Psychosocial Impact of Acne: A Community
Based Cross Sectional Study
Mubashar Mashqoor Mir1* and Mohammad Sarwar Mir2
1Department of Dermatology, Government Medical College, India
2Senior Resident, Department of Hospital Administration, SKIMS, India
Submission: June 01, 2018; Published: September 06, 2018
*Corresponding author: Mubashar Mashqoor Mir, Post Graduate Resident, Post Graduate Department of Dermatology, Government Medical College, Jammu, India.
How to cite this article: Mubashar M M, Mohammad S M. Psychosocial Impact of Acne: A Community Based Cross Sectional Study. Curr Trends Biomedical Eng & Biosci. 2018; 16(3): 555936. DOI:10.19080/CTBEB.2018.16.555936.
Background: It is well-known that acne vulgaris is a common malady of adolescence and is easily recognized.
Objective: To evaluate the level of impact among acne patients on their quality of life.
Methods: A total of 200 patients studied. Acne severity was graded using Global Acne Grading System (GAGS) after the clinical diagnosis. All the patients went through self-administered questionnaire of Cardiff Acne Disability Index (CADI) to fill out, to assess the reflection of patients’ experiences and perceptions.
Results: Out of 200 patients, 114(57.0%) were females and 86 (43.0%) were males. The maximum number of patients was in the age group of 16-20 years (142/200, 71%). Out of total 86 males, 50 (58.3%) had moderate to severe acne, whereas 62 (54.38%) females had such a severe acne. 50.87% (58/114) of females had high CADI scores in comparison to only 27.9 (24/86) of males. The impact on quality of life was more in the age-group of 21-30 years even though in this age group clinical severity of acne was mild to moderate only.
Conclusion: Study found that individuals with acne had profound emotional, as well as, social impact on their quality of life.
Keywords: Acne; Cardiff Acne, Disability Index; Quality of life
It is well-known that acne vulgaris is a common malady of adolescence and is easily recognized. It is common enough to be called as physiological process but is better recognized disease due to its inflammatory component. It can have significant psychosocial disturbances as it affects adolescence that is the critical period during which emotional development and maturity starts taking place . Skin plays an important role in socialization, as skin is considered as an organ of communication. Cosmetic disfigurement produces social disapproval and increase in self-consciousness . It can result in social poor eye contact, academic under achievements and psychosocial disturbances especially when skin diseases like acne occur during adolescence . Acne may also be associated with increased levels of anxiety, anger, depression and frustration. This psychological stress can further aggravate acne through hormonal changes thereby setting up a vicious cycle. It is important to have reliable epidemiological data on acne and its psychosocial impact so that physician can show quantitatively that effective treatment of acne can have significant benefit to
patient’s psychosocial life, apart from physical benefit to their acne .
This study was done in outpatient skin department of a tertiary care hospital in North India from June 2013 to December 2013. A total of 200 patients with clinical diagnosis of acne, aged more than 13 years were enrolled in the study after taking an informed consent. A detailed history was also taken according to proforma. The severity of acne was graded using Global Acne Grading System (GAGS). The patient was then given a self-administered Cardiff Acne Disability Index (CADI) questionnaire Global Acne Grading System (GAGS) Acne was graded using GAGS .
The GAGS consider six locations on face and chest/ upper back with a factor for each location based on surface area, distribution and density of pilosebaceous units. (Area factor: forehead-2, right cheek-2, left cheek-2, nose-1, chin-1, chest and upper back-3). Each of the location was graded separately on 0-4 scale with the most severe lesion within that area determining the local score. (Grade: 0-no lesion, 1-comedone, 2- papule,
3-pustule, 4-nodule). Under good light and without touching, all
the manifestations of acne ranging from comedowns to nodule
were recorded. Local score is calculated by multiplying area
factor with the grade of most severe lesion within that location.
Global score is the summation of all the local scores.
All the enrolled patients with acne above the age of 13 years
completed CADI questionnaire made available in local language.
It is a detailed questionnaire designed to assess disability caused
by acne . It consists of five questions, each with four graded
alternative responses (0-3). CADI is calculated by summing
up the score of each question. The higher score indicates the
greater disability experienced and the lower score indicates the
lesser level of disability.
Out of 200 patients, 114(57.0%) were females and
86(43.0%) were males. The maximum number of patients was
in the age group of 16-20 years (142/200, 71%). Family history
of acne was present in 80(40.0%) patients. Appearance of facial
acne was preceded by application of topical steroids in 40(20%)
patients (Tables 1-4).
Acne has shown significant psychological impact in the
previous studies. The severity of acne was measured by
different grading methods in various studies. According to our
study, females outnumbered males in seeking treatment for
acne. It may be because females are more conscious of their
cosmetic appearance as compared to males. Most of the patients
were adolescents as acne is more prevalent in this age group
. About 40.0 % of patients gave history of acne in parents
or siblings. This is in accordance with various studies which
show that genetic factors influence susceptibility to acne .
One-fifth of patients had applied topical steroids which lead
to further aggravation of acne. It is due to easy availability and
indiscriminate use of topical steroids and marked transient
improvement which ultimately results in steroid dependence. In
our study, males had more moderate to severe acne as compared
to females. This finding is like the previous studies [9-11]. It may
be due to increased androgen levels in males .
Acne may have different psychosocial morbidity according
to gender. Our study showed higher CADI scores in females as
compared to males. This is similar to previous studies which
also found more psychological impact on females . Facial
disfigurement makes females present earlier to treatment even
for milder acne. The impact on quality of life was more in the
age-group of 21-30 years even though in this age group clinical
severity of acne was mild to moderate only. It may be due to
chronicity of acne and the need of more social interactions at this
age. All the patients above 30 years of age had low psychological
impact of acne.
Patients with persistent acne were reported to have higher
CADI scores . This study demonstrated a significant relation
between GAGS and CADI scores. The impact on quality of life
increased with acne severity. It is consistent with previous
studies which also found the similar findings [9-11]. Also,
patients with higher CADI scores tend to present with suicidal
To decrease psychological stress associated with acne and
to build up self-esteem, it is the need of hour in a developing
country like India to establish acne clinic with provision of
counselors. This need stems out of high patient burden with low
doctor: patient ratio. To increase time spent per patient,
these acne clinics with counselors will help achieve the targets. Also,
the patients can be involved in group discussions.
Our study confirmed that acne has profound effect on
psychosocial behavior. The impact on quality of life has been
significantly associated with severity of acne, female gender,
age and long disease duration. Clinicians should be aware that
early treatment of acne and avoidance of aggravating factors can
prevent significant psychological morbidity.