Acne in adolescents and young adults can significantly affect mood, personality, and self-esteem. The effect acne has on mental health suggests dermatologists should consider incorporating psychological assessments into the treatment of these patients, according to a review study published in the Journal of Cosmetic Dermatology.
Researchers from the United States, Romania, and Egypt conducted a review of research studies published from 2001 to 2020. Articles included in the review reported on acne and related psychological components.
The investigators of the review indicate that false myths and poor medical education influence acne’s evolution. Also, many patients with acne buy into “myths and misconceptions” regarding their disease and, as a consequence, many of these patients often seek medical attention at later disease stages.
Psychological impacts of acne that have been reported in the literature include stress, type D personality, social phobia disorder, anxiety, fear, depression, suicidal thoughts/attempts, social dysfunction, sexual dysfunction, and stigmatization. Patients with acne who also experience stress are more likely to pick at the skin, resulting in further inflammation, hyperpigmentation, and scarring. The release of neuropeptides associated with stress can also lead to cytokine production, which can further drive the inflammatory component of acne, the researchers noted.
Some studies have suggested that patients with severe acne have a higher rate of mental hospital admission for anxiety, adjustment disorders, personality disorders, and substance use disorders.
According to the investigators, clinicians should work toward better understanding of a patient’s feelings about how acne is effecting their personal and professional life. In addition, physicians should understand and consider the patient’s self-perception of acne severity.
Overall, the authors noted, clinicians should consider a holistic approach that focuses on how acne effects quality of life (QoL), relationships, and self-image. Psychological evaluation should be considered in conjunction with prescribing dermatological/cosmetic treatments to a patient with acne.
The authors of the review added that treatment teams consisting of a dermatologist, medical-nutritional therapist, general practitioners, “and plastic surgeons should increase therapy adherence and long-term effects on QoL and psychological impact of this disease.”
Stamu-O’Brien C, Jafferany M, Carniciu S, Abdelmaksoud A. Psychodermatology of acne: Psychological aspects and effects of acne vulgaris. Published online October 8, 2020. J Cosmet Dermatol. doi:10.1111/jocd.13765