Acne’s Impact on Quality of Life – A Systematic Review of Patient-Reported Impacts

Acne is a common skin condition, and is present in all age groups. Acne is most common in teens, but it can also affect adults.

Acne affects patients’ quality of life. Various metrics have been invented to quantify this.

Symptoms

Acne affects the quality of life of the patient and can result in psychosocial issues such as depression, anxiety and suicide. Acne symptoms can include red, pus-filled lumps called pustules; blackheads/whiteheads with encircling black pores called blackheads/whiteheads; water-filled cysts under the skin surface called cysts; and more.

Such wounds are not deadly and don’t always negatively impact physical health, but they can be terribly unpleasant for patients. Moreover, these can hinder social interactions and even affect perception of the appearance – which in turn adversely affects self-esteem and mood.

Multiple studies have suggested that acne increases both the quality of life and mental distress. Unfortunately, most cross-sectional research used questionnaires or surveys which can be biased; more research must consider these relationships in greater detail to determine whether appropriate acne treatment could improve these symptoms.

Self-esteem

As a matter of personal value, self-esteem is considered a key component of life satisfaction. A facial acne can have very negative effects on the self-image – embarrassing and low self-worth which has serious consequences for mental health, leading to depression or anxiety later in life.

Not only did researchers find that people with acne had lower self-esteem than people without acne, but self-esteem was also a reliable measure of quality of life: among arthritis patients, poorer self-esteem was associated with higher pain and stiffness reports.

More recently, it has also been shown that acne is very detrimental to people who live with the patient (mates). Acne had an impact on the lives of 89.4% of their cohabitants (highly proportionate to acne severity and depression symptoms), researchers reported.

Social relationships

Acne can seriously affect the intimate and familial life. Type of acne, however severe, can cause frustration, shame and dissatisfaction, which can lead to a loss of social interaction and self-worth. In addition, acne stigma can keep you from getting professional advice or support.

Another found that acne had a detrimental effect on the quality of life of acne sufferers, particularly as the condition progressed. For QoL, the researchers used two measures – Cardiff Acne Disability Index (CADI) and Down-Label Quality Indices (DLQI). Scores on CADI and DLQI were highly correlated, so higher scores on both scales represent greater quality-of-life harm.

Patients and neighbours attending a dermatology outpatient clinic at the hospital Virgen de las Nieves in Granada completed a cross sectional questionnaire survey, including demographic and DLQI/FDLQI, HADS and Cardiff acne disability index questions.

Work

The skin problem is a small component of the quality of life that is largely unrecognised. Acne has effects on its sufferers that don’t stop with the surface: it may erode self-confidence and interpersonal bonds, and it can be a source of psychological suffering with adverse effects on mental health.

Results from this study showed that patients’ self-rated quality of life was correlated with acne severity. The DLQI score was 0-30; the higher the score, the greater the loss of quality of life. The CADI score in turn ranged between 5-9; lower values being mild (10% or less impairment) or moderate (16-30% impairment).

It’s evident in the findings of this research that acne does degrade patients’ lives, but not as badly as chronic illnesses such as diabetes, asthma and cancer. We’ll need to do more longitudinal studies to find out if there are any long-term links between acne and mental health.