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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 4  |  Page : 1098-1102

Psychosocial impact of acne vulgaris on adolescents in preparatory and secondary schools


1 Department of Public Health and Community, Faculty of Medicine, Menofiya University, Shebin-El-Kom, Egypt
2 Department of Dermatology, Faculty of Medicine, Menofiya University, Shebin-El-Kom, Egypt
3 Department of Family Medicine, Faculty of Medicine, Menofiya University, Shebin-El-Kom, Egypt
4 Department of Family Medicine, Quesna Health Center, Quesna, Menofiya Governorate, Egypt

Date of Submission12-Mar-2017
Date of Acceptance23-Apr-2017
Date of Web Publication04-Apr-2018

Correspondence Address:
Heba-Alla M Eshak Omar
Family Medicine, Quesna Health Center, Quesna, Menofiya Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_179_17

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  Abstract 


Objective
The aim of this work was to assess the psychosocial impact of acne on adolescents to improve their quality of life.
Background
Acne vulgaris is a common skin condition with substantial cutaneous and psychological burden. Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases.
Patients and methods
This cross-sectional study included 425 students with acne aged between 11 and 19 years. The psychosocial effect of acne was assessed using the acne quality of life questionnaires.
Results
Overall, 55.5% of our patients were female and 45.5% were male. The mean age was 15.91 years. In all, 90.1% had facial acne, 32.9% had acne in the back, 74.8% had closed comedo, 55.3% had open comedo, 18.4% had pustules, and only 8.2% had cysts and nodules. Of the total, 76, 17.9, and 6.1% of patients had mild, moderate, and severe acne, respectively. Acne severely affected the patients' perception, emotional state, and social activities. The most affected sector in patients' perception was dissatisfaction with their appearance, feeling unattractive, and disturbed self-confidence (P < 0.001). Being bothered by the need to have medication and cover-up available and not looking their best was the worst emotional impact (P < 0.001). The most affected social activity was interacting with the opposite sex (P < 0.001).
Conclusion
Acne vulgaris is incriminated in affecting the patients' perception, psychological state, and social activities with increasing affection with increasing the degree of acne.

Keywords: acne vulgaris, adolescent, quality of life


How to cite this article:
Mahrous OA, Abd Elwahed M, Salama AA, Eshak Omar HAM. Psychosocial impact of acne vulgaris on adolescents in preparatory and secondary schools. Menoufia Med J 2017;30:1098-102

How to cite this URL:
Mahrous OA, Abd Elwahed M, Salama AA, Eshak Omar HAM. Psychosocial impact of acne vulgaris on adolescents in preparatory and secondary schools. Menoufia Med J [serial online] 2017 [cited 2018 Dec 12];30:1098-102. Available from: http://www.mmj.eg.net/text.asp?2017/30/4/1098/229206




  Introduction Top


Humans are social existents who need to interact with each other, both verbally and physically. Factors that impair these functions may have negative psychological consequences[1].

In clinical practice, understanding how a patient's life is impacted by disease allows us to understand the illness from the patient's point of view and can help us in selecting the most appropriate treatment for that patient and may enhance compliance. Therefore, the quality of life (QoL) index can also be a measure of treatment success[2].

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit that affects at least 85% of adolescents and young adults, and makes them feel and look their worst. Therefore, it is not surprising that vulnerable patients with acne are prone to significant psychosocial disability[3]. In addition, patients with acne have a lower employment rate compared with those without[4].

The development of psychometric scales to measure the impact of disease on the QoL has facilitated greater understanding of the psychological impact of acne[5].

The aim of this work was to assess the psychosocial impact of acne on adolescents and to assess the impact of acne on the self-esteem of adolescents.


  Patients and Methods Top


It is a cross-sectional study through multistage stratified random sampling technique. The study was approved by the Ethical Committee of the Faculty of Medicine, Menofiya University, Shebin-El-Kom, Egypt. An official permission letter was obtained from the authorities of both and directed to the administrators of selected school. Informed consent was signed by all participants after simple and clear explanation of the research objectives and procedures. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000.

All preparatory and secondary schools were selected; the study included students with acne aged between 11 and 19 years. The study was conducted during the period from September 2014 to February 2016.

All students with acne (470) were asked for their consent. Predesigned questionnaires were then given to these students and 425 completed questionnaires were returned (response rate = 90.4%).

The questionnaires were administered to all students with acne, with items being read out verbally to students by the researcher. The questions were explained in easy language for the students to understand and the researcher ensured that the students understood each of the questions.

Participants were asked to state their age and sex. Socioeconomic standard was assessed through father's education, occupation, income, and number of individuals per room.

Each student was examined for acne, including head and neck examination. All students with acne were divided into three categories (mild, moderate, and severe) with regard to acne severity[6].

The psychosocial effect of acne was assessed using the acne-QoL[7]. It contains 19 questions organized into four domains (self-perception, role-social, role-emotional, and acne symptoms), which refer to facial acne. For all domains, higher scores reflect better health-related qQoL. The total score varies from zero to 114, distributed as follows: 0–30 (self-perception), 0–24 (role-social), 0–30 (role-emotional), and 0–30 (acne symptoms)[7].

Statistical analysis

Data were analyzed using Statistical Package for Social Science program, version 21 (SPSS Inc., Chicago, Illinois, USA) using personal computer. Data were entered as numerical or categorical, as appropriate. Two types of statistics were performed:

Descriptive statistics

Quantitative data were shown as mean and SD. Qualitative data were expressed as frequency and percent at 95% confidence interval.

Analytical statistics

χ2-tests were used to measure the association between qualitative variables. The Kruskal–Wallis test was used to compare means and SD of more than two sets of quantitative data. P (probability) value was considered to be of statistical significance if it is less than 0.05.


  Results Top


Overall, 55.5% of our patients were female and 45.5% were male. The mean age of the studied group was 15.91 years. On comparing the sex and age distribution in patients with mild, moderate, and severe acne, it was found that moderate and severe acne were more common in male (63.2 and 57.7%, respectively). However, there was no statistically significant difference as regards the age.

As regards the type of the school, the majority of our patients were from the secondary schools (80.2%). The type of school was comparable in patients with mild, moderate, and severe acne. Moderate and severe acne significantly increased in patients with low family income (44.7 and 65.4%, respectively).

On clinical examination, 90.1% had facial acne, 32.9% had acne in the back, 74.8% had closed comedo, 55.3% had open comedo, 18.4% had pustules, and only 8.2% of the studied group had cysts and nodules. On assessing acne severity, 76% of patients had mild acne, 17.9% had moderate acne, and 6.1% had severe acne.

As regards the signs and symptoms of acne, the majority of patients of the studied group had oily skin (92.7%), especially patients with moderate and severe acne (100%).

Acne severely affected the patients' perception, which appeared in the response of the students to the questionnaire, with poor QoL, especially with increasing degree of acne. The most affected sector in patient perception was dissatisfaction with their appearance, feeling unattractive, and disturbed self-confidence [Table 1].
Table 1: Comparison of perception score according to severity of acne on the studied group (Acne-QoLI items)

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Patients with moderate and severe acne had negative psychological impact and worse QoL. The most distressing manifestation was being bothered by the need to have medication and cover-up available followed by not looking their best [Table 2].
Table 2: The emotional impact score among patients with mild, moderate, and severe acne (Acne-QoLI items)

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On assessing the social impact, patients with mild acne significantly showed less social affection compared with patients with moderate and severe acne. The most affected social activities were interacting with the opposite sex followed by concern about going out in public [Table 3].
Table 3: The social impact score among patients with mild, moderate, and severe acne (Acne-QoLI items)

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As regards the symptoms and sign of acne, patients with mild acne showed a significantly better QoL (P< 0.05). The most distressing manifestations were concern about scabbing and scarring from facial acne [Table 4].
Table 4: The symptoms and signs of acne score among patients according to acne seveity (Acne-QoLI items)

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  Discussion Top


Acne vulgaris is a common skin condition with substantial cutaneous and psychological disease burden. Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases, such as diabetes and epilepsy[8].

The current study results revealed that 55.5% of our patients were female and 45.5% were male. The mean age of the studied group was 15.91 ± 1.53 years. In agreement with our results, Noorbala et al.[1] found that acne is more relevant in female population than in male population. The students comprised 52.5% girls and 47.5% boys. The mean age of the students was 16.5 ± 1.12 years.

On comparing the sex and age distribution in patients with mild, moderate, and severe acne, it was found that there was a statistically significant difference between the patients with mild, moderate, and severe acne as regards the sex. Moderate and severe acne were more common in male patients (63.2 and 57.7%, respectively) (P< 0.05). However, there was no statistically significant difference as regards the age (P > 0.05). The findings are consistent with those of Hanisah et al.[9], which found that male patients tend to have more severe acne as compared with female patients. This difference may be related to the presence of oilier complexion and high androgen levels in male patients.

As regards the type of the school, the majority of our patients were from the secondary schools (80.2%). The type of school was comparable in patients with mild, moderate, and severe acne (P > 0.05).

Moderate and severe acne significantly increased in patients with low family income (44.7 and 65.4%, respectively) (P< 0.05). This may be related to the financial handicaps to achieve adequate acne treatment and preventive measures in hand with the poor hygienic measures.

On clinical examination, 90.1% had facial acne, 32.9% had acne in the back, 74.8% having closed comedo, 55.3% had open comedo, 18.4% had pustules, and only 8.2% of the studied group had cysts and nodules. Consistent with our results, Tasoula et al.[10]reported a prevalence of facial acne of 89.1%.

In all, 76% of patients had mild acne, 17.9% had moderate acne, and 6.1% had severe acne. In agreement with our results, Tasoula et al.[10]reported that mild acne was present in 71.2% and moderate–severe acne in 28.8% of the study population.

As regards the signs and symptoms of acne in the studied group, the majority of patients of the studied group had oily skin (92.7%). The mean acne number in the face was 25.87, mean number of white comedo was 23.27, and the no. of scales was 1.54, which was significantly increasing with increasing acne severity (P< 0.05).

Self-perception, role-emotional, role-social, and symptoms of acne were assessed through predesigned questionnaire according to the Acne-QoL, with higher score indicating better QoL. Fehnel et al.[11], on assessing the responsiveness of the Acne-QoL to treatment for acne vulgaris in placebo-controlled clinical trials, confirmed that the Acne-QoL is responsive, internally consistent, and valid.

The present study revealed that acne severely affected the patients' perception, which appeared in the response of the students to the questionnaire, with poor QoL, especially with increasing degree of acne. The most affected sectors in patient perception were dissatisfaction with their appearance (total score: 4.29 ± 1.49), feeling unattractive (total score; 5.19 ± 1.47), and disturbed self-confidence (total score; 5.21 ± 1.5) (P< 0.05).

Concerning the psychological impact in patients with mild, moderate, and severe acne, the quality of life was significantly better in patients with mild acne (P< 0.05). The most distressing manifestation was being bothered by need to have medication and cover-up available (total score: 4.87 ± 1.48) followed by not looking their best (total score: 5.09 ± 1.47).

For assessing the social impact, a question were asked regarding the concern about meeting new people and going out in public, socializing, and interacting with the opposite sex. Patients with mild acne significantly showed less social affection compared with patients with moderate and severe acne (P< 0.05). The most affected social activities were interacting with the opposite sex (total score: 4.91 ± 1.49) and concern about going out in public (total score: 5.13 ± 1.34).

In the study by Tasoula et al.[10], 19.2% of the students were affected in their personal and social lives, especially in their relationship building because of their acne on the face.

As regards the symptoms and sign of acne, patients with mild acne showed significantly better QoL (P< 0.05). The most distressing manifestations were concern about scabbing (total score: 4.95 ± 1.95) and scarring from facial acne (total score: 4.98 ± 1.9).

In our results we found that Acne-QoL domain scores gradually decreases with increasing acne severity. Contradictory to our results, Kamamoto et al.[12] found that Acne-QoL domain scores were similar among the different acne severity groups except for role-social domain.


  Conclusion Top


Acne vulgaris is incriminated in affecting the patients' perception, psychological state, and social activities with increasing affection with increasing the degree of acne.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Noorbala MT, Mozaffary B, Noorbala M. Prevalence of acne and its impact on the quality of life in high school-aged adolescents in Yazd, Iran. J Pak Assoc Derma 2013; 23:168–172.  Back to cited text no. 1
    
2.
Dreno B. Assessing quality of life in patients with acne vulgaris. Implications for treatment. Am J Clin Dermatol 2006; 7:99–106.  Back to cited text no. 2
    
3.
Thomas DR. Psychological effect of acne. J Cutan Med Surg 2004; 8:3–5.  Back to cited text no. 3
    
4.
Demircay Z, Seckin D, Senol A, Demir F. Patient's perspective: an important issue not to be overlooked in assessing acne severity. Can Med Assoc J 1989; 140:1441–1448.  Back to cited text no. 4
    
5.
Kokandi A. Evaluation of acne quality of life and clinical severity in acne female adults. Dermatol Res Prac 2010; 2010:1–3.  Back to cited text no. 5
    
6.
Rubin E. Essential pathology. 3rd ed. Baltimore, MD: Lippincott Williams and Wilkins; 2001.  Back to cited text no. 6
    
7.
Girman CJ, Hartmaier S, Thiboutot D, Johnson J, Barber B, DeMuro-Mercon C, et al. Evaluating health related quality of life in patients with facial acne: development of a self administered questionnaire for clinical trials. Qual Life Res 1996; 5:131–138.  Back to cited text no. 7
    
8.
Saitta P, Grekin SK, Faocd A. Four-question approach to determining the impact of acne treatment on quality of life. J Clin Aesthet Dermatol 2012; 5:51–57.  Back to cited text no. 8
    
9.
Hanisah A, Omar K, Shah SA. Prevalence of acne and its impact on the quality of life in school-aged adolescents in Malaysia. J Prim Health Care 2009; 1:20–25.  Back to cited text no. 9
    
10.
Tasoula E, Gregoriou S, Chalikias J, Lazarou D, Danopoulou I, Katsambas A, et al. The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey. An Bras Dermatol 2012; 87:862–869.  Back to cited text no. 10
    
11.
Fehnel SE, McLeod LD, Brandman J, Arbit DI, McLaughlin-Miley CJ, Coombs JH, et al. Responsiveness of the Acne-Specific Quality of Life Questionnaire (Acne-QoL) to treatment for acne vulgaris in placebo-controlled clinical trials. Qual Life Res 2002; 11:809–816.  Back to cited text no. 11
    
12.
Kamamoto Cde S, Hassun KM, Bagatin E, Tomimori J. Acne-specific quality of life questionnaire (Acne-QoL): translation, cultural adaptation and validation into Brazilian-Portuguese language. An Bras Dermatol 2014; 89:83–90.  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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