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Indian Journal of Dermatology, Venereology and Leprology
Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)
ISSN: 0378-6323 EISSN: 0973-3922
Vol. 75, Num. S1, 2009, pp. 4-5
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Indian Journal of Dermatology, Venereology and Leprology, Vol. 75, No. 7, , 2009, pp. 4-5
Acne in India: Guidelines for management - IAA Consensus Document
Acne and quality of life
Raj Kubba, AK Bajaj, DM Thappa, Rajeev Sharma, Maya Vedamurthy, Sandipan Dhar, S Criton, Rui Fernandez, AJ Kanwar, Uday Khopkar, Malavika Kohli, VP Kuriyipe, Koushik Lahiri, Nina Madnani, Deepak Parikh, Sudhir Pujara, KK Rajababu, S Sacchidanand, VK Sharma, Jayakar Thomas - members Indian Acne Alliance
Correspondence Address: Dr.
Raj Kubba, Consultant Dermatologist, Kubba Clinic, 10, Aradhana Enclave,
Ring Road, New Delhi - 110066, India. rajkubba@hotmail.com
Code Number: dv09232
The impact of skin diseases in general and acne in particular, on quality of life (QoL) has been recognized for over 30 years. Acne is associated with greater psychological burden than a variety of disparate chronic disorders. [1] The levels of social, psychological, and emotional impairments in acne compare with chronic diseases such as asthma, epilepsy, diabetes, and arthritis. [2] The impact of acne on QoL is independent of gender and age, but shows some correlation with disease severity. [3] Besides anxiety and depression, acne patients are prone to low self-esteem, low self-confidence, low self-assertiveness, embarrassment, social inhibition, affectation, shame, altered body image, psychosomatic symptoms (e.g., pain and discomfort), obsessive-compulsiveness, and suicidal ideation. [1],[4] Upto 5.6% of patients with moderate acne may have pre-existing suicidal ideation.[5] Younger patients are subject to scorn, teasing, and stigmatization. However, the impact of acne on a particular patient is not always easy to judge. [2] Patients with acne may experience worsening of their disease during examinations, [6],[7] that manifests without alteration in the sebum production. [7] Acne affects patients′ functional abilities. [8] Patients with acne have higher unemployment rates compared to patients without acne. [9] The impact of acne on QoL in Indian patients remains undocumented. Compared to France, where adolescents worry even about getting acne, [10] Indians appear to accept acne more readily and its impact on QoL in our population is of lower magnitude (consensus of the IAA members). WHO defines QoL as the "individuals′ perception of their position in the context of culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns." [11] Measurement of QoL is done through validated questionnaires. Dermatology specific questionnaires include dermatology life quality index (DLQI), [12] Skindex, [13] and dermatology quality of life scales (DQOLS). [14] Acne-specific measures include acne disability index (ADI), Cardiff acne disability index (CADI), assessment of the psychological and social effects of acne (APSEA), and acne quality of life (AQOL). [8],[15],[16],[17],[18] The measurement tools can be used to monitor change during therapy, and to devise strategies to improve adherence. [19] Impact of acne treatment on quality of life: Assessing QoL at baseline provides important information about patients′ perceptions. In a study assessing the effect of antiacne therapy on 111 patients, it was discovered that treatment substantially improved scores on QoL instruments. [20] Sometimes the opposite may happen in the early stage of the treatment, especially when irritating therapies such as topical retinoids are employed. With due counseling such negative experience can be taken in the stride. The impact of acne on QoL adversely influences adherence; effective therapy improves adherence. [21] There is consensus that psychological inputs optimize doctor-patient relationship and, in general, improve therapeutic outcomes.
References
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| 2. | Mallon E, Newton JN, Klassen A, Stewart-Brown SL, Ryan TJ, Finlay AY. The quality of life in acne: A comparison with general medical conditions using generic questionnaire. Br J Dermatol 1999;140:672-6. Back to cited text no. 2 [PUBMED] [FULLTEXT] |
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| 8. | Motley RJ, Finlay AY. How much disability is caused by acne? Clin Exp Dermatol 1989;14:194-8. Back to cited text no. 8 [PUBMED] |
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| 11. | The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995;41:1403-9. Back to cited text no. 11 |
| 12. | Finlay AY. Quality of life assessment in dermatology. Semin Cutan Med Surg 1998;7:291-6. Back to cited text no. 12 |
| 13. | Chren MM, Lasek RJ, Quinn LM, Mostow EN, Zyzanski SJ. Skindex: A quality-of-life measure for patients with skin disease: Reliability, validity and responsiveness. J Invest Dermatol 1996;107:707-13. Back to cited text no. 13 [PUBMED] |
| 14. | Morgan M, McCreedy R, Simpson J, Hay RJ. Dermatology quality of life scales: A measure of the impact of skin diseases. Br J Dermatol 1997;136:202-6. Back to cited text no. 14 [PUBMED] |
| 15. | Salek MS, Khan GK, Finlay AY. Questionnaire Techniques in assessing acne handicap: Reliability and validity study. Qual Lif Res 1996;5:131-8. Back to cited text no. 15 |
| 16. | Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social impact of acne: A comparison study using three acne disability questionnaires. Br J Dermatol 1997;137:41. Back to cited text no. 16 |
| 17. | Oakley AMM. The acne disability index: Usefulness confirmed. Australas J Dermatol 1996;37:37-9. Back to cited text no. 17 |
| 18. | Gupta MA, Johnson AM, Gupta AK. The development of an acne quality of life scale: Reliability, validity and relation to subjective acne severity in mild to moderate acne vulgaris. Acta Derm Venereol (Stockh) 1998;78:451-8. Back to cited text no. 18 |
| 19. | Finlay AY. Dermatology patients: What do they really need? Clin Exp Dermatol 2000;35:444-50. Back to cited text no. 19 |
| 20. | Newton JN, Mallon E, Klassen A, Ryan TJ, Finlay AY. The effectiveness of acne treatment: an assessment by patients of the outcome of therapy. Br J Dermatol 1997;137:563-7. Back to cited text no. 20 [PUBMED] |
| 21. | Balwin HE. Tricks for improving compliance with acne therapy. Dermatol Ther 2006;19:224-36. Back to cited text no. 21 |
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