Psychological considerations may not be overlooked in management of acne vulgaris. In adult stress 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.
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 psychological burden, 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, a cascade which eventually terminates in stress acne. 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 inflammatory mediators.
Severe acne is associated with increased risk of suicide attempt. Swedish cohort study addresses this issue in Nov 12, 2010 in BMJ, which emphasizes role of counseling in physician’s management of stress acne.
Stratum corneum lipid composite and sebum changes as a result of stress is another aspect of this vicious circle which warrants early intervention. Depletion of skin’s ceramides level and pyrollidone carboxylic acid has been suggested as how sebum under psychological burden alters and gives rise to stress acne.