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Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 143-144
Mental health problems of adolescents with acne: A neglected public health issue

Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, USA

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Date of Web Publication3-May-2016

How to cite this article:
Mahapatra T. Mental health problems of adolescents with acne: A neglected public health issue. Ann Trop Med Public Health 2016;9:143-4

How to cite this URL:
Mahapatra T. Mental health problems of adolescents with acne: A neglected public health issue. Ann Trop Med Public Health [serial online] 2016 [cited 2020 Sep 21];9:143-4. Available from:
Acne vulgaris is the most common chronic inflammatory skin disease of the hair follicle affecting 20% of young people worldwide. Though it is almost universally present in adolescents (about 95% are affected), it frequently continues into adult age.[1],[2] A recently published systematic review on epidemiology of acne indicated that about 64% and 43% of individuals are affected with this condition as they advance into the 20s and 30s, respectively.[1] According to the Global Burden of Disease (GBD) study, acne was the 8th most prevalent skin disorder among young adults in 2010.[3] Despite its high burden and negative health consequences, it is mostly underrecognized by global health planners, particularly in poor-resource settings.

Although the etiology of this condition remained elusive so far, findings from previous studies revealed a strong genetic predisposition in its pathogenesis. The risk of heritability is almost 80% among subjects with first-degree relatives. A strong correlation has been suggested between disease severity and pubertal maturity. Other probable risk factors as outlined in prior studies were socioeconomic conditions, dietary factors (chocolate, dairy products, and high glycemic index diet), topical greasy preparations that block skin pores, humid climate, smoking, obesity, stress, picking, and bacterial infections.[1] In recent years, evidence has emerged that western diet with high glycemic load might trigger the pathogenesis of acne. This hypothesis was supported by a randomized placebo control trial among Korean patients with mild to moderate acne who were assigned to low glycemic load diet had better clinical outcomes compared to control group diet.[4]

The present paper entitled “Depression, Change in Mood and Self-Esteem among Adolescents of 12-25 years with Acne vulgaris in India” provides an opportunity of observing the situation in the Indian context; an emerging public health issue that is mostly overlooked. Globally, it has gained recognition in recent times owning to its strong association with mental health problems, particularly in adolescents. Adolescence is the period of transition from childhood to adulthood characterized by biological maturation, psychological maturation, psychosexual maturation, and social maturation. Due to fluctuations in hormonal levels, there are manifestations of several skin diseases, of which acne is the most frequently diagnosed skin lesion among individuals aged 11-30 years.[5]

Given the fact that acne appears on the face (mostly visible) and affects appearance (inflammation leading to scarring and hyperpigmentation), individuals with acne suffer enhanced psychological distress and emotional scars compared to acne-free individuals, especially adolescents.[6] Self-perceived attractiveness varies significantly among acne-sufferers; it affects the quality of life, interpersonal relationships, and lowers confidence as well as self-esteem. Moreover, teasing by friends aggravates these sufferings and in some cases subjects are compelled into social isolation. In order to avoid social embarrassment, they often wear heavy makeup, grow their hair longer to cover their face, and are needlessly exploited at beauty parlors. Previous studies suggested that apart from cosmetic nuisance, teens with acne are more prone to social anxiety, poor self-image, depression, and suicidal ideation compared to their acne-free counterparts. The extent of psychological comorbidities, namely anxiety, depression, and body image perception, are probably underestimated in acne. In addition, severity of acne increases with emotional stress in a linear fashion and significantly affects their social, vocational, and academic performances.[6],[7]

Given that a sizeable number of individuals with acne suffer from some kind of mental health problem, perhaps the most important point for concern is that treating physicians including dermatologists are not aware of emotional aspects associated with acne. A qualitative study to explore the doctor–patient relationships while treating acne revealed that most of the physicians were insensitive to their psychological sufferings and lacked proper knowledge of handling such sensitive issues.[8] Not only physicians, the complex relationships between the skin and the mind is not well perceived by parents and the society at large. Researchers have indicated that interactions between skin disorders and psychological complications could result into significant comorbidities and could hamper the quality of life. Therefore, raising awareness among the general public and educating the treating physicians regarding psychological problems in patients with skin disorders and the importance of a holistic approach in caring for patients with psychological instability seem to be the need of the hour. Prompt interventions with appropriate medicines and psychotherapy might improve the quality of life and could save millions of adolescents from such emotional stress and social embarrassment. Therefore, dermatologists should be sensitive to such psychological and psychosocial problems of acne on adolescents and must understand the need for treating such associated problems while dealing with acne cases. Researchers have emphasized that individuals with suspected depression and anxiety might need multicomponent collaborative interventions including psychotherapy, pharmacotherapy, and counseling of parents. Although acne is not a life-threatening condition, but the social and psychological consequences are enormous. Thus, psychiatric screening with appropriate counseling of subjects with acne, especially adolescents, remains the cornerstone of acne management.

   References Top

Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol 2013;168:474-85.  Back to cited text no. 1
Degitz K, Placzek M, Borelli C, Plewig G. Pathophysiology of acne. J Dtsch Dermatol Ges 2007;5:316-23.  Back to cited text no. 2
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163-96.  Back to cited text no. 3
Kwon HH, Yoon JY, Hong JS, Jung JY, Park MS, Suh DH. Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: A randomized, controlled trial. Acta Derm Venereol 2012;92:241-6.  Back to cited text no. 4
Bergler-Czop B, Brzezińska-Wcisło L. Dermatological problems of the puberty. Postepy Dermatol Alergol 2013;30:178-87.  Back to cited text no. 5
Lee IS, Lee AR, Lee H, Park HJ, Chung SY, Wallraven C, et al. Psychological distress and attentional bias toward acne lesions in patients with acne. Psychol Health Med 2014;19:680-6.  Back to cited text no. 6
Niemeier V, Kupfer J, Gieler U. Acne vulgaris--psychosomatic aspects. J Dtsch Dermatol Ges 2010;8(Suppl 1):S95-104.  Back to cited text no. 7
Magin PJ, Adams J, Heading GS, Pond CD. Patients with skin disease and their relationships with their doctors: A qualitative study of patients with acne, psoriasis and eczema. Med J Aust 2009;190:62-4.  Back to cited text no. 8

Correspondence Address:
Tanmay Mahapatra
8, Dr. Ashutosh Sastri Road, Kolkata - 700 010, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.179101

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