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The trauma of acne

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That acne in adolescence may cause emotional trauma seems almost self-evident but the few studies reported on the subject can be criticised on grounds of patient selection or age-inappropriate psychological assessments. A study in Nottingham (A Smithard and colleagues. British Journal of Dermatology2001;145:274–9) has attempted to correct these deficiencies.

A total of 317 pupils aged 14–16 attending a single comprehensive school completed an age-appropriate questionnaire aimed at measuring emotional health (the Strengths and Difficulties Questionnaire (SDQ)) and another questionnaire about knowledge of acne and use of treatments. They were then examined using a standardised technique (the Leeds Acne Grading Technique). Half of the pupils (158/317) had acne, 70 very mild, 54 mild, and 34 moderate or severe. More severe acne was associated with greater emotional stress (higher SDQ score) in boys but not in girls although in general girls had higher SDQ scores irrespective of the presence or severity of acne. Overall, young people with mild or worse acne were almost twice as likely as those with no or very mild acne to have a borderline or abnormal SDQ score.

These young people had little knowledge of the causes of acne and their knowledge did not vary according to the presence or severity of acne. They were more likely to discuss the problem with parents or friends than to consult a doctor. Of those with mild or worse acne, only a third had consulted a doctor and another third denied they had acne. Since acne is a treatable condition, education in adolescence might improve treatment uptake and also improve the mental health of acne sufferers.