction has also been observed, including concerns about social relationships with the opposite sex, public appearances, interacting with strangers, and professional opportunities. In addition, acne is associated with anxiety, depression, feelings of anger, and decreased body satisfaction. shown to be negatively associated with the intention to participate in sports and exercise, perhaps as a result of the fear experienced by acne patients of the criticism they will receive from those around them. In a study among schoolchildren in Scotland, 10% avoided swimming and other sports because of the embarrassment caused by acne. Acne has also been shown to negatively affect school and extracurricular activities. Self-esteem issues are also likely to be behind higher unemployment rates among acne sufferers, however there is also a bias that acne sufferers are more likely to be rejected by a prospective employer. There are also studies that report that up to 20% of teenagers with acne experience problems forming relationships because of their acne, or express concerns about socializing, appearing in public, and interacting with the opposite sex. Acne and the effects it causes on the appearance and therefore also on the self-confidence of the patients seem to be related to the depression, social withdrawal and anger that they experience.
It can create a vicious cycle: it is not only acne that can lead to emotional distress, but the stress caused to an acne patient can worsen the skin condition itself at a time when patients are less able to face additional stress.
During adolescence, the incidence of acne increases with age and growth. In girls, the onset of menstruation is associated with an increased incidence of acne. The only relationship between gender and acne in the literature is that quality of life and sexual satisfaction worsens in women with PCOS and acne.
The effect of acne on a particular patient is not always easy to quantify clinically. It has been reported that both women and men find the appearance effects of acne to be the most bothersome aspect of their disease, and the negative effects of acne occur in both older and younger patients. Even mild acne can be a significant problem for some patients, impairing their quality of life and, in some cases, their social functioning.