Skip to main content
Download PDF

Effect of severity of acne on the mental health of Lebanese patients with acne: findings from an online survey

BMC Psychology volume 13, Article number: 502 (2025) Cite this article

Abstract

Background

Acne, an inflammatory chronic skin disease, is one of the most common disorders treated worldwide. Many studies have demonstrated the bidirectional relation that exists between skin disorders, specifically acne and mental health. However, there is paucity of such data in Lebanon where acne is a prevalent skin disease. This cross-sectional study aims to assess the effect of the severity of acne on the mental health of Lebanese patients with acne.

Methods

After receiving the ethical approval for research, a google form questionnaire was shared via Instagram and WhatsApp, starting from December 2021 to February 2022, with 729 Lebanese patients with acne, who were living in Lebanon, were over the age of 16, and were able to read and understand English. The questionnaire included 4 major parts: sociodemographic characteristics, physical health, mental health, and coping strategies.

Results

Out of 729 participants, 57.48% were aged between 21 and 25 years old, 61.59% were females, 35.12% had a Bachelor’s degree, 55% had mild acne and 35% had moderate acne. The results have shown that the severity of acne was associated with increased depression, anxiety, distress, and decreased well-being but didn’t significantly affect social isolation. Female gender and higher educational level were associated with a higher risk of mental illness among acne patients. Regular eating, regular exercise, and coping strategies also played an important role in the mental health state.

Conclusions

This study has confirmed that acne severity has a negative impact on the mental health of Lebanese patients. Therefore, this interaction between the mind and the skin should be addressed by focusing on the psychosocial context of skin diseases, especially acne.

Peer Review reports

Introduction

Acne vulgaris (or simply acne) [1] is one of the most common disorders treated by dermatologists and other health care providers. It is most commonly diagnosed in adolescents and young adults (roughly 85% of them are affected), however, it can also affect adults and even children [2]. Moreover, about 95% of people aged 11 to 30 are affected by acne to some extent [3]. The Global Burden of Disease Study estimates the prevalence of acne at 9.4%, ranking it as the eighth most prevalent disease worldwide [4, 5]. In addition, it is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people [2].

Acne vulgaris is an inflammatory, chronic and self-limiting disorder of the pilosebaceous unit [6]. When the skin becomes oily, hair follicles become blocked with sebum and skin cells, and bumps form [7]. Acne can display as non-inflammatory lesions; whiteheads and blackheads which are closed and open comedones respectively, and inflammatory lesions; papules, pustules, nodules/cysts, and can even develop into fibrosis and scarring [1, 6, 7]. Consequently, physical manifestations such as soreness, pain, and pruritus are common concomitant symptoms of acne lesions [7, 8]. Prescription medications for treating acne include: topical retinoids, topical antibiotics, azelaic acid, antibiotic tablets, the combined contraceptive pill for women. For mild to moderate or moderate to severe acne, treatment typically begins with a combination of topical treatments or antibiotic tablets along with topical treatments. Hormonal therapies or the combined oral contraceptive pill can be effective for women with acne, however, the progestogen-only pill or contraceptive implant may sometimes worsen acne. It can take 2 to 3 months for many of these treatments to show results [3].

Moreover, the mind and the skin are undoubtedly inextricably linked, in other terms, “the skin and the central nervous system are intertwined, both being derived from the same embryological source,” as said by Adam Friedman, MD, FAAD, an Associate Professor of Dermatology in the Department of Dermatology at George Washington School of Medicine and Health Sciences in Washington, DC [9]. So, if somebody is suffering from a chronic inflammatory skin disease such as acne, they may become psychologically distressed and vulnerable [10]. Effectively, it has been proven that acne can lead to anxiety, depression, embarrassment and low self-esteem [11]. Furthermore, it can be even more complicated since it induces poor facial aesthetics and social withdrawal [6]. But equally, if somebody is experiencing a chronic mental health problem, that may trigger or exacerbate their skin condition, or it may decrease their ability to cope with their condition and comply with a specific therapeutic strategy. It can also have a detrimental impact on skin functions as well as a negative effect on skin aging [12].

In the Northern Finland Birth Cohort 1966 (NFBC1966), patients with adult acne (mean age: 46) had more (18.9%) depressive symptoms (BDI-II > 14 points) compared with those without acne (9.7%) but the severity of acne did not correlate with psychological symptoms [13], a significant association was found between the severity of acne and anxiety and depression in an Indian study done by Rayapureddy et al. [14], and a study done in Saudi Arabia revealed a significant difference with the control group for overall anxiety but not for the depression score and a positive correlation between anxiety and depression scores in patients with acne [15]. However, a Turkish study demonstrated that no relationship was found between acne severity and depression or anxiety but the risk of eating disorders among acne patients can be increased by these conditions [16].

In Lebanon, acne is a widespread skin disorder responsible for more than 23% of skin complaints among Lebanese adolescents and young adults diagnosed as outpatients [17]. But there is a lack of studies assessing the impact of acne on mental health in the Lebanese population. Effectively, there’s only one prospective cohort study that involved only 62 patients (of whom 79% were females) between 15 and 40 years old, with moderate-to-severe acne, who were distributed between 2 groups: one group treated with isotretinoin, the other one with systemic antibiotics combined with topical treatments, then they were followed for a period of 6 months. Patients with mild acne, those previously treated with oral isotretinoin, and those with psychiatric diseases were excluded from the study and the aim of this study was to measure the effect of acne on the quality of life by using the Dermatology Life Quality Index (DLQI), Cardiff Acne Disability Index (CADI), and Rosenberg Self-esteem Scale (RSES) before treatment, after 3 months, and after 6 months [18].

Therefore, our cross-sectional research study aims to assess the effect of the severity of acne on the mental health _including well-being, distress, depression, anxiety, and social isolation_ of a large proportion of Lebanese patients with severe, moderate, and even mild acne which is the most frequently encountered severity. All Lebanese patients having acne and who are over the age of 16 could be included, regardless of treatment (taken or not). In addition, it emphasizes the importance of early screening for mental health problems in patients with physical conditions such as acne.

Materials and methods

Study design and population

An observational cross-sectional study was carried out starting from December 2021 to February 2022. The study enrolled 729 Lebanese patients with acne, who were living in Lebanon and were over the age of 16. Added to that, the participants were able to read and understand English in order to be able to give their informed consent and answer all the online survey questions. Finally, they had access to an Instagram or WhatsApp account since the link to the Google form was communicated by using these platforms. Patients who were living outside Lebanon and were under the age of 16 were excluded from the study. Subjects who refused to participate and those with obvious mental disability that precluded them from answering questions were not included.

Procedure

After an Ethical approval for research was granted by the INSPECT-LB Research and Ethics Committee, a Google form was used as a tool to collect participants’ replies. The link of the online survey was shared using social media platforms (WhatsApp and Instagram; two of the most popular social media platforms) in order to reach the highest number of participants possible.

Outcome measures

The questionnaire was divided into four major parts:

  • Sociodemographic characteristics.

  • Participants’ physical health including:

    • Severity of acne (subjectively assessed by participants, based on their global assessment): mild, moderate, severe, very severe.

    • Other physical health conditions.

    • Regular exercise and regular eating.

  • Participants’ mental health which was assessed by using 5 scales:

    • The World Health Organization-5 Well-Being Index (WHO-5) was used to assess the subjective well-being of the respondents over time (over the last two weeks if they had acne when the questionnaire was administered and filled out or, for the purpose of our study, over the period of time during which they had acne; reliability test yields a Cronbach’s alpha of 0.924). It is a short questionnaire consisting of 5 simple and non-invasive questions with each question scored based on a Likert scale coding (0 = at no time, 1 = some of the time, 2 = less than half the time, 3 = more than half the time, 4 = most of the time, 5 = all of the time) [19]. A 0 represents the worst well-being possible and 25 represents the best well-being possible.

    • The Beirut Distress Scale-10 (BDS-10) is a 10-item scale used to assess mental and psychological distress (for the purpose of our study, participants’ psychological distress was assessed over the period of time during which they had acne; reliability test yields a Cronbach’s alpha of 0.769). Each question has a score ranging from 0 to 3 (never = 0, a little bit = 1, moderately = 2, very much = 3) and the total score ranges from 0 to 30 [20]. The higher the score, the more the participants tend to exhibit depressive behaviors.

    • The Generalized Anxiety Disorder-7 (GAD-7) is a 7-item scale that has reporting scores from 0 to 3 on all the questions. It investigates how often the patient has been bothered by seven different symptoms of anxiety over the last two weeks if he had acne when the questionnaire was administered and filled out, with response options such as: “not at all”, “several days”, “more than half the days”, and “nearly daily” scored as 0, 1, 2, and 3, respectively. For the purpose of our study, we also considered participants who have been affected by anxiety symptoms over the period of time during which they had acne. Reliability test yields a Cronbach’s alpha of 0.801. The total GAD-7 score ranges from 0 to 21 [21].

    • The Patient Health Questionnaire-9 (PHQ-9) is a 9-item scale. As a severity measure of the depressive symptoms experienced over the last two weeks if he had acne when the questionnaire was administered and filled out. For the purpose of our study, we also considered participants who have been affected by depressive symptoms over the period of time during which they had acne. Reliability test yields a Cronbach’s alpha of 0.784. The PHQ-9 score can range from 0 to 27, since each of the 9 items can be scored from 0 (not at all) to 3 (nearly every day) [22].

    • The Lubben Social Network Scale-6 (LSNS-6) is a validated instrument designed to gauge social isolation in older adults by measuring the number and frequency of social contacts with friends and family members and the perceived social support received from these sources [23]. In our study, it was used to assess social isolation of the participants over the period of time during which they had acne. Reliability test yields a Cronbach’s alpha of 0.790. The scale consists of 6 items with each item scored from 0 to 5 (none = 0, one = 1, two = 2, three or four = 3, five thru eight = 4, nine or more = 5) and the total score ranges from 0 to 30.

  • Coping strategies adopted by the participants to overcome all the physical and mental health challenges encountered were extracted from a validated questionnaire based on a 5-point Likert scale (0 = Strongly Disagree, 1 = Disagree, 2 = Unsure, 3 = Agree, 4 = Strongly Agree) developed from the previous published studies [24,25,26] and were used as independent variables.

Statistical analysis

The collected data was entered in Excel and analysed using the Statistical Package of the Social Sciences (SPSS). In the univariate statistical analysis, mean ± standard deviation (SD) was used for quantitative variables and percentages used for qualitative variables. In the bivariate statistical analysis, Spearman correlation was used. Scores’ percentages and reliability tests were also used. Statistical tests used were Student’s t test, ANOVA, Kruskal─Wallis test, and Mann─Whitney U test (the 2 last tests were used for nonparametric measures when data was not normally distributed and sample size in each group was less than 30 participants). A P value < 0.05 was considered statistically significant and then, only significant results were reported. In the multivariate statistical analysis, variables with a P value < 0.2 were considered and a MANCOVA was done, comparing multiple dependent variables among subgroups of the population.

Results

Descriptive statistics

Out of 729 participants enrolled in the study, 57.48% were aged between 21 and 25 years old, 61.59% were females, 99.31% were single, 45.54% were living in Mount Lebanon, 35.12% had a Bachelor’s degree, 82.85% weren’t working, 50.21% had a monthly income above 5 000 000 L.L., and 35.53% stated that their number of people at home was 5 (Table 1 in the appendix).

Physical health

55% of participants had mild acne and 35% had moderate acne (Fig. 1 in the appendix); 60% didn’t have other physical health condition. However, approximately 15% of participants had also another skin disease (Fig. 2 in the appendix). Approximately 80% of participants ate sweets, fruits and/or vegetables, and meat and/or fish regularly. However, approximately 50% ate cereals and low-fat products regularly (Fig. 3 in the appendix). Also, 54% of participants regularly exercised few days and 25% never regularly exercised (Fig. 4 in the appendix). Identifying with role models and listening to music were the coping mechanisms that had the highest level of agreement from participants. However, the highest level of disagreement was for watching TV for news (Fig. 5 in the appendix).

Mental health: scores percentages, interpretation, and reliability tests

WHO-5

Most of the participants, more than half the time, woke up feeling fresh and rested (25.2%) and had their daily life filled with things that interested them (29.6%). Also, most of the time, 31.4% (response 4) of the participants have felt cheerful and in good spirits and 28% (response 4) had felt calm and relaxed (Table 2 in the appendix). In this sample, the Cronbach’s alpha = 0.924, indicating a high reliability. Added to that, in the inter-item correlation matrix, no value is equal or smaller than 0.3, indicating a good discrimination of the questions. The lowest raw score was 2 while the highest raw score was 20. In addition, given that a score below 13 indicates poor well-being, most of the participants had a good well-being score since the score below 13 was equal to 38.6%.

BDS-10

Almost 35 to 38% of the participants experienced a little bit rapid mood changes for tiny matters, got angry for ridiculous reasons, had puzzled ideas, difficulty concentrating, and difficulty to relax, and less than 10% of them experienced very much self-isolation, constipation or diarrhea, stomach cramps and heartburn.

52% of them never experienced memory loss and 60.4% of them never experienced stomach heartburn (Table 3 in the appendix). The Cronbach’s alpha of the scale was 0.769, indicating a good reliability. Added to that, in the inter-item correlation matrix, no value is equal or smaller than 0.3, indicating a good discrimination of the questions. Many of the respondents (8.9%) had manifested no distress (score of 0). A score of 10 came second with a percentage of 7.3%.

PHQ-9

About 40% of the participants were feeling down, depressed or hopeless, had little interest or pleasure in doing things as well as feeling tired or having little energy. Less than 10% of all participants experienced all the below depressive symptoms. It is worth mentioning that 18% of the participants had suicidal and self-hurt thoughts several days and 4% of them have these thoughts nearly every day (Table 4 in the appendix).

The Cronbach’s alpha was 0.784, indicating a good reliability concerning the data and the sample collected (good sample size of 729 participants). Added to that, in the inter-item correlation matrix, no value was less than 0.3, indicating a good discrimination of the questions. Moreover, 38.2% and 28% of all participants exhibited, none to minimal depressive symptoms and mild depressive symptoms, respectively (Table 5 in the appendix).

GAD-7

The below percentages are relatively close and about 40% of the participants were feeling, for several days, nervous, anxious or on edge, as well as worrying and becoming easily annoyed or irritable. Between 6 and 15% of the participants felt all the related symptoms nearly every day, which is a higher percentage than those noted with the other mental health scales used above (Table 6 in the appendix). The Cronbach’s alpha was 0.801, indicating a good reliability. Added to that, in the inter-item correlation matrix, no value less than 0.3 was noted, indicating a good discrimination of the questions. Most of the participants had a score ranging between 0 and 4 (38.8%), and 30.4% had a score from 5 to 9. This indicates that they exhibited none to minimal and mild anxiety symptoms respectively (Table 7 in the appendix).

LSNS-6

Since a score of 12 and lower delineates “at risk” for social isolation, 41.2% of the participants had a risk of social isolation and 58.8% did not have this risk (having as a majority about two, three or four friends or relatives) (Table 8 in the appendix). The Cronbach’s alpha = 0.790, indicating a good reliability. Added to that, in the inter-item correlation matrix, no value was less than 0.3, indicating a good discrimination of the questions.

Bivariate analysis

In Table 1, independent variables with a P value less than 0.05 seem to affect the BDS-10 and GAD-7 scores. In Table 2, independent variables with a P value less than 0.05 seem to affect the PHQ-9 and WHO-5 scores.

Table 1 BDS-10 and GAD-7 with all the independent variables
Full size table
Table 2 PHQ-9 and WHO-5 with all the independent variables
Full size table

Effect of severity of acne on mental health

Concerning the WHO-5 score (validated from literature), P value = 0.345 (for the homogeneity of variance), which is not significant and the model is adequate to the data besides, P value (ANOVA) < 0.001 (Table 3), which is highly significant. In addition, we have a negative association. Therefore, when severity of acne increases, the general well-being decreases.

Concerning the BDS-10 score (validated from literature), P value = 0.221 (for the homogeneity of variance), which is not significant and the model is adequate to the data besides, P value (ANOVA) < 0.001 (Table 3), which is highly significant. In addition, we have a positive association. Therefore, when severity of acne increases, distress increases.

Concerning the PHQ-9 score (validated from literature), P value (Kruskal─Wallis) < 0.001 (Table 3), which is highly significant. In addition, we have a positive association. Therefore, when severity of acne increases, depression increases.

Concerning the GAD-7 score (validated from literature), P value = 0.148 (for the homogeneity of variance), which is not significant and the model is adequate to the data besides, P value (ANOVA) < 0.001 (Table 3), which is highly significant. In addition, we have a positive association. Therefore, when severity of acne increases, anxiety increases.

Lastly, concerning the LSNS-6 score (validated from literature), P value (Kruskal─Wallis) = 0.437 (Table 3), which is not significant. Consequently, the severity of acne does not affect social isolation.

Table 3 Comparison of severity of acne on mental health scores (means, standard deviations) and reporting of P value assessed by ANOVA and Kruskal─Wallis tests
Full size table

Multivariate analysis

MANCOVA

Box’s test of equality of covariance matrices is highly significant. Homogeneity of covariance matrices across groups is not assumed. However, since the sample size is large (729 participants), we can continue the analysis using the Pillai’s Trace P value. Table 4 indicates that the following covariates, with a P value less than 0.05, adjust the value of our outcome.

Table 4 Covariates’ descriptive analysis after MANCOVA test, after post-hoc adjustment (Bonferroni correlation)
Full size table

For tests of between-subject effects, please refer to Table 5. There is a significant main effect between the dependent variables and the covariates, referring to the descriptive analysis of the covariates.

Coping strategies “Clearing/finishing my piled-up work” was found to be insignificant for all the dependent variables and was eliminated.

Table 5 Covariates and dependent variables (p value and partial Eta squared)
Full size table
Table 6 Comparison of the estimated marginal means and standard deviations for the dependent variables (WHO-5, BDS-10, PHQ-9 and GAD-7 scores) with the covariate (severity of acne)
Full size table

The partial eta squared measures the effect size of the variables included in the study; 0.01 for small effect size, 0.06 for medium effect size, and 0.14 or higher for large effect size.

A small to medium effect is observed with the BDS-10 score, for being female (0.029), eating well (0.031), sleeping (0.022), and doing mundane house chores (0.020). This effect is also small to medium for the severity of acne, with a partial eta squared of 0.024, showing the significant effect that very severe acne has on the distress score.

A small to medium effect is observed with the WHO-5 score, for the reproductive health and childbirth disease (0.027) and for regularly eating fruits and/or vegetables (0.022). This effect is also small to medium for the severity of acne with a partial eta squared of 0.025, specifically for mild acne.

A small to medium effect is observed with the PHQ-9 score, for eating well (0.027), sleeping (0.025), and doing mundane house chores (0.020). This effect is also small to medium for very severe acne, with a partial eta squared of 0.034.

A small to medium effect is observed with the GAD-7 score, for eating well (0.026) and sleeping (0.020). A medium effect is observed for very severe acne, with a partial eta squared of 0.055. (Tables 5 and 6)

In the estimated marginal means, the following graphs show the variation of each dependent variable. Effectively, well-being, distress, depression, and anxiety are shown to be affected by the severity of acne. (Figures 1, 2, 3, 4 and 5) Female gender and highest educational level (bachelor’s degree) were also significantly affecting those 4 mental health states among acne patients.

Fig. 1
figure 1

Estimated marginal means of WHO-5 score

Full size image
Fig. 2
figure 2

Estimated marginal means of BDS-10 score

Full size image
Fig. 3
figure 3

Estimated marginal means of PHQ-9 score

Full size image
Fig. 4
figure 4

Estimated marginal means of GAD-7 score

Full size image
Fig. 5
figure 5

Estimated marginal means of LSNS-6 score

Full size image

Discussion

Our study enrolled 729 Lebanese patients with acne above 16 years of age from all over Lebanon, unlike other studies that used less inclusive samples [14,15,16]. Added to that, we used five validated mental health scales, in contrast to other studies that examined mental health less extensively, and we have taken into consideration other aspects of physical health and coping strategies.

In our study, the results have shown that the severity of acne vulgaris can be associated with depression, anxiety, distress, and decreased well-being. Effectively, WHO-5 score decreased from roughly 15 with mild acne to 10 with very severe acne; a score below 13, indicating poor well-being, was noted with severe and very severe acne. Distress score increased from 9 to 14, depression score from 6 to 12 (with 18% of the participants having suicidal and self-hurt thoughts several days and 4% of them having these thoughts nearly every day), anxiety score from 6 to 13, when passing from mild to very severe acne respectively. However, the severity of acne didn’t seem to have any impact on social isolation (P value = 0.437).

The relationship between acne severity and mental health is complex and multifaceted. Severe acne can significantly affect an individual’s self-esteem and body image, leading to feelings of embarrassment and social anxiety [27], individuals with more severe acne may avoid social interactions or public settings, fearing judgment or negative attention [28]. On the other hand, societal beauty standards often emphasize clear skin, which can exacerbate feelings of inadequacy in those with acne [29]. Different cultures may have varying levels of stigma associated with skin conditions. Moreover, adolescents are particularly vulnerable to the psychological effects of acne due to ongoing identity formation and peer dynamics [30]. The impact may lessen in adulthood, but severe acne can still lead to lasting effects. Finally, access to effective treatment can mitigate psychological distress, but stigma around seeking help for skin conditions can prevent individuals from pursuing care [31].

Acne’s negative impacts on social isolation may have been unintentionally obscured by the COVID-19 pandemic’s significant influence on social behavior, despite the fact that mask use could have caused acne [32]. Many people with acne experienced fewer in-person encounters as a result of the change to online communication, which would have lessened the immediate social constraints linked to acne. Additionally, the epidemic raised awareness of general health and well-being, which may have caused people to focus on more urgent health issues rather than aesthetic ones like acne. Furthermore, as people dealt with the pandemic’s stress and mental strain, personal issues like acne might have taken a backseat. These facts are expected to have driven the results toward the null hypothesis.

Female patients had a higher risk of depression, anxiety, distress, and decreased well-being, this observation can be justified by the fact that women give a higher importance to their physical appearance. Another finding was the correlation between the higher educational level and the higher risk of mental illnesses, which can be explained by a higher involvement in the workplace and a greater need to look and feel attractive and good-looking. Regular eating also had a significant effect on the risk of mental illness, most probably because it may reduce acne severity and therefore, decrease the stress related to it. Last but not least, the coping strategies, that significantly affected each psychological state, can represent efficient means to decrease the burden of physical illness, to improve treatment compliance, and to promote mental health.

There is paucity of studies showing the effect of acne on mental health in Lebanon. But there’s one prospective cohort study from Lebanon, showing the impact of acne treatment on quality of life and self-esteem, that had proven the social obstacle that acne creates and its recurrence in women of child-bearing age [18]. However, in this study, a low number of patients was targeted since it is a cohort study, the number of participants was unevenly distributed between genders (79%, the great majority, were females), age restriction and exclusion criteria rendered the study sample more limited (particularly, patients with mild severity of acne weren’t included so the variation of acne severity wasn’t studied), the effect of many treatments was studied, and the investigated effect was the effect of acne on the quality of life and self-esteem only.

Other studies also showed that acne affects mental health, the severity of acne increases the severity of depression, females are more prone to mental illnesses, and food consumption has an impact on acne-related mental illness. A study done on outpatients with facial acne vulgaris, who visited the dermatology of the Third Xiangya Hospital, concluded that the severity of depression increases with female gender, the severity of acne and its course [33]. Besides, a cross-sectional study using an online questionnaire and a paper questionnaire that was completed by the patients of dermatology clinics in Lublin, Kielce, and Rzeszów in south-eastern Poland illustrated that acne leads to moderate anxiety, feeling of less attraction, psychological discomfort, decreased emotional well-being, and is a barrier to social interactions. Patients were aware of the fact that acne aggravation and the severity of mood disorders were directly correlated with the consumption of sweets, sweetened beverages, and foods with a high glycemic index [34]. A case-control study done in Egypt showed that serum levels of vitamin B12 and folic acid are predictors for acne severity and depression in females with early-onset acne, long duration of moderate or severe acne, and positive family history [35].

A survey of 2,657 students from Turkey, aged 14–20 years, detected a prevalence of acne, anxiety and depression of 23%, 25%, and 13% respectively, no significant differences in the HAD anxiety and depression subscale scores existed between the acne and control groups, and the severity of acne was not correlated with the HAD anxiety or depression subscale scores. This absence of correlation is contradictory to our findings. However, knowing that boys and girls had the same severity of acne, adolescent girls were more vulnerable than boys to negative psychological effects such as anxiety [36]. Anxiety, depression, suicidal ideation, emotion dysregulation, and social impairment were detected in adolescents in other studies [37,38,39].

A qualitative study demonstrated that women with acne reported depression, anxiety, affected well-being, disrupted social and professional lives, and low self-esteem. However, those women also experienced social isolation, in contradiction to our results [40]. Another study done on one hundred and six patients with acne vulgaris who consecutively attended the dermatology outpatient clinics in Semnan city in 2008 showed that psychoticism (34.0%) and depression (31.1%), respectively, were the most common psychiatric symptoms needing treatment due to disturbed daily life activities [30]. A third study done on clinical participants with dermatologist-validated diagnoses of psoriasis, atopic dermatitis, or acne who were currently taking systemic medication, proved that those skin conditions lead to a more negative cutaneous body image not significantly related to a drive for thinness or to dietary restraint, anxiety and depression in comparison with participants without skin conditions [41]. Finally, a meta-analysis published in 2021 concluded that acne may significantly increase suicide risk and suicide screening should be considered by clinicians when treating acne, which is in accordance with our results [42].

Furthermore, many studies showed the psychosocial burden of other skin diseases. Effectively, a scoping review including the articles published until the end of August 2017 showed that localised cutaneous leishmaniasis has a negative impact on the mental health of patients and leads to social and self-stigmatization [43], 23.5% of participants having leprosy were very likely to have a psychological disorder [44], the prevalence of depression in patients with lichen planus was 25% with a female predominance [45], people with psoriasis [46] or atopic eczema [47] are at increased risk of mental illness, patients with vitiligo have low self-esteem, social anxiety, isolation, depression, with a higher prevalence of depression, anxiety, social anxiety and avoidance in females as well [48], and finally, rosacea was associated with a higher frequency of anxiety and depression (24.7%), a higher risk of anxiety (particularly, generalized anxiety disorder (GAD)) was noted in female patients and in patients having a lower educational level [49].

Limitations

The cross-sectional design of our study is one of its main limitations. Effectively, our participants report both exposures and outcomes. A prospective longitudinal cohort study would thus be the best study design to fulfill our aims. Moreover, a recall bias may be present due to the nature of the tools used. The acne cases weren’t diagnosed by a dermatologist but were identified by the participants themselves, acne severity was self-reported as well without clinical validation, and the nutrition survey does not permit a thorough assessment of dietary habits. However, we suspect this bias to be nondifferential, which could underestimate the association we found and drive the results towards the null hypothesis. In addition, using online surveys for data collection introduces a potential selection bias because many patients won’t be able to participate in the study because they won’t have access to the link of the survey (they don’t have WhatsApp or Instagram account) or they don’t know how to respond online. A larger and more representative sample can lead to more accurate and generalizable conclusions.

Moreover, many residual confounding factors may lead to mental health state deterioration and would interfere with our results in a way that would make it sometimes difficult to confirm that acne is specifically responsible for mental health decline: COVID-19 pandemic, the economic crisis, the multiple stressors currently threatening the Lebanese population, and the presence of mental health problems before the occurrence of acne can all be contributing factors responsible for the confounding bias. For example, a cross-sectional study among Chinese patients with skin diseases found that isolation, income loss, and unemployment were associated with anxiety, depression, and impaired quality of life in patients with skin diseases during the COVID-19 pandemic [50].

Perspectives, practical implications, and future research

The results of this study may lead us to consider many practical implications for patients with acne: mental health support (integrating mental health support into dermatological care is crucial; screening for anxiety and depression in patients with severe acne can lead to timely interventions), education and awareness (raising awareness about the mental health effects of acne can help reduce stigma and encourage individuals to seek help; educational programs can focus on the importance of skin health and its psychological aspects), coping strategies (providing resources for coping strategies, such as mindfulness and self-compassion exercises, can empower individuals to manage the psychological impact of acne), holistic treatment approaches (a multidisciplinary approach that includes dermatologists, psychologists, and counselors can ensure comprehensive care for those affected by acne), community and support groups (establishing support groups can help individuals share their experiences and reduce feelings of isolation, online communities can also provide valuable peer support), and long-term monitoring (ongoing assessments of mental health in patients with acne, especially during treatment, can help track changes and identify those in need of additional support).

A prospective longitudinal cohort study would be the best study design to fulfill our aims and confirm our findings. Besides, a larger and more representative sample (not only patients having Instagram or WhatsApp and who are able to read and understand English) can lead to more accurate and generalizable conclusions. Furthermore, acne severity should be assessed based on a face-to-face interview and clinical validation of acne severity should be thoroughly assessed with a more precise survey.

Conclusions

Acne has a negative influence on the mental health of patients. While treating acne, dermatologists should take into consideration this impact and adopt a holistic approach by using appropriate screening methods and investigation tools. In the era of personalised medicine, establishing a psychodermatology service can bridge the gap between skin diseases and mental health by elaborating effective lifestyle (including diet, exercise, and coping strategies) modification programmes, psychological therapies, mindfulness-based interventions, and treatment compliance promoting strategies, not only to treat but also to prevent mental illnesses that may complicate the course of the skin disease and negatively affect its treatment outcomes.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BDS-10:

Beirut Distress Scale-10

GAD-7:

Generalized Anxiety Disorder-7

LSNS-6:

Lubben Social Network Scale-6

PHQ-9:

Patient Health Questionnaire-9

WHO-5:

World Health Organisation-5 Well-Being Index

References

  1. Nast A, Dréno B, Bettoli V, Degitz K, Erdmann R, Finlay AY, Ganceviciene R, Haedersdal M, Layton A, López-Estebaranz JL, Ochsendorf F, Oprica C, Rosumeck S, Rzany B, Sammain A, Simonart T, Veien NK, Zivković MV, Zouboulis CC, Gollnick H. European Dermatology Forum. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol. 2012;26 Suppl 1:1–29. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1468-3083.2011.04374.x. PMID: 22356611.

  2. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–73.e33. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jaad.2015.12.037. Epub 2016 Feb 17. Erratum in: J Am Acad Dermatol. 2020;82(6):1576. PMID: 26897386.

  3. Acne. UK: NHS. [updated 2023, January 3; cited 2024, October 27]. Available from: https://www.nhs.uk/conditions/acne/

  4. Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, Marks R, Naldi L, Weinstock MA, Wulf SK, Michaud C, Murray JL, Naghavi C. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527–34. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/jid.2013.446. Epub 2013 Oct 28. PMID: 24166134.

    Article  PubMed  Google Scholar 

  5. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA,Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D,Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M,Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F,Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE,Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W,Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J,Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM,Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R,Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB,Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R,Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB,Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A,Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM,Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O’Donnell M, O’Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N,Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ,Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG,Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96. doi: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0140-6736(12)61729-2. Erratum in: Lancet. 2013;381(9867):628. AlMazroa, Mohammad A [added]; Memish, Ziad A [added]. PMID: 23245607; PMCID: PMC6350784.

  6. Sutaria AH, Masood S, Schlessinger J, Acne V. 2022 Aug 1. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29083670.

  7. Vyas A, Kumar Sonker A, Gidwani B. Carrier-based drug delivery system for treatment of acne. ScientificWorldJournal. 2014;2014:276260. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2014/276260. PMID: 24688376; PMCID: PMC3934386.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Reich A, Trybucka K, Tracinska A, Samotij D, Jasiuk B, Srama M, Szepietowski JC. Acne itch: do acne patients suffer from itching? Acta Derm Venereol. 2008;88(1):38–42. https://doiorg.publicaciones.saludcastillayleon.es/10.2340/00015555-0355. PMID: 18176749.

  9. Mind Your Business. Exploring the Mind/Skin Connection. Practical Dermatology. [updated 2017, February 15; cited 2023, January]. Available from: https://practicaldermatology.com/articles/2017-feb/mind-your-business-exploring-the-mindskin-connection

  10. Farzanfar D, Dowlati Y, French LE, Lowes MA, Alavi A, Inflammation. A contributor to depressive comorbidity in inflammatory skin disease. Skin Pharmacol Physiol. 2018;31(5):246–51. https://doiorg.publicaciones.saludcastillayleon.es/10.1159/000490002. Epub 2018 Jun 28. PMID: 29953999.

    Article  PubMed  Google Scholar 

  11. Gieler U, Gieler T, Kupfer JP. Acne and quality of life - impact and management. J Eur Acad Dermatol Venereol. 2015;29 Suppl 4:12–4. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jdv.13191. PMID: 26059729.

  12. Chen Y, Lyga J. Brain-skin connection: stress, inflammation and skin aging. Inflamm Allergy Drug Targets. 2014;13(3):177–90. https://doiorg.publicaciones.saludcastillayleon.es/10.2174/1871528113666140522104422. PMID: 24853682; PMCID: PMC4082169.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Leskelä M, Jokelainen J, Huilaja L, Sinikumpu SP. Adult acne in middle-age: effects on mental health in general population of the Northern Finland birth cohort 1966. Acta Derm Venereol. 2024;104:adv14733. https://doiorg.publicaciones.saludcastillayleon.es/10.2340/actadv.v104.14733. PMID: 38270258; PMCID: PMC10831867.

    Article  PubMed  Google Scholar 

  14. Rayapureddy S, Benerji T, Kodali M, Pallekona R, Enamurthy H, Ravi Kumar MS. Anxiety and depression in patients with acne vulgaris at tertiary care hospital: a cross-sectional study. J Dr NTR Univ Health Sci. 2022;11:351–5. https://doiorg.publicaciones.saludcastillayleon.es/10.4103/jdrntruhs.jdrntruhs_88_22

    Article  Google Scholar 

  15. Molla A, Alrizqi H, Alharbi E, Alsubhi A, Alrizqi S, Shahada O. Assessment of anxiety and depression in patients with acne vulgaris in Medina: a case-control study. Clin Cosmet Investig Dermatol. 2021;14:999–1007. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/CCID.S302311

    Article  PubMed  PubMed Central  Google Scholar 

  16. Karaagaç M, Akça HM, Acat Ö. Lack of association of acne severity with depression, anxiety, stress, and eating attitudes: a cross-sectional study. J Pers Med. 2024;14:133. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jpm14020133

    Article  PubMed  PubMed Central  Google Scholar 

  17. Khattar JA, Hamadeh GN, Rahi AC, Musharrafieh UM. Common dermatologic diseases among students at a tertiary care center in Lebanon. J Med Liban. 2010;58(4):195-8. PMID: 21409941.

  18. Kaikati J, Zoghaib S, Kechichian E, Stephan F, Helou J, Sleilaty G, Tomb R. The impact of acne treatment on quality of life and self-esteem: a prospective cohort study from Lebanon. Int J Womens Dermatol. 2021;7(4):415–21. PMID: 34621953; PMCID: PMC8484949.

    Article  PubMed  PubMed Central  Google Scholar 

  19. World Health Organization. Regional Office for Europe. Wellbeing measures in primary health care/the depcare project: report on a WHO meeting: Stockholm, Sweden, 12–13 February 1998. World Health Organ Reg Office Europe. 1998. https://iris.who.int/handle/10665/349766.

  20. Malaeb D, Farchakh Y, Haddad C, Sacre H, Obeid S, Hallit S, Salameh P. Validation of the Beirut distress scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population. Perspect Psychiatr Care. 2022;58(1):304–13. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/ppc.12787. Epub 2021 Apr 6. PMID: 33821486.

    Article  PubMed  Google Scholar 

  21. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/archinte.166.10.1092. PMID: 16717171.

  22. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. https://doiorg.publicaciones.saludcastillayleon.es/10.1046/j.1525-1497.2001.016009606.x. PMID: 11556941; PMCID: PMC1495268.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lubben J, Blozik E, Gillmann G, Iliffe S, von Renteln Kruse W, Beck JC, Stuck AE. Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. Gerontologist. 2006;46(4):503–13. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/geront/46.4.503. PMID: 16921004.

  24. Sameer AS, Khan MA, Nissar S, Banday MZ. Assessment of mental health and various coping strategies among general population living under imposed COVID-lockdown across world: a cross-sectional study. Ethics Med Public Health. 2020;15:100571. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jemep.2020.100571. Epub 2020 Jul 28. PMID: 32838000; PMCID: PMC7386294.

  25. Soliman M. Perception of stress and coping strategies by medical students at King Saud university, Riyadh, Saudi Arabia. J Taibah Univ Med Sci. 2014;9:30–5.

    Google Scholar 

  26. Abouammoh N, Irfan F, AlFaris E. Stress coping strategies among medical students and trainees in Saudi Arabia: a qualitative study. BMC Med Educ. 2020;20(1):124. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12909-020-02039-y. PMID: 32321498; PMCID: PMC7178558.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tasneem T, Begum A, Chowdhury MR, Rahman S, Macassa G, Manzoor J, Rashid M. Effects of acne severity and acne-related quality of life on depressive symptoms among adolescents and young adults: a cross-sectional study in Bangladesh. Front Psychol. 2023;14:1153101.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mufaddel A, Elnour AA, Omer AA, Alshora EH. Psychiatric comorbidity in patients with acne. Open J Psychiatry. 2017;7(3):176–85.

    Article  Google Scholar 

  29. Morshed ASM, Noor T, Uddin Ahmed MA, Mili FS, Ikram S, Rahman M, Ahmed S, Uddin MB. Understanding the impact of acne vulgaris and associated psychological distress on self-esteem and quality of life via regression modeling with CADI, DLQI, and WHOQoL. Scientific Reports. 2023;13(1):21084.

  30. Behnam B, Taheri R, Ghorbani R, Allameh P. Psychological impairments in the patients with acne. Indian J Dermatology. 2013;58(1):26–9.

    Article  Google Scholar 

  31. Shields A, Nock MR, Ly S, Manjaly P, Mostaghimi A, Barbieri JS. Evaluation of stigma toward individuals with acne. JAMA Dermatology. 2024;160(1):93–8.

    Article  PubMed  Google Scholar 

  32. Berjawi A, Salameh P, Fadel N, El Khoury JR. Mask-acne prevalence and risk factors during the COVID‐19 pandemic: a cross‐sectional single institution study. Dermatol Ther. 2023;2023(1):9470636.

    Article  Google Scholar 

  33. Kang L, Liu J, An R, Huang J, Huang H, Yi Q. Depression in patients with facial acne vulgaris and the influential factors. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015;40(10):1115-20. Chinese. https://doiorg.publicaciones.saludcastillayleon.es/10.11817/j.issn.1672-7347.2015.10.010. PMID: 26541846.

  34. Kostecka M, Kostecka J, Szwed-Gułaga O, Jackowska I, Kostecka-Jarecka J. 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(24):5293. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/nu14245293. PMID: 36558452; PMCID: PMC9784447.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ahmed SH, El-Kelish AA, Hafeez NA, El-Bakry ST. Influential factors of depression in patients with moderate and severe acne. J Clin Aesthet Dermatol. 2020;13(2):13–6. Epub 2020 Feb 1. PMID: 32308780; PMCID: PMC7158912.

    PubMed  PubMed Central  Google Scholar 

  36. Aktan S, Ozmen E, Sanli B. Anxiety, depression, and nature of acne vulgaris in adolescents. Int J Dermatol. 2000;39(5):354-7. https://doiorg.publicaciones.saludcastillayleon.es/10.1046/j.1365-4362.2000.00907.x. PMID: 10849125.

  37. Misery L. Consequences of psychological distress in adolescents with acne. J Invest Dermatol. 2011;131(2):290-2. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/jid.2010.375. PMID: 21228811.

  38. Turan S, Turan IK, Özbağcıvan Ö. Emotion regulation in adolescents with acne vulgaris: correlates of medication adherence, clinical dimensions and psychopathology symptoms: a cross-sectional study. Turk J Pediatr. 2020;62(6):1012–1020. https://doiorg.publicaciones.saludcastillayleon.es/10.24953/turkjped.2020.06.013. PMID: 33372440.

  39. Halvorsen JA, Stern RS, Dalgard F, Thoresen M, Bjertness E, Lien L. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol. 2011;131(2):363–70. Epub 2010 Sep 16. PMID: 20844551.

    Article  PubMed  Google Scholar 

  40. 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(9):1040–6. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/jamadermatol.2021.2185. PMID: 34319378; PMCID: PMC8319821.

    Article  PubMed  Google Scholar 

  41. Hinkley SB, Holub SC, Menter A. The validity of cutaneous body image as a construct and as a mediator of the relationship between cutaneous disease and mental health. Dermatol Ther (Heidelb). 2020;10(1):203–11. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s13555-020-00351-5. Epub 2020 Jan 16. PMID: 31950338; PMCID: PMC6994570.

    Article  PubMed  Google Scholar 

  42. Xu S, Zhu Y, Hu H, Liu X, Li L, Yang B, Wu W, Liang Z, Deng D. The analysis of acne increasing suicide risk. Med (Baltim). 2021;100(24):e26035. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/MD.0000000000026035. PMID: 34128844; PMCID: PMC8213250.

    Article  Google Scholar 

  43. Bennis I, De Brouwere V, Belrhiti Z, Sahibi H, Boelaert M. Psychosocial burden of localised cutaneous leishmaniasis: a scoping review. BMC Public Health. 2018;18(1):358. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12889-018-5260-9. PMID: 29544463; PMCID: PMC5855994.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Xiong M, Wang X, Su T, Yang B, Li M, Zheng D. Relationship between psychological health and quality of life of people affected by leprosy in the community in Guangdong Province, China: a cross-sectional study. BMC Public Health. 2019;19(1):424. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12889-019-6672-x. PMID: 31014307; PMCID: PMC6480913.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Sawant NS, Vanjari NA, Khopkar U, Adulkar S. A study of depression and quality of life in patients of lichen planus. ScientificWorldJournal. 2015;2015:817481. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2015/817481. Epub 2015 Feb 23. PMID: 25802892; PMCID: PMC4353444.

  46. Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010;146(8):891–5. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/archdermatol.2010.186. PMID: 20713823; PMCID: PMC2928071.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM. Atopic eczema in adulthood and risk of depression and anxiety: a Population-Based cohort study. J Allergy Clin Immunol Pract. 2020;8(1):248–e25716. Epub 2019 Aug 31. PMID: 31479767; PMCID: PMC6947493.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Sawant NS, Vanjari NA, Khopkar U. Gender differences in depression, coping, stigma, and quality of life in patients of vitiligo. Dermatol Res Pract. 2019;2019:6879412. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2019/6879412. PMID: 31065260; PMCID: PMC6466925.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Incel Uysal P, Akdogan N, Hayran Y, Oktem A, Yalcin B. Rosacea associated with increased risk of generalized anxiety disorder: a case-control study of prevalence and risk of anxiety in patients with rosacea. Bras Dermatol. 2019;94(6):704–9. Epub 2019 Oct 26. PMID: 31789266; PMCID: PMC6939083.

  50. Guo Y, Shen M, Zhang X, Xiao Y, Zhao S, Yin M, Bu W, Wang Y, Chen X, Su J. Association of socioeconomic changes due to the COVID-19 pandemic with health outcomes in patients with skin diseases: cross-sectional survey study. J Med Internet Res. 2020;22(9):e22288. https://doiorg.publicaciones.saludcastillayleon.es/10.2196/22288. PMID: 32845850; PMCID: PMC7490117.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

The authors declare that no funding was received.

Author information

Authors and Affiliations

  1. Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon

    Tia El Kazzi & Pascale Salameh

  2. Faculty of Pharmacy, Lebanese University, Beirut, Lebanon

    Mayssam Shahine & Pascale Salameh

  3. School of Medicine, Lebanese American University, Byblos, Lebanon

    Pascale Salameh

  4. Institut National de Santé Publique d’Épidémiologie Clinique et de Toxicologie- Liban (INSPECT-LB), Beirut, Lebanon

    Pascale Salameh

  5. Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, 2417, Cyprus

    Pascale Salameh

Authors
  1. Tia El Kazzi
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Mayssam Shahine
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Pascale Salameh
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

T.E. conceived or designed the work, collected the data, wrote the manuscript, and participated in the data analysis and interpretation and critical revision of the manuscript. M.S. performed data analysis and interpretation and participated in the writing of the Results section. P.S. supervised all the research process and participated in the critical revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tia El Kazzi.

Ethics declarations

Ethics approval and consent to participate

The study was conducted according to the research ethical guidelines and considerations recognized in the Declaration of Helsinki. Approval was granted by the INSPECT-LB Research and Ethics Committee (IRB ID: 2022REC-001-INSPECT-01-14). After understanding the aims of the study, the participants voluntarily agreed to take part in this research project by giving their written informed consent and completing the questionnaire and their responses were completely anonymous and confidential.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Kazzi, T., Shahine, M. & Salameh, P. Effect of severity of acne on the mental health of Lebanese patients with acne: findings from an online survey. BMC Psychol 13, 502 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40359-025-02808-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40359-025-02808-8

Keywords

BMC Psychology

ISSN: 2050-7283

Contact us