INTRODUCTION
Acne vulgaris is a chronic inflammatory skin condition that makes up a significant proportion of dermatology consultations.1 The global prevalence of acne vulgaris has risen in the last three decades, now affecting about 9.4% of people.1,2 Those who suffer from acne commonly experience poor psychosocial wellness, permanent scarring, and physical pain.3 Given the high prevalence and adverse effects of this disease, understanding the pathogenesis of acne is critical.
In recent years, acne's multifactorial etiology has been emphasized within dermatology. A popular phrase used to describe this phenomenon is the "acne exposome", defined as the sum of the environmental influences on one's health, including factors such as nutrition, exercise, medication, and psychology.4 Given that 35-40% of patients with dermatologic conditions have concomitant psychiatric diagnoses,5 the field of psychodermatology has gained traction, as it seeks to understand an essential part of the exposome: the mind-body connection. Viewing skin diseases through the lens of psychodermatology is critical in providing holistic patient care. Focusing on acne with this interdisciplinary approach will widen the growing body of psychodermatological knowledge and better inform clinical reasoning and recommendations.
Currently, robust literature exists linking acne with psychological stress,6 with some studies showing that psychological intervention is effective in reducing psychiatric outcomes secondary to the disease.7 Patients with known psychological conditions may benefit from techniques like cognitive behavioral therapy (CBT) and other stress reduction strategies. However, there is little data regarding the efficacy of such psychotherapeutic interventions in reducing acne severity. This letter serves to illuminate the available data and urge additional research on the efficacy of psychotherapeutic intervention in acne patients.
Overview of the Limited Research
Existing studies on the effects of psychotherapeutic interventions on acne vulgaris have explored a few different techniques, highlighting their potential. A 2019 randomized controlled trial8 examined a novel method called the Pythagorean Self-Awareness Intervention (PSAI) in acne patients. Like CBT, PSAI emphasizes introspection, intending to challenge destructive or self-deprecating thought patterns. Thirty women with acne vulgaris were randomized to receive either standard care alone or standard care in addition to eight weekly group sessions of PSAI therapy along with twice daily reflective journaling. The results showed that the intervention group experienced a significant improvement in severity (ie, cure, mild, moderate, moderate severe, severe) compared to the control group.
Another observational study9 on women with acne in the setting of Polycystic Ovarian Syndrome (PCOS) administered a set of surveys, including a five-item acne questionnaire, before and after nine weeks of mindfulness meditation. While the study focused mainly on the subjective experience of acne, an item on the questionnaire that read "How often do you have acne on your face?" showed post-intervention improvement, though not statistically significant.
A final case report10 briefly describes a 17-year-old girl socially debilitated by anxiety stemming from her acne who received four 45-minute therapy sessions, as well as dermatological intervention. While a lack of objective acne measurement limits this record, the report ends by stating that the patient’s skin remained clear over the next 18 months.
Call to Action
Given the interplay between the mind and skin, psychotherapeutic interventions may help treat acne. Further investigation is warranted to evaluate the impact of psychotherapeutic techniques on the number and severity of acne lesions. Future studies should focus on larger, more diverse patient enrollment, long-term follow-up, and expansion of the criteria for objective measurement of acne blemishes. We advocate that the available data are encouraging, and psychotherapeutic interventions have the potential to improve the severity of an incredibly prevalent dermatologic condition.
In recent years, acne's multifactorial etiology has been emphasized within dermatology. A popular phrase used to describe this phenomenon is the "acne exposome", defined as the sum of the environmental influences on one's health, including factors such as nutrition, exercise, medication, and psychology.4 Given that 35-40% of patients with dermatologic conditions have concomitant psychiatric diagnoses,5 the field of psychodermatology has gained traction, as it seeks to understand an essential part of the exposome: the mind-body connection. Viewing skin diseases through the lens of psychodermatology is critical in providing holistic patient care. Focusing on acne with this interdisciplinary approach will widen the growing body of psychodermatological knowledge and better inform clinical reasoning and recommendations.
Currently, robust literature exists linking acne with psychological stress,6 with some studies showing that psychological intervention is effective in reducing psychiatric outcomes secondary to the disease.7 Patients with known psychological conditions may benefit from techniques like cognitive behavioral therapy (CBT) and other stress reduction strategies. However, there is little data regarding the efficacy of such psychotherapeutic interventions in reducing acne severity. This letter serves to illuminate the available data and urge additional research on the efficacy of psychotherapeutic intervention in acne patients.
Overview of the Limited Research
Existing studies on the effects of psychotherapeutic interventions on acne vulgaris have explored a few different techniques, highlighting their potential. A 2019 randomized controlled trial8 examined a novel method called the Pythagorean Self-Awareness Intervention (PSAI) in acne patients. Like CBT, PSAI emphasizes introspection, intending to challenge destructive or self-deprecating thought patterns. Thirty women with acne vulgaris were randomized to receive either standard care alone or standard care in addition to eight weekly group sessions of PSAI therapy along with twice daily reflective journaling. The results showed that the intervention group experienced a significant improvement in severity (ie, cure, mild, moderate, moderate severe, severe) compared to the control group.
Another observational study9 on women with acne in the setting of Polycystic Ovarian Syndrome (PCOS) administered a set of surveys, including a five-item acne questionnaire, before and after nine weeks of mindfulness meditation. While the study focused mainly on the subjective experience of acne, an item on the questionnaire that read "How often do you have acne on your face?" showed post-intervention improvement, though not statistically significant.
A final case report10 briefly describes a 17-year-old girl socially debilitated by anxiety stemming from her acne who received four 45-minute therapy sessions, as well as dermatological intervention. While a lack of objective acne measurement limits this record, the report ends by stating that the patient’s skin remained clear over the next 18 months.
Call to Action
Given the interplay between the mind and skin, psychotherapeutic interventions may help treat acne. Further investigation is warranted to evaluate the impact of psychotherapeutic techniques on the number and severity of acne lesions. Future studies should focus on larger, more diverse patient enrollment, long-term follow-up, and expansion of the criteria for objective measurement of acne blemishes. We advocate that the available data are encouraging, and psychotherapeutic interventions have the potential to improve the severity of an incredibly prevalent dermatologic condition.
