Psychological considerations may not be overlooked in management of acne. In adult acne, as in many skin diseases, stress has been incriminated as a causative factor, which may greatly affect course of treatment, determined principally based on acne types and severity. There is no doubt that anxiety and depression, secondary to the development and persistence of acne , are commonly experienced and may render the patient a social outcast. These factors and their impact on quality of life of the patients must be taken seriously in treatment of acne.
For majority of adults with stress acne the actual appearance of their skin and the consequent lack of self-esteem are the most important considerations. Acne patients also refer to the amount of time they spend concealing their acne. Lack of understanding of the problem is common, other people often do not realize the physical and emotional suffering that adult acne can cause. Interpersonal difficulties are common. Patients can be hurt by insensitivity of their co-workers. Patients may seek over-the-counter acne treatments and become more disappointed by not getting cured. Some studies suggest that the way patients cope with their acne is more significantly associated with severity of their lesions than number of stressful events they receive.
Unemployment can result from severe acne. The appearance of the skin can also be a limiting factor in employment. Anxiety is also common especially worrying about scarring. Depression is also a feature, fueled by concern about appearance. Social life is often affected. Most of adult females had tried to conceal their acne lesions with make-up, but this was largely unsuccessful.
A study by Rubinow et al evaluated the psychiatric morbidity and mood characteristics of seventy-two patients with cystic acne before and after treatment with one of three dosage schedules of isotretinoin. No excess psychiatric morbidity was observed but substantial evidence of psychological distress was noted before treatment. After acne treatment significant reduction in anxiety were observed, with greatest mitigation of anxiety and depression in those patients with the greatest dermatological improvement with isotretinoin.
Kenyon found no evidence for adult acne being initiated de novo by psychological factors. However, he did find in the predisposed individual that exacerbation of acne can occur as a result of emotional stress. If acne is made worse by stress, an effect of the treatment of inflammation is the most likely profitable route of investigation. Indeed calming the inflamed skin is one of the successful approaches to treatment of acne. Does body lesions such as back acne would follow the same pattern of development? Even though there are less studies on pathology of acne lesions in areas other than the face, epidermis structures and sebaceous glands share the same characteristic as of facial lesions. However, population of sebaceous glands in the skin of the back, chest and arms is much less compare to that of the face.
Another study by Toyoda M, Morohashi M. suggests that cutaneous neurogenic factors may stimulate lipogenesis of the sebaceous glands which may be followed by proliferation of Propionibacerium acnes, and may yield a potent influence on the sebaceous glands by provocation of inflammatory reactions via mast cells. This study uses cutaneous neurogenic factors changes as a means to examine involvement of psychological factors in acne vulgaris and concludes that these factors including subtance P should contribute to onset and/or exacerbation of acne inflammation.
Severe acne is associated with increased risk of suicide attempt. Swedish cohort study addresses this issue in Nov 12, 2010 in BMJ.