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Kazan D, Inci BB, Ilchan S, Ozkoca D. Evaluation of Depression, Self-esteem, Anxiety, and Dermatological Quality of Life Index in Adolescent Acne Patients: A Case-Control Study. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:210-215. [PMID: 39021686 PMCID: PMC11249996 DOI: 10.14744/semb.2024.38268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/25/2024] [Accepted: 03/24/2024] [Indexed: 07/20/2024]
Abstract
Objectives Acne vulgaris is a common skin condition that affects adolescents and can have a significant impact on their mental health. In this study, we aimed to evaluate the depression and anxiety symptoms, self-esteem and dermatological quality of life indexes of adolescent patients with acne vulgaris. Methods A total of 160 patients aged between 10 and 19 years with acne vulgaris and 100 healthy controls were included in the study. All participants completed the Reynolds Adolescent Depression Scale (RADS), Beck Adolescent Anxiety Scale (BAAS), and Coopersmith Self-Esteem Survey Scale (CSES), alone and independently. The dermatologists evaluated the acne disease severity of the study group using the Global Acne Grading System, while the Children's Dermatological Quality of Life Index (CDLQI) was evaluated in the same group. Age, gender, and scale results of all participants were recorded on case report forms for further analysis. Results The study group had significantly higher RADS (27.5% vs 12.5%, p=0.003) and BAAS scores (80% vs 64%, p=0.001) than the control group. The percentage of patients with CSES scores below 20 in the study group was significantly higher than the control group (p=0.001). Higher RADS and BAAS scores were associated with higher CDLQI scores (p=0.001, p=0.001, respectively), while higher CSES scores were associated with lower CDLQI scores (p=0.001). Conclusion The study shows that acne vulgaris has a significant impact on the depression, anxiety, and self-esteem levels of adolescent patients. Dermatologists should pay attention to the psychological well-being of patients and provide psychiatric evaluation if necessary.
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Affiliation(s)
- Didem Kazan
- Department of Dermatology and Venerology, Kutahya Health Science University, Evliya Celebi Training and Research Hospital, Kutahya, Türkiye; Department of Dermatology and Venerology, Istanbul Arel University, Istanbul, Türkiye
| | - Burcu Bahar Inci
- Department of Dermatology and Venerology, Kutahya Health Science University, Evliya Celebi Training and Research Hospital, Kutahya, Türkiye
| | - Selin Ilchan
- Department of Dermatology and Venerology, Kocaeli University, Kocaeli, Türkiye
| | - Defne Ozkoca
- Department of Dermatology and Venerology, Zonguldak Ataturk State Hospital, Zonguldak, Türkiye
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Orenay OM, Temel B, Capci AK, Bal ZI, Karaosmanoglu N. Evaluation of isotretinoin effects on depression, sleep apnea and sleep quality. Cutan Ocul Toxicol 2024; 43:129-133. [PMID: 38608451 DOI: 10.1080/15569527.2024.2340435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Isotretinoin is used to treat severe acne, treatment-resistant moderate acne, and acne that leads to scarring or psychological distress. It has many side effects and is also associated with depression, sleep apnea, and sleep disturbances. OBJECTIVES In this study, we aimed to evaluate the effects of isotretinoin on depression, sleep apnea, and sleep quality. METHODS A total of 42 patients diagnosed with acne and started isotretinoin treatment were included in the study. In order to compare the effects of isotretinoin, patients were asked to fill out a questionnaire containing the Beck Depression Inventory (BDI), the Berlin Questionnaire (BQ), and the Pittsburg Sleep Quality Index (PSQI) at baseline and third months of treatment. RESULTS There was no statistically significant difference in BDI, BQ, and PSQI scores between the 1st and 3rd months of treatment (p = .53, p = .5, p = .35). CONCLUSION This study showed that isotretinoin had no significant effects on depression and sleep quality.
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Affiliation(s)
- Ozge Mine Orenay
- Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Berkay Temel
- Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Arcan Kivanc Capci
- Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Zulal Inci Bal
- Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Nermin Karaosmanoglu
- Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
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Hughes O, Bewley A. Is it really ever 'just acne'? Considering the psychodermatology of acne. Br J Dermatol 2023; 189:i11-i16. [PMID: 37903071 DOI: 10.1093/bjd/ljad251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 11/01/2023]
Abstract
Acne can create a significant burden for people of all ages. However, the psychological consequences might often be overlooked. This review comments on recent evidence in the field of psychodermatology, to highlight the importance of considering a person's mental health in the treatment of acne. A range of presenting issues are discussed, and cases of underserved patients needing additional considerations are highlighted. This article considers how the psychological sequelae can contribute to the pathogenesis of acne, and discusses how psychotherapeutic approaches can be of benefit to people experiencing appearance-related distress. Importantly, attention is paid to the need for clinicians to assess a patient's wellbeing alongside their physical symptoms. In doing this, early intervention can be facilitated if psychological comorbidities are present, with referral to appropriate specialist services, where available. To improve treatment outcomes, the skin and the mind must be addressed together in a multidisciplinary approach to dermatology care.
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Affiliation(s)
- Olivia Hughes
- School of Psychology, Cardiff University, Cardiff, UK
| | - Anthony Bewley
- Barts Health NHS Trust and Queen Mary University of London Medical School, London, UK
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Chen Y, Knight R, Gallo RL. Evolving approaches to profiling the microbiome in skin disease. Front Immunol 2023; 14:1151527. [PMID: 37081873 PMCID: PMC10110978 DOI: 10.3389/fimmu.2023.1151527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/14/2023] [Indexed: 04/22/2023] Open
Abstract
Despite its harsh and dry environment, human skin is home to diverse microbes, including bacteria, fungi, viruses, and microscopic mites. These microbes form communities that may exist at the skin surface, deeper skin layers, and within microhabitats such as the hair follicle and sweat glands, allowing complex interactions with the host immune system. Imbalances in the skin microbiome, known as dysbiosis, have been linked to various inflammatory skin disorders, including atopic dermatitis, acne, and psoriasis. The roles of abundant commensal bacteria belonging to Staphylococcus and Cutibacterium taxa and the fungi Malassezia, where particular species or strains can benefit the host or cause disease, are increasingly appreciated in skin disorders. Furthermore, recent research suggests that the interactions between microorganisms and the host's immune system on the skin can have distant and systemic effects on the body, such as on the gut and brain, known as the "skin-gut" or "skin-brain" axes. Studies on the microbiome in skin disease have typically relied on 16S rRNA gene sequencing methods, which cannot provide accurate information about species or strains of microorganisms on the skin. However, advancing technologies, including metagenomics and other functional 'omic' approaches, have great potential to provide more comprehensive and detailed information about the skin microbiome in health and disease. Additionally, inter-species and multi-kingdom interactions can cause cascading shifts towards dysbiosis and are crucial but yet-to-be-explored aspects of many skin disorders. Better understanding these complex dynamics will require meta-omic studies complemented with experiments and clinical trials to confirm function. Evolving how we profile the skin microbiome alongside technological advances is essential to exploring such relationships. This review presents the current and emerging methods and their findings for profiling skin microbes to advance our understanding of the microbiome in skin disease.
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Affiliation(s)
- Yang Chen
- Department of Dermatology, University of California San Diego, La Jolla, CA, United States
- Department of Pediatrics, University of California San Diego, La Jolla, CA, United States
- Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, United States
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, United States
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, United States
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, United States
| | - Richard L. Gallo
- Department of Dermatology, University of California San Diego, La Jolla, CA, United States
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, United States
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Liu L, Xue Y, Chen Y, Chen T, Zhong J, Shao X, Chen J. Acne and risk of mental disorders: A two-sample Mendelian randomization study based on large genome-wide association data. Front Public Health 2023; 11:1156522. [PMID: 37064666 PMCID: PMC10102334 DOI: 10.3389/fpubh.2023.1156522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundDespite a growing body of evidence that acne impacts mental disorders, the actual causality has not been established for the possible presence of recall bias and confounders in observational studies.MethodsWe performed a two-sample Mendelian randomization (MR) analysis to evaluate the effect of acne on the risk of six common mental disorders, i.e., depression, anxiety, schizophrenia, obsessive–compulsive disorder (OCD), bipolar disorder, and post-traumatic stress disorder (PTSD). We acquired genetic instruments for assessing acne from the largest genome-wide association study (GWAS) of acne (N = 615,396) and collected summary statistics from the largest available GWAS for depression (N = 500,199), anxiety (N = 17,310), schizophrenia (N = 130,644), OCD (N = 9,725), bipolar disorder (N = 413,466), and PTSD (N = 174,659). Next, we performed the two-sample MR analysis using four methods: inverse-variance weighted method, MR-Egger, weighted median, and MR pleiotropy residual sum and outliers. Sensitivity analysis was also performed for heterogeneity and pleiotropy tests.ResultsThere was no evidence of a causal impact of acne on the risk of depression [odds ratio (OR): 1.002, p = 0.874], anxiety (OR: 0.961, p = 0.49), OCD (OR: 0.979, p = 0.741), bipolar disorder (OR: 0.972, p = 0.261), and PTSD (OR: 1.054, p = 0.069). Moreover, a mild protective effect of acne against schizophrenia was observed (OR: 0.944; p = 0.033).ConclusionThe increased prevalence of mental disorders observed in patients with acne in clinical practice was caused by modifiable factors, and was not a direct outcome of acne. Therefore, strategies targeting the elimination of potential factors and minimization of the occurrence of adverse mental events in acne should be implemented.
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Affiliation(s)
- Lin Liu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhou Xue
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yangmei Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingqiao Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Judan Zhong
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Shao
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Jin Chen,
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Kridin K, Ludwig RJ. Isotretinoin and the risk of psychiatric disturbances: A global study shedding new light on a debatable story. J Am Acad Dermatol 2023; 88:388-394. [PMID: 36273659 DOI: 10.1016/j.jaad.2022.10.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Isotretinoin-related risk of depression and suicidal behavior is a topic of inconclusiveness. A crucial knowledge gap exists in defining the association of isotretinoin with other psychiatric comorbidities. OBJECTIVE To evaluate the risk of psychiatric outcomes among patients with acne treated with isotretinoin versus oral antibiotics. METHODS A global population-based retrospective cohort study enrolled 2 groups of patients with acne managed by isotretinoin (n = 75,708) and oral antibiotics (n = 75,708). Patients were compared regarding the risk of 9 psychiatric outcomes. RESULTS Relative to those treated with oral antibiotics, patients prescribed isotretinoin experienced lower risk of depression (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87-0.93; P < .001), but comparable risk of major depressive disorder (HR, 0.97; 95% CI, 0.92-1.03; P = .318). Risk of suicidal attempts was comparable between groups (HR, 0.97; 95% CI, 0.85-1.11; P = .663), despite the elevated risk of suicidal ideation in those under isotretinoin (HR, 1.41; 95% CI, 1.32-1.50; P < .001). Patients under isotretinoin had lower risk of post-traumatic stress disorder (HR, 0.75; 95% CI, 0.68-0.82; P < .001), anxiety (HR, 0.84; 95% CI, 0.82-0.87; P < .001), bipolar disorder (HR, 0.65; 95% CI, 0.59-0.72; P < .001), schizophrenia (HR, 0.60; 95% CI, 0.48-0.76; P < .001), and adjustment disorder (HR, 0.82; 95% CI, 0.77-0.87; P < .001). LIMITATIONS Retrospective data collection. CONCLUSION Isotretinoin confers lower risk of 6 psychiatric comorbidities and comparable risk of suicidal attempts.
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Affiliation(s)
- Khalaf Kridin
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Unit of Dermatology and Skin Research Laboratory, Barch Padeh Medical Center, Poriya, Israel.
| | - Ralf J Ludwig
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany
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Effect of Sarecycline on the Acne Symptom and Impact Scale and Concerns in Moderate-to-Severe Truncal Acne in Open-Label Pilot Study. Antibiotics (Basel) 2023; 12:antibiotics12010094. [PMID: 36671294 PMCID: PMC9854980 DOI: 10.3390/antibiotics12010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Truncal acne is common, and the psychosocial burden may be underestimated as patients most often complain of facial acne. The Acne Symptom and Impact Scale (ASIS) is a 17-item patient-reported outcome (PRO) measure designed to assess the signs and impacts of acne vulgaris. ASIS has previously been validated in a prospective, non-interventional study as a reliable PRO instrument for facial acne. In a pilot study, ASIS, and an additional 10 new questions that focused on the concerns of patients (ASIS-C), were given to 10 patients with moderate-to-severe truncal acne vulgaris who received 3 months of monotherapy with oral sarecycline, a narrow-spectrum tetracycline-class antibiotic. ASIS-C questionnaires were also given to 10 acne-free control subjects. Average ASIS-C answers decreased by 4% for Signs, 15% for Impact, and 16% for Concerns in the 10 patients, with greater decreases of 5% for Signs, 20% for Impact, and 19% for Concerns in the 60% of patients whose truncal acne was clear or almost clear after 12 weeks of sarecycline treatment. In this study, sarecycline was effective in reducing the psychosocial burden associated with truncal acne based on the ASIS-C PRO measures.
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8
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Wang J, Luo Y, Wang Z, Hounye AH, Cao C, Hou M, Zhang J. A cell phone app for facial acne severity assessment. APPL INTELL 2023; 53:7614-7633. [PMID: 35919632 PMCID: PMC9336136 DOI: 10.1007/s10489-022-03774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
Acne vulgaris, the most common skin disease, can cause substantial economic and psychological impacts to the people it affects, and its accurate grading plays a crucial role in the treatment of patients. In this paper, we firstly proposed an acne grading criterion that considers lesion classifications and a metric for producing accurate severity ratings. Due to similar appearance of acne lesions with comparable severities and difficult-to-count lesions, severity assessment is a challenging task. We cropped facial skin images of several lesion patches and then addressed the acne lesion with a lightweight acne regular network (Acne-RegNet). Acne-RegNet was built by using a median filter and histogram equalization to improve image quality, a channel attention mechanism to boost the representational power of network, a region-based focal loss to handle classification imbalances and a model pruning and feature-based knowledge distillation to reduce model size. After the application of Acne-RegNet, the severity score is calculated, and the acne grading is further optimized by the metadata of the patients. The entire acne assessment procedure was deployed to a mobile device, and a phone app was designed. Compared with state-of-the-art lightweight models, the proposed Acne-RegNet significantly improves the accuracy of lesion classifications. The acne app demonstrated promising results in severity assessments (accuracy: 94.56%) and showed a dermatologist-level diagnosis on the internal clinical dataset.The proposed acne app could be a useful adjunct to assess acne severity in clinical practice and it enables anyone with a smartphone to immediately assess acne, anywhere and anytime.
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Affiliation(s)
- Jiaoju Wang
- School of Mathematics and Statistics, Central South University, Changsha, 410083 Hunan China
| | - Yan Luo
- Department of dermatology of Xiangya hospital, Central South University, Changsha, 410083 Hunan China
| | - Zheng Wang
- School of Mathematics and Statistics, Central South University, Changsha, 410083 Hunan China.,Science and Engineering School, Hunan First Normal University, Changsha, 410083 Hunan China
| | - Alphonse Houssou Hounye
- School of Mathematics and Statistics, Central South University, Changsha, 410083 Hunan China
| | - Cong Cao
- School of Mathematics and Statistics, Central South University, Changsha, 410083 Hunan China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha, 410083 Hunan China
| | - Jianglin Zhang
- Department of Dermatology of Shenzhen People's Hospital The Second Clinical Medical College of Jinan Uninversity, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020 Guangdong China.,Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, 518020 Guangdong China
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9
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The Impact of Common Acne on the Well-Being of Young People Aged 15-35 Years and the Influence of Nutrition Knowledge and Diet on Acne Development. Nutrients 2022; 14:nu14245293. [PMID: 36558452 PMCID: PMC9784447 DOI: 10.3390/nu14245293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Acne is a disorder of sebaceous glands, and it most commonly develops on the face. The role of the diet in triggering and treating acne is controversial and has been widely debated in the literature. A knowledge of the environmental factors that contribute to acne could improve the patient’s physical and emotional well-being, increase the efficacy of treatment, and minimize the risk of anxiety and depressive disorders. The aim of this study was to assess the impact of acne on the daily lives and well-being of people aged 15−30 years, to analyze young people’s knowledge about the influence of various foods and other dietary factors on the prevalence, severity, and treatment of acne, as well as their adherence to an anti-acne diet. The study was conducted between April 2021 and May 2022. A total of 1329 respondents, including 963 women and 366 men, participated in the study. In 99% of men and women respondents, acne breakouts were typically located on the face. An analysis of HADS scores revealed moderate anxiety in 57% of women (F) and 22.5% of men (M) respondents. Acne breakouts located on the face were problematic for 81% of the study population (regardless of sex). More than ¾ of women and 2/3 of men claimed that acne made them feel less attractive. The impact of acne on the participants’ emotional well-being and social life differed between genders. Women experienced psychological discomfort more frequently than men (p = 0.0023). More than 50% of the participants eliminated acne-triggering foods from their diets, and 2/3 of these respondents observed a marked improvement or disappearance of skin breakouts as a result. A significantly higher number of respondents with severe/moderate anxiety were convinced that acne breakouts were affected by diet (OR 1.56; 95% CI 1.23−1.87, p < 0.001) and foods with a high glycemic index (OR 1.56; 95% CI 1.23−1.94, p < 0.001). Acne affects the patients’ emotional well-being. It can act as a barrier to social interactions and lead to mood disorders of varied severity. Persons with moderate/severe mood disorders associated with anxiety significantly more often recognized the role of dietary factors in acne aggravation, and the severity of mood disorders was directly correlated with more frequent consumption of sweets, sweetened beverages, and foods with a high glycemic index.
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Ning X, Zhang Y, Wang W, Yan H. The association between social support and depression among patients with vitiligo in China. Front Psychol 2022; 13:939845. [PMID: 36081711 PMCID: PMC9445617 DOI: 10.3389/fpsyg.2022.939845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Vitiligo is a common depigmenting skin disease with profound psychosocial impacts. Depression is one of the most common mental distress. Social support has a significant impact on the psychological status of patients. The aim of this study is to investigate the depression and social support status of patients with vitiligo in China, and further explore the correlation between social support and depression. The outpatients with vitiligo were investigated face to face with SDS (Self-rating depression scale) and SSRS (Social support rate scale). The mean SDS score of the patients was 44.05 ± 6.76, which was significantly higher than Chinese norms (p = 0.000). Female patients, unmarried, disease at rapid progressive stage and skin lesions at the exposed site had higher SDS scores (all p < 0.05). The scores of total social support, subjective support, objective support and support availability were lower than Chinese norms (all p < 0.01), and all were negatively correlated with SDS scores (all p < 0.001). In conclusion, low social support is one of the risk factors for depression in patients with vitiligo in China. More support and acceptance should be given to the patients.
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Affiliation(s)
| | - Yanfei Zhang
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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11
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Wang TM, Chou CH, Lee YL, Chung CH, Huang YC, Lai XC, Sun CA, Kang CY, Wu GJ, Chien WC. Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan. Int J Womens Health 2022; 14:1173-1189. [PMID: 36059578 PMCID: PMC9432384 DOI: 10.2147/ijwh.s376244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Previous studies have shown an increased in psychiatric disorders in women with disorders associated with hyperandrogenism, but few nationwide cohorts have studied this phenomenon. Therefore, this study is aimed to examine the association between the clinical manifestations of hyperandrogenism and subsequent psychiatric disorders. Methods Based on the National Health Insurance Research Database, 49,770 enrolled participants were matched for age and index date between January 1, 2000, and December 31, 2015. Hirsutism, polycystic ovary syndrome, and acne are characterized by hyperandrogenism. After adjusting for confounding factors, we used Cox proportional analysis to compare the risk of psychiatric disorders during the 16 years of follow-up. Results Of all the participants, 1319 (13.25%) had psychiatric disorders in the study group, whereas only 3900(9.80%) had psychiatric disorders in the control group. After adjusting for age, and monthly income, the Cox regression analysis showed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.004, 95% confidence interval [CI] = 1.327–2.724, P < 0.001). The results demonstrated that women aged 20–29 years had a more significant risk. Conclusion Women with clinical characteristics of hyperandrogenism have a higher risk of developing psychiatric disorders, especially those aged 20–29 years.
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Affiliation(s)
- Tsan-Min Wang
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Taipei Municipal Jianguo High School, Taipei, Taiwan
| | - Cheng-Hao Chou
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Taipei Municipal Jianguo High School, Taipei, Taiwan
| | - Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Yao-Ching Huang
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, Taiwan
| | - Xiao-Cheng Lai
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Chieh-Yi Kang
- Chi Mei Medical Center Gynecologic Oncologist Division, Department of Obstetrics & Gynecology, Tainan City, Taiwan, Republic of China
- Correspondence: Gwo-Jang Wu; Chieh-Yi Kang, Email ;
| | - Gwo-Jang Wu
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Gwo-Jang Wu; Chieh-Yi Kang, Email ;
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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12
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Tan J, Beissert S, Cook-Bolden F, Chavda R, Harper J, Hebert A, Lain E, Layton A, Rocha M, Weiss J, Dréno B. Evaluation of Psychological Wellbeing and Social Impact of Combined Facial and Truncal Acne: a Multi-national, Mixed-Methods Study. Dermatol Ther (Heidelb) 2022; 12:1847-1858. [PMID: 35904707 PMCID: PMC9357600 DOI: 10.1007/s13555-022-00768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Half of the individuals with facial acne develop truncal acne, but the impact of combined facial and truncal acne (CA) on patients' quality of life is poorly researched. METHODS A 60-min interview of 30 participants with CA was conducted that formed the basis for a cross-sectional survey of 694 adolescents and adults with CA. RESULTS The main themes identified from the qualitative interviews among CA subjects included acceptability to self and others, social functioning and emotional wellbeing. Feelings of embarrassment, self-consciousness and low confidence were experienced often or all the time by over 50% of participants, and were more frequent in those who perceived their acne to be out of control (P = 0.003). Half of patients reported feeling stigmatised because of their CA, and 65.4% believed that others associated their truncal acne with unhealthy or unhygienic habits. Perceived stigma was associated with more feelings of embarrassment (P = 0.005), self-consciousness (P = 0.034) and low self-confidence (P = 0.017). Overall, 64% participants reported that CA interfered with daily life, 46.4% often or always avoided social interaction, 48.6% were often concerned about talking to unfamiliar people and 47.4% were uncomfortable showing affection. Further, 32% and 24.4% participants ≥ 16 years old avoided dating or having romantic/intimate relationships because of their facial and truncal acne, respectively. Social and leisure activities were more frequently negatively impacted among those with perceived uncontrolled CA than among those with controlled CA. Avoiding undressing in front of spouse/partner/friends/relatives was more commonly reported by participants with perceived uncontrolled truncal acne than by those with controlled truncal acne (90.5% versus 80.6%, P = 0.031). CONCLUSION CA is associated with considerable psychological morbidity, with several exacerbating (e.g. perceived stigma) and attenuating factors (e.g. acne being perceived as being under control) that should be accounted for in CA management.
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Affiliation(s)
- Jerry Tan
- Schulich School of Medicine and Dentistry, Western University Canada, 2224 Walker Rd, Suite 300, Windsor, ON, N8W 5L7, Canada.
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Fran Cook-Bolden
- Mount Sinai Department of Dermatology, New York, 5 East 98th Street, New York, NY, 10029, USA
| | | | - Julie Harper
- The Dermatology and Skin Care Center of Birmingham, 2470 Rocky Ridge Rd # 100, Vestavia Hills, AL, 35243, USA
| | - Adelaide Hebert
- The University of Texas Medical School-Houston, 6655 Travis, Suite 980, Houston, TX, 77030, USA
| | - Edward Lain
- Austin Institute for Clinical Research, 1601 E Pflugerville Pkwy Suite 1101, Pflugerville, TX, USA
| | - Alison Layton
- Hull York Medical School, University Rd, Heslington, YO10 5DD, York, UK
| | - Marco Rocha
- Federal University of São Paulo, R. Sena Madureira, 1500-Vila Clementino, São Paulo, SP, 04021-001, Brazil
| | - Jonathan Weiss
- Georgia Dermatology Partners, (Formerly, Gwinnett Dermatology, PC), 2383 Pate St., N, Snellville, GA, 30078, USA
| | - Brigitte Dréno
- Unité Thérapie Cellulaire et Génique, Faculté de Médecine de Nantes, CHU Nantes-Place Alexis Ricordeau, 44093, Cedex 01, France
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Tan J, Chavda R, Leclerc M, Dréno B. Projective Personification Approach to the Experience of People With Acne and Acne Scarring-Expressing the Unspoken. JAMA Dermatol 2022; 158:1005-1012. [PMID: 35857307 PMCID: PMC9301587 DOI: 10.1001/jamadermatol.2022.2742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The association of acne with emotional and social well-being is not limited to active acne because acne scarring can extend long after cessation of active lesions. Objective To explore the psychosocial burden of facial and truncal acne (FTA) and acne scars (AS) in a spontaneous manner using qualitative research. Design, Setting, and Participants This qualitative study recruited participants via local panels. A personification exercise, "Letter to my Disease," was developed for participants of 2 independent arms, FTA and AS, of an international qualitative study in the form of letter completion. Main Outcomes and Measures Study outcomes comprised perceptions, psychosocial effects of FTA and AS, and coping behaviors. Results A total of 60 participants were recruited for the FTA and AS study. Among participants with FTA, 17 were women (57%), 21 (70%) were aged 13 to 25 years, and 9 (30%) were aged 26 to 40 years. Twenty-six (87%) participants had severe active acne and 4 (13%) had moderate active acne. Among participants with AS, 18 were women (60%), 9 (30%) were aged 18 to 24 years, and 21 (70%) were aged between 25 and 45 years. Of these 60 participants, 56 (FTA, 28 and AS, 28) completed the projective exercise, "Letter to my Disease," the analysis of which is presented in the current study. During completion of the letter exercise, participants spontaneously expressed emotional and physical burden as well as the social stigma associated with their skin condition. Three major themes emerged, namely, (1) burden of the condition, (2) attitudes and beliefs, and (3) relationship to the personified condition. Conclusions and Relevance Consistent with their skin condition, participants associated acne, through personification, with the character of an intruder and unwanted companion responsible for their poor self-esteem and emotional impairment. The findings of the joint analyses of letters (FTA and AS), as a catalytic process and free-expression space, outline the continuous burden of active acne starting from adolescence and then continuing into adulthood and beyond active lesions with AS, and highlight the struggle for self-acceptance.
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Affiliation(s)
- Jerry Tan
- Western University Canada, Schulich School of Medicine and Dentistry, Windsor, Ontario, Canada
| | - Rajeev Chavda
- Galderma SA Rue d'Entre-deux-Villes 10, La Tour-de-Peilz, Switzerland
| | | | - Brigitte Dréno
- Nantes Université, Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
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14
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Mandeng Ma Linwa E, Sigha OB, Djeumen Touka AJ, Eposse Ekoube C, Ngo Linwa EE, Budzi MN, Meh MG, Nzozone HF, Kouotou EA, Zoung Kanyi Bissek A. Trends in dermatology consultations in the COVID‐19 era in Cameroon. SKIN HEALTH AND DISEASE 2022; 2:e113. [PMID: 35600146 PMCID: PMC9111051 DOI: 10.1002/ski2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/13/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
Abstract
Introduction With the advent of COVID‐19, a highly infectious viral pandemic, first declared in Cameroon in March 2020, access to expert dermatology care was postulated to decrease. We carried out a descriptive study to understand the epidemiology of skin diseases amongst patients consulting at an outpatient dermatology clinic and its variations with the onset of COVID‐19. Methods We conducted a retrospective database study over a period of 2 years at Laquintinie hospital, Cameroon. Two periods were distinguished: 1 March 2019 to 29 February 2020 (pre‐COVID‐19 era) and 1 March 2020 to 28 February 2021 (COVID‐19 era). Results Overall, 5946 patients with one or more clinical conditions were analysed. The most common age group described was young adults (18–40 years). Females consulted twice as much as males (M/F ratio; 1:1.7). The mean age was 28.9 (±18.0) years with an age range of 1 month to 89 years. Infectious dermatoses predominated. However, the single most prevalent dermatologic condition was acne. There was a 35.6% drop in consultation frequency in the COVID‐19 era. Conclusion Three in four patients consulting at dermatology clinic are below 40 years, with a female predominance. Epidemiological profile of dermatoses in Cameroon is similar to that in the rest of Africa. Consultation frequency decreased in the COVID‐19 era but trends in consultations were rather unaltered except for patients above 50 years where eczema and scabies increased. More studies should be conducted to understand these trends better at a national level and envisage training of health personnel on prevalent dermatoses.
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Affiliation(s)
- Edgar Mandeng Ma Linwa
- Faculty of Health Sciences University of Buea Buea Cameroon
- Hopital Laquintinie de Douala Douala Cameroon
| | - Odette Berline Sigha
- Hopital Laquintinie de Douala Douala Cameroon
- Faculty of Health Sciences University of Bamenda Bamenda Cameroon
| | | | - Charlotte Eposse Ekoube
- Hopital Laquintinie de Douala Douala Cameroon
- Faculté de Médecine et des Sciences Pharmaceutiques Université de Douala Douala Cameroun
| | | | - Michael Ngenge Budzi
- Faculty of Health Sciences University of Buea Buea Cameroon
- Non‐Communicable Disease Prevention and Control Programme Cameroon Baptist Convention, Health Services Yaounde Cameroon
| | - Martin Geh Meh
- Faculty of Health Sciences University of Buea Buea Cameroon
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15
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Remes O, Mendes JF, Templeton P. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sci 2021; 11:1633. [PMID: 34942936 PMCID: PMC8699555 DOI: 10.3390/brainsci11121633] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.
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Affiliation(s)
- Olivia Remes
- Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK
| | | | - Peter Templeton
- IfM Engage Limited, Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK;
- The William Templeton Foundation for Young People’s Mental Health (YPMH), Cambridge CB2 0AH, UK
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16
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Torres-Zegarra C, Sundararajan D, Benson J, Seagle H, Witten M, Walders-Abramson N, Simon SL, Huguelet P, Nokoff NJ, Cree-Green M. Care for Adolescents With Polycystic Ovary Syndrome: Development and Prescribing Patterns of a Multidisciplinary Clinic. J Pediatr Adolesc Gynecol 2021; 34:617-625. [PMID: 33794340 PMCID: PMC8808364 DOI: 10.1016/j.jpag.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Based on updated guidelines and expressed patient needs, we created a multidisciplinary clinic including endocrinology, gynecology/adolescent medicine, dermatology, psychology, and nutrition to provide comprehensive care to adolescent girls with polycystic ovary syndrome (PCOS). We describe the patient population presenting to this clinic, and prescribing patterns when a multidisciplinary approach is used. DESIGN Retrospective chart review. SETTING Tertiary care hospital. PARTICIPANTS Female patients, aged 11-24 years, presenting for initial assessment in a multidisciplinary PCOS clinic. INTERVENTIONS None. MAIN OUTCOME MEASURES Medical history, physical examination findings, laboratory measurements and prescribed therapies. RESULTS A total of 92 patients seen from 2014 to 2018 are described (age 15.9 years, range 11-24 years, body mass index 35.6 kg/m2, range 19.9-53.5). Metabolic syndrome features were common: 26% had a prediabetes hemoglobin A1c (>5.6%), 83% had a high-density lipoprotein (HDL) <50 mg/dL, 40% had a systolic blood pressure >120 mm Hg, and 43% had an alanine aminotransferase level of >30 U/L. Dermatologic findings included acne 93%, hirsutism 38%, acanthosis nigricans 85%, hidradenitis suppurativa 16%, and androgenic alopecia 2%. Of the patients, 33% had a diagnosis of depression or anxiety, 16% of patients had a diagnosis of obstructive sleep apnea, and an additional 59% had symptoms warranting a sleep study The most commonly prescribed medications were topical acne preparations (62%), followed by estrogen-containing hormonal therapy (56%) and metformin (40%). CONCLUSION In adolescents with PCOS and obesity, metabolic, dermatologic, and psychologic co-morbidities are common. The use of a multidisciplinary clinic model including dermatology in addition to endocrinology, gynecology, psychology, and lifestyle experts provides care for most aspects of PCOS.
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Affiliation(s)
- C Torres-Zegarra
- (1)Department of Surgery, Division of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - D Sundararajan
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - J Benson
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - H Seagle
- Department of Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - M Witten
- Department of Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - N Walders-Abramson
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - S L Simon
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - P Huguelet
- Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - N J Nokoff
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - M Cree-Green
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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17
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Braun H, Zhang Q, Getahun D, Silverberg MJ, Tangpricha V, Goodman M, Yeung H. Moderate-to-Severe Acne and Mental Health Symptoms in Transmasculine Persons Who Have Received Testosterone. JAMA Dermatol 2021; 157:344-346. [PMID: 33471032 DOI: 10.1001/jamadermatol.2020.5353] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hayley Braun
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Qi Zhang
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Regional Telehealth Service, VA Veterans Integrated Service Network 7 Southeast Network, Decatur, Georgia
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18
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Barbieri JS, Mostaghimi A, Noe MH, Margolis DJ, Gelfand JM. Use of primary care services among patients with chronic skin disease seen by dermatologists. JAAD Int 2021; 2:31-36. [PMID: 34409351 PMCID: PMC8362270 DOI: 10.1016/j.jdin.2020.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background Skin diseases, such as psoriasis, hidradenitis suppurativa, acne, and alopecia areata, have increasingly been linked to systemic and mental health comorbidities, such as depression. Although identification and management of these comorbidities is typically a part of primary care, some patients might not have an established relationship with a primary care provider and may only be seeing their dermatologist. Objective To examine the frequency with which dermatologists are the main contact within a health care system for patients with these chronic skin conditions. Methods We performed a retrospective cohort study using Optum's deidentified Clinformatics Data Mart Database. The primary outcome was the proportion of patients who established care with a dermatologist and had no encounters with a primary care provider during the subsequent year after this dermatology encounter. Results Across each of the skin diseases evaluated, 21.6%-31.2% of men and 16.9%-26.2% of women had no primary care visits in the subsequent year after establishing care with their dermatologist. Conclusion and Relevance For many patients with chronic skin diseases, their dermatologist might be their only source of contact with the health care system. There may be an opportunity for dermatologists to improve the quality of care for our patients by screening for associated comorbidities.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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19
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Fallah H, Rademaker M. Isotretinoin for acne vulgaris - an update on adverse effects and laboratory monitoring. J DERMATOL TREAT 2021; 33:2414-2424. [PMID: 34379039 DOI: 10.1080/09546634.2021.1967269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A significant barrier to the usage of isotretinoin has been concerns regarding its adverse effect profile. The dose-dependent mucocutaneous side effects of isotretinoin are well recognised and easily managed, particularly if a lower dose is used. A possible association with depression has gained widespread media attention and is a source of concern for many patients and their carers, but data from prospective studies and recent meta-analyses has been reassuring. Furthermore, there has been much confusion amongst both patients and physicians regarding a possible association with inflammatory bowel disease, as well the ocular and rheumatological adverse effects of isotretinoin. We provide an update on the evidence surrounding the adverse effects of isotretinoin, and discuss practical strategies to prevent and manage these adverse effects. We also discuss appropriate laboratory monitoring for patients taking isotretinoin.
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Affiliation(s)
- Haady Fallah
- The University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,The Skin Hospital, Sydney, Australia
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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20
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Barbieri JS, Fulton R, Neergaard R, Nelson MN, Barg FK, Margolis DJ. Patient Perspectives on the Lived Experience of Acne and Its Treatment Among Adult Women With Acne: A Qualitative Study. JAMA Dermatol 2021; 157:1040-1046. [PMID: 34319378 DOI: 10.1001/jamadermatol.2021.2185] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction Acne often persists into adulthood in women. However, few studies have specifically explored the lived experience of acne in adult populations. Objective To examine the lived experience of acne and its treatment among a cohort of adult women. Design, Setting, and Participants A qualitative analysis was conducted from free listing and open-ended, semistructured interviews of patients at a large academic health care system (University of Pennsylvania Health System) and a private practice (Dermatologists of Southwest Ohio). Fifty women 18 to 40 years of age with moderate to severe acne participated in interviews conducted between August 30, 2019, and December 31, 2020. Main Outcomes and Measures Free-listing data from interviews were used to calculate the Smith S, a measure of saliency for each list item. Semistructured interviews were examined to detect themes about patient perspectives regarding their acne and its treatment. Results Fifty participants (mean [SD] age, 28 [5.38] years; 24 [48%] White) described acne-related concerns about their appearance that affected their social, professional, and personal lives, with many altering their behavior because of their acne. Depression, anxiety, and social isolation were commonly reported. Participants described successful treatment as having completely clear skin over time or a manageable number of blemishes. Many participants described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne. Conclusions and Relevance The results of this qualitative study suggest that women with acne have strong concerns about appearance and experience mental and emotional health consequences and disruption of their personal and professional lives. In addition, many patients describe challenges finding effective treatments and accessing care. Future trials to understand the optimal treatment approaches for women with acne are needed to improve outcomes in this population.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rachel Fulton
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Rebecca Neergaard
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Maria N Nelson
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances K Barg
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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21
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Bagatin E, Rocha MADD, Freitas THP, Costa CS. Treatment challenges in adult female acne and future directions. Expert Rev Clin Pharmacol 2021; 14:687-701. [PMID: 33957838 DOI: 10.1080/17512433.2021.1917376] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Acne is a chronic, inflammatory, and immune-mediated disease of the pilosebaceous unit, highly prevalent in adolescents. However, an increasing number of adults over 25 years old with facial acne, particularly women, have been observed. It is considered a different disease when compared to acne vulgaris. Face is the mainly involved area with inflammatory lesions and more sensitive skin, pointing out the need of a holistic approach.Areas covered: We performed a comprehensive literature search on PubMed database, up to January 2021, regarding adult female acne. We synthesized data about pathogenesis; differences compared to acne vulgaris; and treatment, with focus in the management challenges and perspectives.Expert opinion: It is essential to value the negative impact on quality of life of adult female acne, independently of severity. The disease has prolonged evolution, and patient might be resilient once the improvement, regardless of the treatment option, will just be noticeable after 3 months. Aggravating factors should be clearly discussed, such as the need of changing many habits, especially lesions manipulation. The therapeutic regimen includes make-up and tailored skin care (considering proneness to sensitivity), while anti-acne drugs should be chosen in accordance with desire to be pregnant, presence of pregnancy or breastfeeding.
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Affiliation(s)
| | | | | | - Caroline Sousa Costa
- Department of Specialized Medicine, Discipline of Dermatology - Universidade Federal Do Piauí, Teresina, Brazil
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22
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Ugonabo N, Love E, Wong PW, Rieder EA, Orlow SJ, Kim RH, Nagler AR. Psychiatric disorders and suicidal behavior in patients with acne prescribed oral antibiotics versus isotretinoin: Analysis of a large commercial insurance claims database. J Am Acad Dermatol 2021; 85:878-884. [PMID: 33727021 DOI: 10.1016/j.jaad.2021.01.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/09/2021] [Accepted: 01/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The association between isotretinoin and psychiatric disturbance, including depression and suicidal behavior, is controversial. OBJECTIVE To investigate whether acne patients prescribed isotretinoin or antibiotics were more likely to have psychiatric disorders and/or engage in suicidal behavior. METHODS Retrospective cohort study using the IBM MarketScan Research Databases, which contain commercial insurance claims in the United States, to identify acne patients who were prescribed isotretinoin or oral antibiotics between 2011 and 2017 and who were diagnosed with psychiatric disorders or suicidal behavior. RESULTS A total of 72,555 patients were included in the study. Patients in the general population were 1.47 times more likely to be diagnosed with suicidal ideation or attempt compared to acne patients prescribed isotretinoin (adjusted odds ratio [OR] 1.47; confidence interval [95% CI], 1.27, 1.70; P < .0001). The general population (adjusted OR 0.87; 95% CI, 0.84, 0.89; P < .0001) and acne patients prescribed antibiotics (adjusted OR 0.88; 95% CI, 0.85, 0.91; P < .0001) were less likely to have a psychiatric diagnosis compared to acne patients prescribed isotretinoin. The prevalence of suicidal behavior during isotretinoin treatment was lower (0.10%; P = .082) than in the year prior to isotretinoin treatment (0.22%) and in the year following treatment (0.34%; P = .004). LIMITATIONS The study excluded individuals with public insurance and those who were uninsured, and the data in the study relied on the accuracy of the medical coding. CONCLUSIONS Compared to the general population, acne patients prescribed isotretinoin were less likely to engage in suicidal behavior. Further exploration into the slight increase in suicidal behavior seen in isotretinoin patients 1 year after therapy is warranted.
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Affiliation(s)
- Nkemjika Ugonabo
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Elyse Love
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Priscilla W Wong
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Evan A Rieder
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Arielle R Nagler
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
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Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. Association of Race/Ethnicity and Sex With Differences in Health Care Use and Treatment for Acne. JAMA Dermatol 2020; 156:312-319. [PMID: 32022834 DOI: 10.1001/jamadermatol.2019.4818] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Our understanding of potential racial/ethnic, sex, and other differences in health care use and treatment for acne is limited. Objective To identify potential disparities in acne care by evaluating factors associated with health care use and specific treatments for acne. Design, Setting, and Participants This retrospective cohort study used the Optum deidentified electronic health record data set to identify patients treated for acne from January 1, 2007, to June 30, 2017. Patients had at least 1 International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code for acne and at least 1 year of continuous enrollment after the first diagnosis of acne. Data analysis was performed from September 1, 2019, to November 20, 2019. Main Outcomes and Measures Multivariable regression was used to quantify associations between basic patient demographic and socioeconomic characteristics and the outcomes of health care use and treatment for acne during 1 year of follow-up. Results A total of 29 928 patients (median [interquartile range] age, 20.2 [15.4-34.9] years; 19 127 [63.9%] female; 20 310 [67.9%] white) met the inclusion criteria for the study. Compared with non-Hispanic white patients, non-Hispanic black patients were more likely to be seen by a dermatologist (odds ratio [OR], 1.20; 95% CI, 1.09-1.31) but received fewer prescriptions for acne medications (incidence rate ratio, 0.89; 95% CI, 0.84-0.95). Of the acne treatment options, non-Hispanic black patients were more likely to receive prescriptions for topical retinoids (OR, 1.25; 95% CI, 1.14-1.38) and topical antibiotics (OR, 1.35; 95% CI, 1.21-1.52) and less likely to receive prescriptions for oral antibiotics (OR, 0.80; 95% CI, 0.72-0.87), spironolactone (OR, 0.68; 95% CI, 0.49-0.94), and isotretinoin (OR, 0.39; 95% CI, 0.23-0.65) than non-Hispanic white patients. Male patients were more likely to be prescribed isotretinoin than female patients (OR, 2.44; 95% CI, 2.01-2.95). Compared with patients with commercial insurance, those with Medicaid were less likely to see a dermatologist (OR, 0.46; 95% CI, 0.41-0.52) or to be prescribed topical retinoids (OR, 0.82; 95% CI, 0.73-0.92), oral antibiotics (OR, 0.87; 95% CI, 0.79-0.97), spironolactone (OR, 0.50; 95% CI, 0.31-0.80), and isotretinoin (OR, 0.43; 95% CI, 0.25-0.75). Conclusions and Relevance The findings identify racial/ethnic, sex, and insurance-based differences in health care use and prescribing patterns for acne that are independent of other sociodemographic factors and suggest potential disparities in acne care. In particular, the study found underuse of systemic therapies among racial/ethnic minorities and isotretinoin among female patients with acne. Further study is needed to confirm and understand the reasons for these differences.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shiyu Wang
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - David J Margolis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Singer S, Keuroghlian AS. A Call for Gender Identity Data Collection in iPLEDGE and Increasing the Number of Isotretinoin Prescribers Among Transgender Health Providers. LGBT Health 2020; 7:216-219. [DOI: 10.1089/lgbt.2019.0313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Sean Singer
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S. Keuroghlian
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- National LGBT Health Education Center, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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25
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Samuels DV, Rosenthal R, Lin R, Chaudhari S, Natsuaki MN. Acne vulgaris and risk of depression and anxiety: A meta-analytic review. J Am Acad Dermatol 2020; 83:532-541. [PMID: 32088269 DOI: 10.1016/j.jaad.2020.02.040] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted. OBJECTIVE We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety. METHODS A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region. RESULTS Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region. LIMITATIONS Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature. CONCLUSIONS Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.
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Affiliation(s)
- Danielle V Samuels
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts.
| | - Robert Rosenthal
- Department of Psychology, University of California, Riverside, California
| | - Rick Lin
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, Texas; Bay Area Corpus Christi Medical Center, South Texas Dermatology Residency Program, McAllen, Texas
| | - Soham Chaudhari
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, Texas; Bay Area Corpus Christi Medical Center, South Texas Dermatology Residency Program, McAllen, Texas
| | - Misaki N Natsuaki
- Department of Psychology, University of California, Riverside, California
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26
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Taylor MT, Barbieri JS. Depression screening at visits for acne in the United States, 2005-2016. J Am Acad Dermatol 2020; 83:936-938. [PMID: 31972260 DOI: 10.1016/j.jaad.2019.12.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew T Taylor
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia.
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27
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Singer S, Tkachenko E, Sharma P, Barbieri JS, Mostaghimi A. Psychiatric Adverse Events in Patients Taking Isotretinoin as Reported in a Food and Drug Administration Database From 1997 to 2017. JAMA Dermatol 2019; 155:1162-1166. [PMID: 31268488 DOI: 10.1001/jamadermatol.2019.1416] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Isotretinoin is a highly effective medication for severe acne. Although no causal link between isotretinoin and psychiatric adverse effects has been established, widespread media reporting of depression and suicidality with use of isotretinoin have raised concerns in both patients and clinicians and generated numerous cases of costly litigation. Objective To evaluate reports of psychiatric adverse events associated with isotretinoin use submitted to the US Food and Drug Administration from January 1, 1997, through December 31, 2017. Design, Setting, and Participants This retrospective study evaluated reports of psychiatric adverse events with isotretinoin as the primary suspect drug in the US Food and Drug Administration's Adverse Event Reporting System from 1997 through 2017. Publicly available data on number of patients enrolled in the iPLEDGE program were used to calculate rates of completed suicide per 100 000 patients enrolled in iPLEDGE in 2009 and 2010. All data were analyzed between July 1, 2018, and January 31, 2019. Main Outcomes and Measures The main outcomes were frequency and type of psychiatric adverse events in patients taking isotretinoin. Secondary analyses were stratification by age and sex and evaluation of completed suicide rates. Results Between 1997 and 2017, 17 829 psychiatric adverse events with isotretinoin use were reported to the US Food and Drug Administration, with depressive disorders, emotional lability, and anxiety disorders reported most frequently. Of these events, 8936 (50.1%) were reported among men and 8362 (46.9%) among women; the sex of the individual was not reported for 531 events (3.0%). Of the 13 553 reports that included patient age, the mean (SD) age was 22.1 (8.6) years. More than half (52.5%) of all events occurred in 10- to 19-year-old individuals. Whereas depression and anxiety were reported equally between sexes, eating disorders were more common in females (58 of 85 [68.2%]), while attention-deficit/hyperactivity disorder (55 of 83 events [66.3%]) and completed suicides (290 of 368 [78.8%]) were more common in males. The rates of completed suicide were 8.4 and 5.6 suicides per 100 000 patients enrolled in iPLEDGE in 2009 and 2010, respectively. Conclusions and Relevance Although depressive disorders and suicidality were frequently reported with isotretinoin use, these reports must be considered in the context of elevated rates of depression and suicide among patients with acne at large. These data suggest that the rate of completed suicide in patients taking isotretinoin may be lower than that of the general US population. Many psychiatric adverse events unrelated to depression and suicidality were also reported, but it is unclear if they were a result of isotretinoin therapy. Although no causal link between isotretinoin and psychiatric risk has been established, patients taking the drug appear vulnerable to psychiatric concerns. Mandated monthly iPLEDGE visits may provide an opportunity to screen patients for psychiatric conditions and improve outcomes.
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Affiliation(s)
- Sean Singer
- Medical student, Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Medical student, University of Massachusetts Medical School, Worcester
| | - Priyank Sharma
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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28
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Singam V, Rastogi S, Patel KR, Lee HH, Silverberg JI. The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample. Clin Exp Dermatol 2019; 44:766-772. [PMID: 30706514 DOI: 10.1111/ced.13919] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the mental health (MH) hospitalization among patients with acne and rosacea. AIMS To determine the MH disorders and cost burden associated with acne and rosacea. METHODS Data were examined from the 2002-2012 US National Inpatient Sample, comprising a sample of ~20% of all US paediatric and adult hospitalizations (n = 87 053 155 admissions). RESULTS A diagnosis of ≥ 1 MH disorder was much more common among all inpatients with vs. those without a diagnosis of acne (43.7% vs. 20.0%, respectively) and rosacea (35.1% vs. 20.0%, respectively). In multivariable logistic regression models controlling for sex, age, race/ethnicity and insurance status, acne (adjusted OR = 13.02; 95% CI 11.75-14.42) and rosacea (adjusted OR = 1.70; 95% CI 1.56-1.95) were associated with significantly higher odds of a primary admission for an MH disorder (13 and 8, respectively, of 15 MH disorders examined). Both acne and rosacea were associated with higher risk of mood, anxiety, impulse control and personality disorders, and with > $2 million of excess mean annual costs of hospitalization for MH disorders in the USA. CONCLUSION In this study, inpatients with acne or rosacea had increased odds of comorbid MH disorders. In particular, there was an increased number of hospital admissions secondary to a primary MH disorder with coexistent acne/rosacea. MH comorbidities were associated with considerable excess costs among inpatients with acne or rosacea.
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Affiliation(s)
- V Singam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Rastogi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K R Patel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - H H Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J I Silverberg
- Departments of Dermatology, Preventative Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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29
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Metekoglu S, Oral E, Ucar C, Akalin M. Does isotretinoin cause depression and anxiety in acne patients? Dermatol Ther 2018; 32:e12795. [DOI: 10.1111/dth.12795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Safak Metekoglu
- Department of Dermatology, Beyazit Medico‐Social CenterIstanbul University Istanbul Turkey
| | | | - Cagla Ucar
- Department of Psychology, Beyazit Medico‐Social CenterIstanbul University Istanbul Turkey
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30
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Vallerand IA, Lewinson RT, Parsons LM, Hardin J, Haber RM, Lowerison MW, Barnabe C, Patten SB. Vitiligo and major depressive disorder: A bidirectional population-based cohort study. J Am Acad Dermatol 2018; 80:1371-1379. [PMID: 30528503 DOI: 10.1016/j.jaad.2018.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vitiligo patients often report their mental health has an effect on their skin. However, it is unknown as to whether a common mental disorder, such as major depressive disorder (MDD), can also precipitate the onset of vitiligo. OBJECTIVE Evaluate a bidirectional relationship between MDD and vitiligo using The Health Improvement Network database. METHODS Incident MDD and referent cohorts were followed until the development of vitiligo. Also, incident vitiligo and referent cohorts were followed until the development of MDD. Cox proportional hazards models were used, and numerous covariates were adjusted for. RESULTS In adjusted models, MDD patients (n = 405,397) were at a 64% increased risk for vitiligo (hazard ratio 1.64, 95% confidence interval [CI] 1.43-1.87, P < .0001) compared with the referent cohort (n = 5,739,048). This risk was decreased in patients using antidepressants. Compared with the referent cohort (n = 6,137,696), patients with vitiligo (n = 7104) that were <30 years of age at diagnosis had a higher risk of developing MDD than patients ≥30 years of age (hazard ratio 1.31, 95% CI 1.14-1.50, P < .0001 vs 1.22, 95% CI 1.08-1.37, P = .001, respectively). LIMITATIONS This study did not evaluate the severity of MDD or vitiligo on outcome development. CONCLUSION These results highlight the burden of depression in patients with vitiligo and support the possible existence of pathophysiological connections between these 2 conditions.
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Affiliation(s)
- Isabelle A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Ryan T Lewinson
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Laurie M Parsons
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jori Hardin
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Richard M Haber
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark W Lowerison
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
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31
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Davern J, O’Donnell AT. Stigma predicts health-related quality of life impairment, psychological distress, and somatic symptoms in acne sufferers. PLoS One 2018; 13:e0205009. [PMID: 30265724 PMCID: PMC6161901 DOI: 10.1371/journal.pone.0205009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/18/2018] [Indexed: 11/18/2022] Open
Abstract
Acne vulgaris has been associated with deficits in psychological well-being and health-related quality of life. Few studies have investigated how stigma contributes to our understanding of the well-being of acne sufferers, although it is clear that acne is stigmatized and stigmatization is associated with impaired well-being. The current study aimed to investigate the ability of perceived stigma to predict health-related quality of life, psychological distress, and somatic symptoms over and above established predictors. University students and staff suffering from acne completed self-report measures online. Hierarchical multiple regression analyses showed that perceived stigma significantly contributed to the prediction of all three well-being measures, over and above the effects of gender, acne severity, acne location, and use of medication. Indeed, perceived stigma made the largest unique contribution to predicting well-being. Our findings suggest that interventions that attempt to counter stigma could also improve the overall well-being of people affected by acne.
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Affiliation(s)
- Jamie Davern
- Department of Psychology and Centre for Social Issues Research, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Aisling T. O’Donnell
- Department of Psychology and Centre for Social Issues Research, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
- * E-mail:
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32
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Green-Armytage M, Simonds LM, John M, Woodger N. Depictions of acne and psoriasis influence interpersonal aversion. PSYCHOL HEALTH MED 2018; 24:94-100. [PMID: 30048157 DOI: 10.1080/13548506.2018.1497188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of infection. The current study investigated interpersonal aversion towards individuals with the appearance of acne and psoriasis. Participants (N = 196) either viewed a female face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the person, and indicated their willingness for social and indirect contact with them. The person depicted with acne was rated significantly less attractive than the person with psoriasis or no dermatological condition. Participants reported significantly less willingness for indirect contact with the person depicted with acne or psoriasis compared to the person with no visible dermatological condition. In contrast, participants expressed more willingness for social contact with a person with acne than with the person with psoriasis or no dermatological condition. Group differences were significant when controlling for attractiveness ratings. Unwarranted fear of infection might underpin avoidance and discriminatory behaviour towards those with skin conditions. Further research is required to understand factors that influence avoidance of contact.
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Affiliation(s)
| | - Laura M Simonds
- a School of Psychology , University of Surrey , Guildford , UK
| | - Mary John
- a School of Psychology , University of Surrey , Guildford , UK
| | - Nigel Woodger
- a School of Psychology , University of Surrey , Guildford , UK
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33
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Vallerand I, Lewinson R, Parsons L, Lowerison M, Frolkis A, Kaplan G, Barnabe C, Bulloch A, Patten S. Is depression screening in patients with acne critical?: reply from authors. Br J Dermatol 2018; 179:227-228. [DOI: 10.1111/bjd.16673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I.A. Vallerand
- Department of Community Health Sciences; University of Calgary; Calgary Canada
- Leaders in Medicine Program; University of Calgary; Calgary Canada
| | - R.T. Lewinson
- Leaders in Medicine Program; University of Calgary; Calgary Canada
| | - L.M. Parsons
- Division of Dermatology; University of Calgary; Calgary Canada
- Department of Medicine; University of Calgary; Calgary Canada
| | - M.W. Lowerison
- Department of Community Health Sciences; University of Calgary; Calgary Canada
| | - A.D. Frolkis
- Department of Medicine; University of Calgary; Calgary Canada
| | - G.G. Kaplan
- Department of Community Health Sciences; University of Calgary; Calgary Canada
- Department of Medicine; University of Calgary; Calgary Canada
| | - C. Barnabe
- Department of Community Health Sciences; University of Calgary; Calgary Canada
- Department of Medicine; University of Calgary; Calgary Canada
| | - A.G.M. Bulloch
- Department of Community Health Sciences; University of Calgary; Calgary Canada
- Department of Physiology & Pharmacology; University of Calgary; Calgary Canada
- Department of Psychiatry; University of Calgary; Calgary Canada
| | - S.B. Patten
- Department of Community Health Sciences; University of Calgary; Calgary Canada
- Department of Psychiatry; University of Calgary; Calgary Canada
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34
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Unrue E, Feldman S. Is depression screening in patients with acne critical? Br J Dermatol 2018; 179:226-227. [DOI: 10.1111/bjd.16669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E.L. Unrue
- Dermatology; Wake Forest Baptist Medical Center; 4618 Country Club Road Winston-Salem NC 27157-0001 U.S.A
| | - S.R. Feldman
- Dermatology; Wake Forest Baptist Medical Center; 4618 Country Club Road Winston-Salem NC 27157-0001 U.S.A
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