Impulsivity, Psychological Distress, and Quality of Life Among the Patients With Acne Vulgaris: Factors Related to Acne Scars

BACKGROUND: Acne scars affect up to 95% of acne vulgaris (AV) patients. However, there is little clinical data to predict which patients are more prone to create scars. OBJECTIVE: In this study, we aimed to evaluate the impulsivity, psychological distress, and quality of life in acne patients and factors related to acne scars. METHODS: This study included 403 AV patients aged 18 years and older. The Global Evaluation Acne (GEA) Scale and the Global Scale for Acne Scar Severity (SCAR-S) were used to assess acne and scar severity. The patients completed a form that included epidemiologic data, such as smoking habits, alcohol consumption, acne characteristics, the Acne Quality of Life Instrument (AQLI), the Barratt Impulsivity Scale-11 Short Form (BIS-11-SF), and the Depression Anxiety Stress Scale-21 (DASS-21). RESULTS: Of the 403 acne patients, 56% (n = 226) had scars. The male sex, mean disease duration, and severity of acne were higher, and the age of acne onset was lower in the group with acne scars (p < 0.001, p = 0.030, p < 0.001, p < 0.001). Oily skin type was more frequent in patients with acne scars (p < 0.001), and Fitzpatrick skin types 3 and 4 were more frequent in patients with acne scars (p < 0.001, p < 0.001). Pruritus and postinflammatory hyperpigmentation were more frequent in the group with acne scars (p < 0.001, p < 0.001). The time from the first acne lesion to the beginning of treatment was longer in the group with acne scars (p < 0.001). The history of systemic drug, topical drug, and dermo-cosmetic product use for acne treatment was lower in the group with acne scars (p = 0.010, p < 0.001, p < 0.001, p < 0.001). The mean AQLI, BIS-11-SF, total DASS-21, depression subscale, and stress subscale scores were higher in the group with acne scars (p < 0.001, p < 0.001, p = 0.002, p = 0.007, p = 0.002). There was a negative correlation between scar severity score and the age of acne onset and a positive correlation between scar severity score and disease duration (p < 0.001, r = 0.16, p < 0.001, r = -0.3, respectively). There was a positive correlation between scar severity score and the mean AQLI, BIS-11-SF, total DASS-21, depression subscale, and stress subscale (p < 0.001, r = 0.2, p < 0.001, r = 0.16, p < 0.001, r = 0.16; p < 0.001, r = 0.17, p = 0.003, r = 0.15, respectively). CONCLUSION: Male sex, early onset of acne, prolonged acne duration, severe acne, delayed treatment, oily skin type, darker skin type, presence of pruritus, and higher impulsivity were associated with acne scars. The presence of scars had adverse effects on quality of life and psychoemotional status, such as depression and stress.