Adolescents with Acne Not Predisposed to Alexithymia

Alina Jankowska-Konsur, PhD

A new investigation into acne found that the skin condition did not predispose affected patients to alexithymia. However, in subjects with acne alexithymia was significantly associated with impaired quality of life and increased stigmatization levels.

Investigators noted that patients with acne are at an increased risk for the development of psychological comorbidities, and frequently present with depressive symptoms and anxiety reactions.

Additionally, previous studies had documented difficulties in emotion regulation among patients with acne. The prevalence of alexithymia in particular was assessed as 10-13% globally, with the condition being common in patients suffering from various disorders.

As such, investigators led by Alina Jankowska-Konsur, PhD, Department of Dermatology, Venereology and Allergology at Wroclaw Medical University, Poland, evaluated alexithymia in adolescents struggling with acne.

The Methods

The cross-sectional study was conducted across selected high schools in Southeast and central Poland.

Participation was fully anonymous and voluntary and included adult students ad students under the age of 18 years with written informed consent from their patents.

Data were collected in in-person interviews by investigators during classes, anddemographic data were obtained using a specially designed questionnaire that included the age and sex of the patients.

Self-reported acne was documented, and students were tasked with assessing the severity of their acne by marking 1 of 5 provided standardized color photographs.

No acne, minimal acne, mild acne, moderate acne, and severe acne were the categories provided in the study and were based on the Investigators Global Assessment Scale.

The study was conducted for 2 months between September and November 2021.

Meanwhile, the Toronto Alexithymia Scale (TAS-20) was used to assess the presence of alexithymia in participants. The scale contained 20 question with each question being rated on the 5-point Likert scale.

Patients scoring less than 52 points are treated as non-alexithymia and those with scores between 52 and 60 points are considered as possibly having alexithymia. The TAS-20 questions are grouped to evaluate three domains of alexithymia, described as: difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT).

The Findings

A total of 730 students were selected for the study, with 547 reporting a presence of acne lesions. A total of 59.1% of students reported minimal acne, while 31.8% reported mild acne, 7.3% reported moderate acne, and 1.8% reported severe acne.

Alexithymia was documented in 226 (31%) students and appeared to be significantly more common in girls suffering from acne (37.5%) than in boys suffering from acne (20.9%). The same phenomenon was observed in adolescents without acne (36.0% and 20.8%, respectively) without any significant difference between both analyzed groups.

However, investigators observed that there was no correlation between TAS-20 scores and clinical severity of acne. The mean scoring on the TAS-20 in patients with acne (53.1 ± 12.8 points) was not significantly different from that of the non-acne group (53.5 ± 11.9 points), though significant correlations between TAS-20 scores and QoL assessments (r = 0.332, p < 0.001) as well as stigmatization level (r = 0.284, p < 0.001) were found.

Additionally, despite the lack of relationship between prevalence of alexithymia and acne, alexithymia was significantly more common in those with a more decreased quality of life (p < 0.001) among participants with acne.

“It is also important to underline that patients with alexithymia might be less prone to participate in our study,” the team wrote. “Nevertheless, out of 738 students asked to participate only 8 declined. Therefore, we think that the response rate of 98.9% is sufficient for adequately reflecting this population.”

The study, "Alexithymia in Adolescents with Acne: Association with Quality of Life Impairment and Stigmatization," was published online in the Journal of Clinical Medicine.