Crimson Publishers Publish With Us Reprints e-Books Video articles

Full Text

COJ Nursing & Healthcare

Psychosocial Impact of Acne: A Community Based Cross Sectional Study

Mohammad Sarwar Mir

Department of Hospital Administration, SKIMS, India

*Corresponding author: Mohammad Sarwar Mir, Senior Resident, Department of Hospital Administration, SKIMS, Srinagar, India, Email:mohammedsarwarmir@gmail.com

Submission: May 29, 2018;Published: July 17, 2018

DOI: 10.31031/COJNH.2018.03.000570

ISSN: 2577-2007
Volume3 Issue4

Abstract

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.

Result: 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

Introduction

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 [1].

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 [2]. It can result in social poor eye contact, academic under achievements and psychosocial disturbances especially when skin diseases like acne occur during adolescence [3]. 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 Table 1, apart from physical benefit to their acne [4].

Methods

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 [5].

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 come done to nodule were recorded Table 2. 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.

Table 1:Relationship between acne severity Global Acne Grading System (GAGS) and gender.

P value < 0.05 (Non-significant).


Table 2:Relationship between Cardiff Acne Disability Index and gender.

p=0.05; Significant.


Cardiff Acne Disability Index (CADI)

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.6It 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.

Result

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 Table 3.

Table 3:Relationship between cardiff acne disability index (CADI) and duration of acne.

p=0.001; Highly significant


Discussion

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 [6,7].

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 [8]. 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 similar to the previous studies [8-11]. It may be due to increased androgen levels in males [7].

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 [9]. 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 [9]. 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 [10,11]. Also patients with higher CADI scores tend to present with suicidal ideations.

Recommendations

Table 4:Relationship between Global Acne Grading System (GAGS) and Cardiff Acne Disability Index (CADI).


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. In order 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 Table 4.

Conclusion

Our study confirmed that acne has profound effect on psychosocial behaviour. 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. S.

References

  1. Sumir K, Ravinder S, Sandeep K, Bharat BM (2016) Psychosocial impact of acne on quality of life in North India: A hospital-based cross-sectional study. Journal of Pakistan Association of Dermatologists 26(1): 35-39.
  2. Koo J (1995) The psychosocial impact of acne: patients’ perceptions. J Am Acad Dermatol 32(5 Pt 3): S26-S30.
  3. Fried RG, Wechsler A (2006) Psychological problems in the acne patient. Dermatol Ther 19(4): 237-240.
  4. Thomas DR (2004) Psychosocial effects of acne. J Cutan Med Surg 8(Suppl 4): 3-5.
  5. Doshi A, Zaheer A, Stiller MJ (1997) A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol 36(6): 416-418.
  6. Motley RJ, Finlay AY (1992) Practical use of a disability index in the routine management of acne. Clin Exp Dermatol 17(1): 1-3.
  7. Burton JL, Cunliffe WJ, Stafford L, Shuster S (1971) The prevalence of acne vulgaris in adolescents. Br J Dermatol 85(2): 119-126.
  8. Walton S, Wyatt E, Cunliffe WJ (1988) Genetic control of sebum excretion and acne-A twin study. Br J Dermatol 118(3): 393-396.
  9. Do JE, Cho SM, In SI, Lim KY, Lee S, et al. (2009) Psychosocial aspects of acne vulgaris: A community-based study with korean adolescents. Ann Dermatol 21(2): 125-129.
  10. Atkan S, Ozmen E, Sanli B (2000) Anxiety, depression and nature of acne vulgaris in adolescents. Int J Dermatol 39(5): 354-357.
  11. Hanisah A, Omar K, Shah SA (2009) Prevalence of acne and its impact on the quality of life in school-aged adolescents in Malaysia. J Primary Health Care 1(1): 20-25.

© 2018 Mohammad Sarwar Mir. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.