Conclusion
The presence of acne can negatively affect quality of life, self-esteem, and mood in adolescents. Acne is associated with an increased incidence of anxiety, depression, and suicidal ideation. The presence of these and other co-morbid psychological disorders should be considered in the treatment of acne patients when appropriate. A strong physician-patient relationship and thorough history taking may help to identify patients at risk for the adverse psychological effects of acne. Successful treatment of acne with isotretinoin qualitatively decreases depressive symptoms and improves quality of life. The effect of other topical and systemic therapies for acne on psychological symptoms has not been assessed.
In addition to the effect of acne on the patient, family and social relationships may also be strained. Parents may worry about the short- and long-term repercussions of their child’s appearance, such as being bullied at school or having permanent scarring from acne lesions. As teens gain independence during adolescence, their attitudes toward treatment and adherence to the prescribed regimen may be adversely affected. Parents and patients may not always be adequately educated about the causes and treatment of acne, which may further delay or affect successful treatment [30]. Poor adherence to therapy is a barrier to successful acne treatment. There is a positive correlation between treatment adherence and improved quality of life for other cutaneous diseases such as psoriasis [31, 32] and is an important area of future research in the clinical setting of acne treatment.
One limitation of the presented studies is that the majority are qualitative, questionnaire-based, case-controlled, or cross-sectional studies, which may introduce bias associated with self-reporting. The questionnaires used are appropriate as screening tools to assess for underlying psychological disorders, but are not sufficient to diagnose clinical depression or anxiety. Future prospective trials may help to more clearly define the psychological effects of acne on patients and their families and determine whether anti-acne therapy is successful in improving these parameters.