Acne vulgaris is a chronic inflammatory condition characterized by lesions such as papules, pustules, and nodules in the pilosebaceous units. Typically beginning in adolescence, acne often regresses in the mid-20s. The multifactorial pathogenesis of acne includes increased sebum production, altered keratinization leading to comedone formation, follicular colonization by Propionibacterium acnes (P. acnes), and inflammatory responses around the pilosebaceous unit (PSU) [1]. Acne vulgaris (AV) is a common chronic inflammatory disease that affects the hair follicles and sebaceous glands in the skin. It is characterized by the formation of open or closed comedones, reddish papules, pustules, and cysts, which can appear on the face or body. AV usually starts during adolescence, with a prevalence reaching up to 85% [2]. The condition of acne can be a significant source of dissatisfaction with facial appearance and impaired self-image, leading to anxiety, depression, decreased self-esteem, and problematic social relations [3].

The association between AV and these psycho-logical factors may vary depending on gender, age, study setting, personal habits, and region [4]. In addition to the psychological and occupational impairments listed, AV can have a major impact on self-esteem and self-image. Self-esteem is defined as “the reasonable or justifiable sense of one’s worth or importance [5]. The study expects to find significant correlations between acne severity, self-esteem, and anxiety, highlighting the necessity of holistic acne management approaches. Understanding these correlations can inform better clinical practices, integrating psychological support with dermatological treatments to enhance patient outcomes [6].

This study aims to quantify the impact of acne vulgaris on self-esteem and anxiety in an Indian clinical setting, providing insights into the psychological dimensions of acne treatment.

Aim and Objectives

To study self-esteem and anxiety in patients with acne vulgaris. Examine the effect of anxiety levels and self-esteem on the well-being of acne patients.

Study Design: Cross-sectional study.

Study Duration: 18 months.

Study Setting: OPD of the Department of Dermatology, Chirayu Medical College and Hospital, Bhopal.

Study Participants: Patients diagnosed with acne vulgaris visiting the Dermatology OPD.

Inclusion Criteria

Patients aged 18-45 diagnosed with acne vulgaris for the first time.

Exclusion Criteria:

1. Syndromic dermatological illnesses.
2. Severe mental illness.
3. Substance use.
4. Non-consent for participation.
5. Other chronic medical conditions.

Sample Size:

50 patients (10% relative precision, 95% confidence interval, prevalence 27%)

Study Procedure:

• Obtain informed consent.
• Collect socio-demographic data.
• Administer the following scales:
• Rosenberg Self-Esteem Scale.
• Hamilton Anxiety Rating Scale (HAM-A).

Measurement Methods:

1. Rosenberg Self-Esteem Scale:

• 10 items, 4-point Likert scale.
• Internal consistency: 0.77; Reproducibility: ≥0.90.

2. Hamilton Anxiety Rating Scale (HAM-A):

• 14 items scored 0-4.
• Total score range: 0-56 (mild: <17, moderate: 18-24, moderate to severe: 25-30).
• Interrater reliability: 0.92; Cronbach alpha: 0.86.

Data Analysis

 Data analyzed using SPSS with t-tests and Chi-square tests for significance.

A total of 50 patients diagnosed with acne vulgaris participated in this cross-sectional study conducted at the OPD of the Department of Dermatology, Chirayu Medical College and Hospital, Bhopal. The demographic profile of the participants revealed a mean age of 24.6 years (SD ± 4.2), with a fairly balanced gender distribution (52% male, 48% female). Educational attainment varied, with 35% having completed high school, 45% undergraduates, and 20% postgraduates.

Table 1: Demographic Characteristics

The study included a total of 50 participants diagnosed with acne vulgaris, with a mean age of 24.6 years (SD ± 4.2). The gender distribution was fairly balanced, with 52% male and 48% female participants. In terms of educational background, 35% of participants had completed high school, 45% were undergraduates, and 20% held postgraduate degrees.

Table 2: Acne Severity Distribution

The severity of acne vulgaris varied among the 50 participants included in the study. The distribution of acne severity levels was as follows: 40% of participants had mild acne, 45% had moderate acne, and 15% had severe acne vulgaris.

Table 3: Self-Esteem Scores by Acne Severity

The mean self-esteem scores varied significantly across different severity levels of acne vulgaris among the study participants. Participants with mild acne reported a mean self-esteem score of 16.2 (± 2.5), while those with moderate acne had a lower mean score of 14.3 (± 2.9). The lowest mean self-esteem score was observed in participants with severe acne, measuring 12.7 (± 3.2).

Table 4: Anxiety Scores by Acne Severity

The study assessed anxiety levels across varying severity levels of acne vulgaris among the participants. Participants with mild acne reported a mean anxiety score of 18.3 (± 4.7), which increased to 21.8 (± 5.0) for those with moderate acne. The highest mean anxiety score was observed in participants with severe acne, measuring 25.4 (± 5.8).

Key Findings

This study identified that patient with acne vulgaris have significantly lower self-esteem and higher anxiety levels compared to the general population. Additionally, a negative correlation was observed between anxiety and well-being, while a positive correlation was noted between self-esteem and well-being, underscoring the psychological burden of acne.

Self-Esteem and Acne Vulgaris

 Our findings indicate a significant decrease in self-esteem among acne patients, consistent with Yoqub et al [10], who reported that adolescents with acne have significantly lower self-esteem compared to their peers. Mallon et al [7] also noted poorer self-image and overall well-being among acne patients.

Anxiety and Acne Vulgaris: A substantial number of patients with acne exhibit moderate to severe anxiety, corroborating the study by Thomas et al [9], which found increased anxiety levels in acne patients. Hunt et al [8] also highlighted the association between acne severity and higher anxiety levels.

Implications for Clinical Practice

The results advocate for an integrated approach combining dermatological treatment with psychological support, emphasizing the necessity for early and effective management of both physical and psychological aspects of acne.

Limitations

This study is limited by its cross-sectional design, preventing causal inferences, and the single-center setting, which may limit generalizability. Future research should explore longitudinal studies and multi-center trials to validate these findings and develop comprehensive treatment protocols.

This study underscores the significant impact of acne vulgaris on patients' psychological well-being, particularly self-esteem and anxiety levels. The findings highlight the necessity for holistic management strategies that address both dermatological and psychological needs to enhance patient outcomes and overall quality of life. Integrated care approaches that combine medical treatment with psychological support can potentially alleviate the psychological burden of acne, fostering better patient satisfaction and well-being.

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