Comments

The form of relation between acne and Psychological factors

The highest incidence of depression and suicidal ideation in dermatology patients was reported with those who have severe forms of acne and psoriasis [11] [12] [13] [19] [20] .

Anxiety disorders in general and social phobia (social anxiety) in particular are more common in patients with acne than control subjects [12] [13] [15] [20] [21] .

Major psychiatric disorders associated with acne:

Depression

Anxiety disorders

Social phobia

Body dysmorphic disorder

Psychological factors can affect the course of skin diseases and acne can be exacerbated following stressful situations. There are some theories trying to explain the role of stress in exacerbations of acne such as Brain-Gut-Skin theory [1] [18] [19] .

Psychological factors affecting the course of acne:

e.g. the role of stress in exacerbation of acne

The quality of life of patients with acne can be as severely affected as those with other chronic medical conditions.

The change in the skin’ s appearance may be complicated by a changed body image, psychological distress, anger, fear, shame, embarrassment, and bullying and stigmatization within peer groups [9] [35] [36] [37] [38] [39] .

Other psychological problems secondary to skin conditions:

Impact on quality of life

Psychological distress reflected in emotional problems (e.g. shame, anger, embarrassment…etc.)

Isotretinoin is a vitamin A derivative which is approved for treatment of severe acne. It can limit or prevent scarring and decrease the length of the condition resulting in significant psychosocial improvement [22] [23] [24] . However, isotretinoin is reported among the Food and Drug Administration’s (FDA) 10 top drugs to be associated with depression and suicidal attempts [25] .

Psychiatric side effects of medications used for treatment of acne:

E.g. risk of depression and suicidal thoughts due to use of isotretinoin

Psychotropic medications can cause drug-induced acne such as trazodone, haloperidol, lithium and aripiprazole. Anticonvulsants may be associated with skin rash, alopecia, acne eruptions, erythema multiforme, psoriasis and pruritus, while lamotrigine may be associated with life threatening Stevens-Johnson syndrome [42] [43] [44] [45] [46]

Acne as side effect of psychotropic medications:

Antidepressants,

Antipsychotics

Anticonvulsants and mood stabilizers