Why is acne such a big deal for young people? After all, it is the most common of all skin diseases, and affects at one time or another about 85 per cent of those aged 12 to 25. The condition, however, affects young people at a time when they are undergoing maximum social and physical changes and can produce significant psychological as well as physical scarring.
Teenagers tend to be more vulnerable to the development of depression so when having acne causes feelings of low self-esteem, self-consciousness, embarrassment, frustration and negative body image, the consequences can be serious.
According to a recent Canadian study published in the British Journal of Dermatology, even a mild case of acne can result in feelings of low self- esteem, depression and even thoughts of suicide. The study, led by Canadian doctors, Dr. Madhulika A. Gupta (a psychiatrist) and Dr. Aditya K. Gupta (a dermatologist), looked at 480 dermatology patients with skin disorders (acne; localized areas of hair loss; eczema; and psoriasis). The purpose of the study was to examine the prevalence of depressive symptoms (measured by the Carroll Rating Scale for Depression - CSRD), wishes to be dead, and thoughts of suicide.
Results revealed that severely affected psoriasis patients had the highest CSRD score, followed by the patients with mild to moderate acne. Both scores were in the range for clinical depression. The prevalence of active suicidal thoughts among the psoriasis and acne patients was higher than the prevalence reported among general medical patients.
These findings highlight the importance of recognizing depression among dermatology patients. A further study published in the British Journal of Dermatology concluded that greater self-reported severity of acne was associated with greater psychological distress.
"Parents should be on the look-out for changes in their child's normal routine." says Dr. Madhulika Gupta, a psychiatrist and Professor (part-time) at The University of Western Ontario in London. "As our study showed, acne can be associated with clinical depression."
Signs of depression can include changes in mood (i.e., a persistent negativity or increased moodiness and irritability); physical symptoms (i.e., loss or increase of appetite, trouble sleeping or sleeping too much, lack of energy); behavioural changes (i.e., avoiding friends, social isolation, missing school classes); or negative thoughts that range from feeling helpless and lonely to thoughts of worthlessness, self-harm or suicide.
Although mild episodes of acne usually clear up over a short time period, however, moderate to severe acne lesions typically do not go away on their own, and, may continue to get worse. Facial appearance is decidedly important to a person's sense of self-worth and it is hardly surprising that acne has a significant impact.
One of the first clinicians to highlight the psychosocial impact of acne were Sulzberger and Zaidens in 1948 who noted, "There is no single disease which causes more psychic trauma and more maladjustment between parents and children, more general insecurity and feelings of inferiority, and greater sums of psychic assessment than does acne vulgaris."
Several studies since have shown that acne can cause lowered self-esteem, interpersonal difficulties, increased incidence of anxiety and depression and unemployment.
Although knowledge about treating chronic acne has grown considerably in recent years, relatively few studies have assessed the impact of acne treatment on a patient's emotional state. One study, led by British dermatologists, S.C. Kellett and D.J. Gawkrodger, assessed 34 patients with chronic acne for psychological, emotional and dermatological effect using a variety of self-report questionnaires over 16 weeks treatment with isotretinoin (Accutane(TM)).
When first assessed, 44 per cent reported clinically significant levels of anxiety, and 18 per cent reported significant depression. Women with acne were significantly more embarrassed about their acne lesions than their male counterparts.
The final assessment showed that treatment produced significant improvements across a wide variety of psychological functions, although the emotional status of patients appeared to be more resistant to change. The researchers concluded that acne is a condition that has the potential to damage the emotional functioning of some patients.
"As health professionals, the link between acne and depression should be a wake-up call to us", says Dr. Karen Scully, Assistant Clinical Professor, Department of Medicine at McMaster University in Hamilton. "We need to be asking teenagers about their emotional state when we're treating their acne. Parents should be asking too."
A medical review published in the Journal of Cutaneous Medicine and Surgery by British dermatologist, Dr. Alison M. Layton, noted that acne- related anxiety can be significantly reduced after successful acne treatment and patients also experienced a significant reduction in depression after therapy.
A study in Dermatology found the early use of isotretinoin in acne minimized scarring. "Scarring may occur in some patients with acne, which is why a young person should seek treatment before acne scars appear," says Dr. Scully. "It's best to seek early treatment of acne from a dermatologist than wait for the acne to go away by itself."