The psychosocial impact of acne, vitiligo, and psoriasis: a review

Figures & data

Table 1 Summary of papers reviewed and their findings, organized by disease discussed

Author	Title	Year	Size	Survey	Findings
Vitiligo
Sangma et al^Citation27	Quality of life and psychological morbidity in patients with vitiligo: a study in a teaching hospital from north-East India	2015	n=100	DLQI, Hamilton Depression Rating Scale	Married females have a lower quality of life than married males due to discrimination and in-law relationships 59% of patients with vitiligo had depression
Pahw et al^Citation21	The psychosocial impact of vitiligo in Indian patients	2013	n=50	Interview	Patients were unhappy with the way they now looked and seriously undermined the way they felt about themselves Disease was a cause for worry, depression, and low self-esteem Difficult to participate in competitions in school, leave school for doctor visits Unmarried anticipate difficulty in getting married, and the disease was not revealed to the partner at the time of marriage due to embarrassment or the fear of rejection. One patient had been rejected by her in-laws and told to get divorced if not cured The severity of the psychosocial impact can be seen in some patients who constantly thought about their disease and could not bear to look at themselves in the mirror even if affected areas were covered
Alghamdi et al^Citation25	Public perceptions and attitudes toward vitiligo	2012	n=924	Questionnaire	33.1% believe vitiligo is contagious, 56.1% do not want to marry a patient with vitiligo
Wang et al^Citation26	Health-related quality of life and marital quality of vitiligo patients in China	2011	n=101	DLQI, SF-36, ENRICH	>50% of patients report relationship problems with the opposite sex; most feel trouble and shame when meeting a stranger or beginning a sexual or emotional relation with a new partner 16% of patients with vitiligo reported sexual problems, while 25%–35% had classical symptoms of depression, such as loss of sexual drive
Thompson et al^Citation20	Vitiligo linked to stigmatization in British South Asian women: a qualitative study of the experiences of living with vitiligo	2010	n=7	Face-to-face or e-mail interview	Vitiligo is seen to negatively affect social acceptability and marriage potential Development of the “spoiled identity” in relation to the internalization of the experience of stigmatization
Talsania et al^Citation6	Vitiligo is more than skin deep: a survey of members of the Vitiligo Society	2010	n=520	Questionnaire	Fear of getting sunburned on the affected body areas can have major effects on behavior and social participation Patients are less willing to take part in activities such as swimming and sports that involve additional skin exposure
Sampogna et al^Citation24	Impact of different skin conditions on quality of life	2013	n=2478 n=2402	Skindex-29 (sx) Skindex-17 (ps)	Patients with vitiligo have low symptom impairment but high psychosocial impairment
Krishna et al^Citation38	Vitiligo impact scale: an instrument to assess the psychosocial burden of vitiligo	2013	n=100	VIS	Validation of VIS: scores on the scale as a whole and responses to individual items can serve as a guide for treatment decisions including psychological intervention May be useful to assess treatment modalities in diminishing the psychosocial burden of vitiligo
Chan et al^Citation39	Investigating factors associated with depression of patients with vitiligo in Singapore	2011	n=145	Center for Epidemiologic Studies Depression Scale, Rosenberg Self-Esteem Scale, DLQI	Patients with vitiligo affected in both quality of life and self-esteem, which is particularly negatively affected Suicidal ideation is a major issue
Alghamdi^Citation37	Beliefs and perceptions of Arab patients with vitiligo regarding their condition	2010	n=164	Illness perception questionnaire	>50% of patients reported depression when they think about their illness >50% reported anxiety In females, both anxiety and depression were more prevalent in female patients
Acne
Marron et al^Citation18	Anxiety, depression, quality of life and patient satisfaction in patients with acne treated with oral isotretinoin	2013	n=334	DLQI, Health SF-36, Hospital Anxiety and Depression Scale	Baseline DLQI 13.2 that is more negative than the general population Mean ± SD anxiety score was 8.9±3.9, which is higher than the general population Depression was clinically significant in 12 cases out of 334
Tasoula et al^Citation16	The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey	2012	n=1531	DLQI, CDLQI	21% of the acne adolescents were affected in their school work and personal activities due to acne 19.4% were affected in their hobbies due to acne 19.2% of the students were affected in their personal and social lives, especially in their relationship building because of their acne on the face 14% avoided swimming and other sports due to embarrassment; the same results were noticed in patients with back acne
Shahzad et al^Citation9	Frequency and psychosocial impact of acne on university and college students	2011	n=950	CADI	Mean CADI score was 2.67±5.35 Acne had a greater psychosocial impact on females as compared to males
Bez et al^Citation10	High social phobia frequency and related disability in patients with acne vulgaris	2011	n=140	LSAS, HADS, Sheehan Disability Scale, interview by psychiatrist	Social phobia was diagnosed in 45.7% of patients with acne vulgaris and in 18.4% of control subjects: social phobia diagnosis predicted disability at work Patients with acne vulgaris had higher avoidance scores in LSAS than controls Patients with acne vulgaris without social phobia had higher scores in HADS and LSAS than the patients with acne vulgaris with social phobia. They were more disabled in their occupational, social, and familial lives Social phobia seems to be a common psychiatric comorbidity, which may give rise to some additional disability among patients with acne vulgaris
Roosta et al^Citation14	Skin disease and stigma in emerging adulthood: impact on healthy development	2010	n=336	Web-based survey	Likelihood of experiencing perceived stigma was 3.19 times higher for those with acne compared to those without acne
Kubota et al^Citation19	Community-based epidemiological study of psychosocial effects of acne in Japanese adolescents	2010	n=859	MHI or SF-36	Students with acne were significantly more depressed than those without skin problems Girls were significantly more depressed than boys Among students with acne, students who had acne with a duration of >2 years showed a significantly lower MHI score compared to those who reported having acne for <6 months; similar results for depression
Alexis et al^Citation12	Development of a new patient-reported outcome measure for facial acne: the Acne Symptom and Impact Scale (ASIS)	2014	n=48	Acne Symptom and Impact Scale	The most frequently reported impacts were impacts on appearance, self-consciousness, annoyance, bothersomeness, mood, social criticism, embarrassment, confidence, and social withdrawal
Callender et al^Citation13	Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne	2014	n=208	Patient Health Questionnaire	Depression rates were similar among White/Caucasian vs non-White/Caucasian patients More White/Caucasian patients felt self-conscious around other people More non-White/Caucasian patients felt that nonacne sufferers could not relate to experiencing adult acne
Darwish et al^Citation17	Knowledge, beliefs, and psychosocial effect of acne vulgaris among Saudi patients with acne	2013	n=160	Questionnaire	13.3%, affected schoolwork performance 21.1%, affected spousal relationship 30.6%, affected marriage willingness 17.2%, affected friendship relations
Pruthi et al^Citation15	Physical and psychosocial impact of acne in adult females	2012	n=11	Open-ended questions	Indian women believed that physical attractiveness increased ability to secure jobs and life partners Ultimately felt that the nature and qualities of a person mattered more in the long term
Ritvo et al^Citation11	Psychosocial judgements and perceptions of adolescents with acne vulgaris: a blinded, controlled comparison of adult and peer evaluations	2011	n=1,002	Questionnaire	Social bullying was perceived to be greater in patients with acne Acne was associated with more negative descriptors
Psoriasis
Martinez-Garcia et al^Citation28	Quality of life in persons living with patients with psoriasis	2014	n=130	DLQI, FDLQI, HADS	87.8% of the cohabitants with patients with psoriasis had impaired quality of life FDLQI scores of cohabitants were significantly associated with the DLQI scores of the patients Anxiety and depression levels did not differ between patients and cohabitants but were significantly higher than in the control groups
Cather^Citation32	Psoriasis in children and women: addressing some special needs	2014	n=60	Interview	In women <35 years of age, the likelihood of pregnancy was 22% lower than the average, nondiseased population Women with psoriasis also tended to have fewer children than controls 100% of patients reported an adverse impact on their intimate relationships, with 91% related to sexual desire and 79% sexual ability
Bewley et al^Citation30	Identifying individual psychosocial and adherence support needs in patients with psoriasis: a multinational two-stage qualitative and quantitative study	2014	n=1,884	Survey	Depressive symptoms associated with psoriasis have in turn been associated with health-impairing behavior patterns such as smoking, drinking, and decreased physical activity or obesity Questions relating to isolation, social stigma, impact of psoriasis on activities, and feelings of hopelessness should be included in consultations
Sampogna et al^Citation24	Impact of different skin conditions on quality of life	2013	n=2,478 n=2,402	Skindex-29 (sx) Skindex-17 (ps)	Patients with psoriasis had high symptom impairment and high psychosocial impairment
Chularojanamontri et al^Citation36	The Simplified Psoriasis Index (SPI): a practical tool for assessing psoriasis	2013	n=150	DLQI, SPI	The close correlation between SPI-p (psychosocial domain) and DLQI in our study confirms that SPI-p is a good instrument for assessing the psychological impact of psoriasis
Anstey et al^Citation29	Extending psychosocial assessment of patients with psoriasis in the UK, using a self-rated, web-based survey	2012	n=1,760	Web-based survey	Important social issues highlighted were a lack of understanding of psoriasis by the public, avoidance, or limitation of social activities Negatively affects ability to interact socially and make new friends and cancel social engagements
Sampogna et al^Citation35	Living with psoriasis: prevalence of shame, anger, worry, and problems in daily activities and social life	2012	n=936	Skindex-29	Stigma affecting social domains such as relationships, social activities, and work Problems in work was also more frequent in patients with palmoplantar psoriasis Psoriasis may have a negative impact on work, both for psychological and clinical reasons
Armstrong et al^Citation31	Quality of life and work productivity impairment among patients with psoriasis: findings from the National Psoriasis Foundation survey data 2003–2011	2012	n=5,604	Survey	12% of patients were unemployed 92% of those unemployed cited psoriasis as the sole cause for unemployment Patients with severe psoriasis had 1.8 times greater chance of being unemployed 49% of patients who worked missed days from work regularly due to psoriasis

Abbreviations: DLQI, Dermatology Life Quality Index; SF-36, Short Form-36; VIS, Vitiligo Impact Scale; SD, standard deviation; CADI, Cardiff Acne Disability Index; LSAS, Liebowitz Social Anxiety Scale; HADS, Hospital Anxiety and Depression Scale; MHI, Mental Health Inventory; ASIS, Acne Symptom and Impact Scale; FDLQI, Family Dermatology Life Quality Index; SPI, Simplified Psoriasis Index; CDLQI, Children’s Dermatology Life Quality Index; ENRICH, evaluating and nurturing relationship issues, communication, happiness.

Table 2 Erickson stages of development outline the psychosocial conflict and primary relationships formed in each age group

Age group	Psychosocial conflict	Primary relationships formed
Adolescent (12–18 years old)	Identity vs confusion	Peers
Young adulthood (20–25 years old)	Intimacy vs isolation	Friends and lovers
Middle adulthood (26–64 years old)	Generativity vs stagnation	Family and society

SangmaLNNathJBhagabatiDQuality of life and psychological morbidity in vitiligo patients: a study in a teaching hospital from north-East IndiaIndian J Dermatol201560214214625814701

 PubMed Web of Science ®Google Scholar

PahwaPMehtaMKhaitanBKSharmaVKRamamMThe psychosocial impact of vitiligo in Indian patientsIndian J Dermatol Venereol Leprol201379567968523974584

 PubMed Web of Science ®Google Scholar

AlghamdiKMMoussaNAMandilAPublic perceptions and attitudes toward vitiligoJ Cutan Med Surg201216533434022971308

 PubMed Web of Science ®Google Scholar

WangKYWangKHZhangZPHealth-related quality of life and marital quality of vitiligo patients in ChinaJ Eur Acad Dermatol Venereol201125442943520666878

 PubMed Web of Science ®Google Scholar

ThompsonARClarkeSANewellRJGawkrodgerDJAppearance Research CollaborationVitiligo linked to stigmatization in British South Asian women: a qualitative study of the experiences of living with vitiligoBr J Dermatol2010163348148620426784

 PubMed Web of Science ®Google Scholar

TalsaniaNLambBBewleyAVitiligo is more than skin deep: a survey of members of the Vitiligo SocietyClin Exp Dermatol201035773673920015281

 PubMed Web of Science ®Google Scholar

SampognaFTabolliSAbeniDImpact of different skin conditions on quality of lifeG Ital Dermatol Venereol2013148325526123670062

 PubMed Web of Science ®Google Scholar

KrishnaGSRamamMMehtaMSreenivasVSharmaVKKhandpurSVitiligo impact scale: an instrument to assess the psychosocial burden of vitiligoIndian J Dermatol Venereol Leprol201379220521023442459

 PubMed Web of Science ®Google Scholar

ChanMFChuaTLGohBKAwCWThngTGLeeSMInvestigating factors associated with depression of vitiligo patients in SingaporeJ Clin Nurs20122111–121614162121771136

 PubMed Web of Science ®Google Scholar

AlghamdiKMBeliefs and perceptions of Arab vitiligo patients regarding their conditionInt J Dermatol201049101141114520931686

 PubMed Web of Science ®Google Scholar

MarronSETomas-AragonesLBoiraSAnxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoinActa Derm Venereol201393670170623727704

 PubMed Web of Science ®Google Scholar

TasoulaEGregoriouSChalikiasJThe impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population surveyAn Bras Dermatol201287686286923197205

 PubMed Web of Science ®Google Scholar

ShahzadNNasirJIkramUAsmaa-ulHQadirASohailMAFrequency and psychosocial impact of acne on university and college studentsJ Coll Physicians Surg Park2011217442443

 Web of Science ®Google Scholar

BezYYesilovaYKayaMCSirAHigh social phobia frequency and related disability in patients with acne vulgarisEur J Dermatol201121575676021700535

 PubMed Web of Science ®Google Scholar

RoostaNBlackDSPengDRileyLWSkin disease and stigma in emerging adulthood: impact on healthy developmentJ Cutan Med Surg201014628529021084021

 PubMed Web of Science ®Google Scholar

KubotaYShirahigeYNakaiKKatsuuraJMoriueTYonedaKCommunity-based epidemiological study of psychosocial effects of acne in Japanese adolescentsJ Dermatol201037761762220629827

 PubMed Web of Science ®Google Scholar

AlexisADanielsSRJohnsonNPompilusFBurgessSMHarperJCDevelopment of a new patient-reported outcome measure for facial acne: the Acne Symptom and Impact Scale (ASIS)J Drugs Dermatol201413333334024595580

 PubMed Web of Science ®Google Scholar

CallenderVDAlexisAFDanielsSRRacial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acneJ Am Acad Dermatol2014771931

 Google Scholar

DarwishMAAl-RubayaAAKnowledge, beliefs, and psychosocial effect of acne vulgaris among Saudi acne patientsISRN Dermatol2013201392934024490080

 PubMedGoogle Scholar

PruthiGKBabuNPhysical and psychosocial impact of acne in adult femalesIndian J Dermatol2012571262922470204

 PubMedGoogle Scholar

RitvoEDel RossoJQStillmanMALa RicheCPsychosocial judgements and perceptions of adolescents with acne vulgaris: a blinded, controlled comparison of adult and peer evaluationsBiopsychosoc Med2011511121838915

 PubMedGoogle Scholar

Martínez-GarcíaEArias-SantiagoSValenzuela-SalasIGarrido-ColmeneroCGarcía-MelladoVBuendía-EismanAQuality of life in persons living with psoriasis patientsJ Am Acad Dermatol201471230230724836080

 PubMed Web of Science ®Google Scholar

CatherJCPsoriasis in children and women: addressing some special needsSemin Cutan Med Surg2014332 Suppl 2S42S4424979545

 PubMed Web of Science ®Google Scholar

BewleyABurrageDMErsserSJHansenMWardCIdentifying individual psychosocial and adherence support needs in patients with psoriasis: a multinational two-stage qualitative and quantitative studyJ Eur Acad Dermatol Venereol201428676377023663069

 PubMed Web of Science ®Google Scholar

ChularojanamontriLGriffithsCEChalmersRJThe Simplified Psoriasis Index (SPI): a practical tool for assessing psoriasisJ Invest Dermatol201313381956196223807685

 PubMed Web of Science ®Google Scholar

AnsteyAMcAteerHKamathNPercivalFExtending psychosocial assessment of patients with psoriasis in the UK, using a self-rated, web-based surveyClin Exp Dermatol201237773574022998542

 PubMed Web of Science ®Google Scholar

SampognaFTabolliSAbeniDIDIMPRoVE investigatorsLiving with psoriasis: prevalence of shame, anger, worry, and problems in daily activities and social lifeActa dermato-venereologica201292329930322678565

 PubMed Web of Science ®Google Scholar

ArmstrongAWSchuppCWuJBeboBQuality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003–2011PLoS One2012712e5293523285231

 PubMed Web of Science ®Google Scholar