Acne Vulgaris – Epidemiology, Cost, and Psychosocial Implications
Acne vulgaris is a ubiquitous, multifactorial disorder of the pilosebaceous unit. The source of the word acne is controversial. It may be derived from the Greek achne, a word meaning efflorescence, or the Greek acme (Latin acme), which implies a summit or peak. Others have pointed to a hieroglyphic for the word AKU-T as the first written record referring to acne, a symbol interpreted to mean “boils,” “pustules,” or “a painful swelling” (1).
The clinical picture can range from mild comedonal acne to a fulminant, scarring, and systemic condition. Approximately 95% to 100% of adolescent boys and 83% to 85% of adolescent girls aged 16 to 17 years are afflicted (2). Although acne tends to resolve in many cases following adolescence, 42.5% of men and 50.9% of women continue to suffer from this disease into their twenties (3). At 40 years of age, 1% of men and 5% of women still have acne lesions (4). Acne remains the leading cause for visits to a dermatologist (5), and the average total cost per episode of care for an acne patient is estimated at $689.06 (6).
Although many dermatological diseases are not life threatening, they pose a unique challenge to the human psyche. Cutaneous disease carries a distinctive psychosocial burden in that patients who suffer from these diseases display the stigma on their skin for the world to see and criticize on a daily basis. Specif-ically, acne has a known potential to cause significant psychological distress. Between 30% and 50% of adolescents experience psychological difficulties associated with acne, including body image concerns, embarrassment, social impairment, anxiety, frustration, anger, depression, and poor self-esteem (7).
Additionally, suicidal ideation and suicide attempts related to the negative psychosocial impacts of acne have also been documented (8,9). The prevalence of body dysmorphic disorder among acne patients has been measured to be as high as 21% in some office settings (10), and these patients are more likely to report dissatisfaction with dermatologic treatment, attempt suicide, and threaten health care providers both legally and physically (11,12). Not only does acne result in emotional distress, but also the anxiety evoked by having acne can aggravate the skin condition itself, thereby creating a vicious cycle (13).
The purpose of this post series is to provide a comprehensive and up-to-date review of acne vulgaris. It was written to serve as a resource for students, researchers, and clinicians alike. Pathophysiology, management, and treatment options will be discussed along with novel discoveries, cutting edge therapeutic approaches, and areas in which further research is needed.