Hospital based comparative study of anxiety and depression in adolescents with or without acne vulgaris

Acne vulgaris is a very common problem of adolescents. It is well known, easily recognizable, physiological process but is better regarded as a disease due to its inflammatory component. It causes disfigurement on the face, which is socially and psychologically the most important body region. This disfigurement leads to a greater psychological burden than a variety of other chronic diseases. Patients with severe acne and scarring have demonstrated a wide range of psychological abnormalities including depression, suicidal ideation, anxiety, psychosomatic symptoms( pain and discomfort ), embarrassment, body dysmorphic disorder and social inhibition. We conducted a cross sectional case control study which included 50 cases and 50 controls in our Department of Dermatology, Venereology & Leprosy of a rural based tertiary hospital. Patients were asked to answer the preformed questionnaires according to Hospital Anxiety and Depression scale (HADS). Statistical analysis was done using EPI 6 Info software. By doing such study in adolescents in rural based tertiary hospital we know the actual incidence of these symptoms in acne patients and accordingly manage the condition. We found acne vulgaris to be the most common physiological condition in adolescents. It can be concluded from this study that acne is likely to be associated with anxiety and depression. Introduction Acne vulgaris is commonly seen in teens1. It is a well-known, easily recognizable, physiological process but is better regarded as a disease due to its inflammatory component. It causes disfigurement on the face, which is socially and psychologically the most important body region. Thus, this disfigurement leads to a greater psychological burden than a variety of other chronic diseases. Patients with severe acne and scarring have demonstrated a wide range of psychological abnormalities including depression, suicidal tendency, anxiety, Egyptian Dermatology Online Journal Vol. 10 No 2: 3, December 2014 2 http://www.edoj.org.eg psychosomatic symptoms (pain and discomfort), embarrassment, body dysmorphic disorder, and social inhibition.2 In some studies, increase in prevalence of anxiety in patients with acne and positive relationship between severity of anxiety and severity of acne are reported3. However, in some other studies, no relationship between acne and anxiety is seen or the severity of anxiety and depression was not related to the severity of acne clinically4. Some studies reported that anxiety and depression are not correlated with age and sex3,4 but other studies reported that these disorders are more prevalent in women5. Depression is a multifactorial disorder and both acne and psychiatric disorders6, often affect people in the 15-24 years age group. Eighty-five to 90% of adolescents and young adults have some degree of acne. The main goal of acne treatment is to prevent physical scarring by limiting the number of lesions and the duration of the disease, thereby minimizing its psychological impact7. Acne has a demonstrable association with depression and anxiety; it affects personality, emotions, self-image and esteem, feelings of social isolation and the ability to form relationships8. Acne is a chronic inflammatory disease of the pilosebaceous unit. It is characterized by seborrhoea, formation of comedones, erythematous papules and pustules, less frequently by nodules and deep pustules or pseudocysts and in some cases is accompanied by scarring9. Subjects and Methods This was a cross sectional study to determine the incidence of anxiety and depression in adolescents with or without acne vulgaris which included 50 cases and 50 controls, who were the patients attending the skin Outpatient department of our hospital. Clearance from institutional ethical committee (IEC) was taken for research on human subjects. Informed consent of study subjects was also taken. The study was conducted over a period of two months from June to July 2012.