Acne Is Not a Trivial Disease! Psychosomatic Aspects in Routine Therapy

Abstract

Patients with acne may develop psychological problems as a consequence of their condition – often independent of the severity of their skin condition. Emotional problems due to the disease should be taken seriously and included in the treatment plan. A purely dermatological therapy may not achieve its purpose. Even mild to moderate disease can be associated with significant depression and suicidal ideation, and psychologic change does not necessarily correlate with disease severity. Acne patients suffer particularly under social limitations and reduced quality of life. Psychic comorbidities in acne are probably greater than generally assumed. Attention should be paid to psychosomatic aspects especially if there is suspicion of depressive-anxious disorders, particularly with evidence of suicidal tendencies, body dysmorphic disorders, or also of disrupted compliance. Therefore, patients who report particularly high emotional distress or dysmorphic tendencies due to the disease should be treated adequately, if possible, by interdisciplinary therapy. The dermatologist must have some knowledge of the basics of psychotherapy and psychopharmacology, which sometimes must be coupled with systemic and topical treatments of acne in conjunction with socalled psychosomatic basic treatment.

The Psychological Correlates of Treatment Efficacy in Acne

“…Another methodological consideration for the present study is sample attrition. That is that the present acne sample consists of selected patients, who may differ from patients in general medical practice, or even from other patients who do not consult their doctor because of their acne [Niemeier et al, 2002;Kramer and Garralda, 1998]. Also a significant number of people may be put off due to the sensitivity of the topic, or may be more compliant as they are interested in the topic of research.…”

“…The tendency for doctors to regard acne as trivial is clearly changing, however, the psychological effects of acne on the individual should not be underestimated, as even mild acne can cause extreme emotional upset. A recent study by Niemeier et al [2002] reported that many patients with acne develop psychological problems as a consequence of their skin condition, and that this is often independent of the severity of their disease. Rademaker et al [1989] found that only 15-17% of acne sufferers consulted their family doctor about their acne.…”

Development of a Questionnaire to Assess Attitudes towards Psychotherapeutic Treatment

“…Several authors have studied attitudes of healthy individuals and affected patients towards inpatient psychiatric and dermatological treatment settings [Hornstein et al, 1973;Angermeyer and Link, 1987;Burra et al, 1982;Kilian et al, 2001]. In addition, several studies have focused on potential psychotherapy patients' motivation and psychological mindedness [Conte et al, 1990;Beitel and Cecero, 2003] or on compliance with psychotherapy [Aarela et al, 1997]; these issues have also been discussed in patients with chronic skin diseases [Niemeier et al, 2002;Leonardou et al, 2002]. DiClemente and Prochaska [1982] proposed five stages of motivation for behavior change, 'precontemplation', 'contemplation', 'preparation', 'action', and 'maintenance'.…”

Treatment Seeking in Young Women with Acne

“…However, impairment is not necessarily positively correlated with the objective severity of acne [Medansky, 1981;Niemeier et al, 1998]. Even a mild to moderate level of acne severity can be associated with severe depression and suicidal ideation [Niemeier et al, 2002]. Various personality traits have been associated with distress about acne and physical appearance.…”