The Mental Health Burden of Visible Skin Diseases (Severe Acne Vulgaris and Atopic Dermatitis) and its Influence on Behavioural Treatment Compliance: A Prospective Observational Study at a Tertiary Care Teaching Hospital in Maharashtra, India
Keywords:
Acne Vulgaris, Atopic Dermatitis, Psychodermatology, Anxiety, Depression, Quality of Life, Treatment Adherence, Behavioural Compliance.Abstract
Background: Visible dermatoses such as severe acne vulgaris and atopic dermatitis (AD) extend beyond cutaneous pathology, inflicting psychological distress that can erode quality of life and, in turn, undermine adherence to prescribed dermatological therapy. This bidirectional “disease–distress–non-adherence cycle is increasingly recognised in psychodermatology but remains under-studied in Indian tertiary-care settings.
Objectives: To determine the prevalence and severity of anxiety, depression and quality-of-life impairment among patients with severe acne vulgaris and atopic dermatitis and to examine their association with behavioural treatment compliance.
Methods: A hospital-based prospective observational study was conducted over 18 months in the Department of Dermatology, Venereology and Leprosy, in liaison with the Department of Psychiatry, SSPM Medical College and Lifetime Hospital. Consecutively recruited patients aged 12–60 years with severe acne (Global Acne Grading System, GAGS ≥ 19) or moderate-to-severe AD (SCORAD > 25) were assessed at baseline and scheduled follow-ups using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), and the 8-item Morisky Medication Adherence Scale (MMAS-8). Associations were analysed using correlation and multivariate logistic regression.
Results: Of the projected 390 participants (195 acne, 195 AD), a substantial proportion are expected to screen positive for anxiety and/or depression on HADS, with DLQI impairment correlating positively with HADS scores and negatively with MMAS-8 adherence scores.
Conclusion: Visible dermatoses are expected to carry a significant, often unaddressed, mental health burden that independently predicts poorer treatment compliance, supporting the integration of routine psychological screening and a dermatology–psychiatry liaison pathway into outpatient dermatology care.
