Internalized stigma in acne vulgaris and its relationship with quality of life, general health, body perception, and depression

Abstract

Backround: Internalized stigma, adoption of negative attitudes, and societal stereotypes regarding acne vulgaris (AV) have not been previously studied.

Objective: To investigate the internalized stigma state in AV and determine its association with quality of life, perceived health, body image, and depression.

Methods: A total of 77 AV patients (43 female, 34 male; aged 19.7 ± 2.3 years) were enrolled in this cross-sectional study. The scales used in the study were Acne Internalized Stigma Scale (AISS), Acne Quality of Life scale (AQOL), FDA Global score, Perceived Health Status (PHS), Body Image Scale (BIS), and Beck Depression Inventory (BDI).

Results: Mean AISS scores (53.68 ± 13.6) were significantly higher in males than in females (57.41 ± 14.37, 50.39 ± 12.25, P = 0.042). There was a significant positive correlation between mean values of AISS and AQOL (r = 0.816, P < 0.001), FDA Global grade (r = 0.391, P = 0.002) and BDI (r = 0.440, P < 0.001). Lower PHS (P = 0.027) was another determinant of high AISS scores. The mean AISS score of patients with a family history was significantly lower than those without a family history (P = 0.007). VAS was also found to be correlated with mean values of AISS and AQOL. Linear regression analysis revealed that the most important determinant of internalized stigma was AQOL (β = 0,632; P < 0.001), followed by gender (β = -0,229; P = 0.001), FDA Global score (β = 0,193; P = 0.007), and BDI (β = 0,177; P = 0.024).

Discussion: Significant and independent predictive factors for high internalized stigma state were the negative quality of life, male gender, the severity of the illness, and depression. Therefore, internalized stigma may be one of the major factors responsible for the psychosocial burden of AV.

Keywords: Acne vulgaris; depression; psychodermatology; quality of life; stigmatization.