The importance of psychological care for patients with acne vulgaris was discussed in a review article published in Dermatologic Therapy. Acne is frequently associated with low self-esteem, stress, anxiety, and depression.
Clinical research suggests that acne often negatively affects quality of life, the study authors noted, particularly in women, adolescents, and patients with significant facial involvement. In a meta-analysis of 42 studies, depression was significantly more common in patients with acne compared with the general population. The investigators mentioned that studies have also demonstrated a link between acne vulgaris and anxiety, particularly in women and adolescents. Acne is also associated with low self-esteem, stress, and thoughts of self-harm. In one study of patients in Europe (n=213), the study authors cited, 4% reported that they had suicidal ideation related to their acne. Studies of adolescents with acne have revealed even higher rates of suicidal ideation. The psychiatric burden of acne is significant, and should be considered comparable to that of psoriasis, urticaria, and other psychodermatological diseases which typically receive dual psychological and dermatological treatment, it was suggested.
Typically, the researchers continued, medical treatment of acne vulgaris can improve anxiety and depression without psychiatric treatment. In patients with acne-related depression or anxiety, cognitive behavioral therapy has been associated with significant improvements in psychiatric symptoms. The use of antidepressants may also be useful, depending on the patient’s specific psychiatric profile. While Dermatology-Psychiatry Liaison clinics typically treat more severe skin conditions such as psoriasis, urticaria, and prurigo, patients with acne could also benefit from psychodermatological treatment, the investigators believe.
Dermatologists should conduct psychological evaluations of patients with acne who present with depression or anxiety, the investigators concluded. Based on their findings, the study authors believe that care should be taken to evaluate all aspects of acne and refer patients to appropriate care.
Aslan Kayiran M, Karadag AS, Jafferany M. Psychodermatology of acne: dermatologist’s guide to inner side of acne and management approach [published online August 8, 2020]. Dermatol Ther. doi: 10.1111/dth.14150