title: Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study.
abstract: BACKGROUND
  Acne vulgaris is a distressing condition that affects the majority of adolescents, but its impact on mental health in this age group is poorly understood.
  
  
  OBJECTIVE
  To determine the prevalence of acne, knowledge about acne and rates of help-seeking behaviour in English teenagers. It was hypothesized that presence of acne would be associated with higher rates of emotional and behavioural difficulties.
  
  
  METHODS
  Three hundred and seventeen pupils (80% response rate) aged 14-16 years participated from a comprehensive school in Nottingham. An age-appropriate, validated measure of emotional well-being, the Strengths and Difficulties Questionnaire (SDQ), and an Acne Management Questionnaire were used to assess participants' psychological health, level of acne knowledge and help-seeking behaviour. Acne severity was by graded by visual facial examination using an adaptation of the Leeds Acne Grading Technique.
  
  
  RESULTS
  There was a prevalence of acne in 50% of the study sample, with 11% of participants having moderate to severe acne (> 20 inflammatory lesions). Participants with definite acne (12+ lesions) (P < 0.01) and girls (P < 0.05) had higher levels of emotional and behavioural difficulties. Participants with acne were nearly twice as likely as those without acne to score in the abnormal/borderline range of the SDQ (32% vs. 20%; odds ratio 1.86, 95% confidence interval 1.03-3.34). Knowledge about the causes of acne was low (mean 45%), and was unrelated to acne status. Fewer than a third of participants with definite acne had sought help from a doctor.
  
  
  CONCLUSIONS
  Acne is a common disorder in English adolescents and appears to have a considerable impact on emotional health in this age group. Low levels of acne knowledge and poor acne management are concerns that could be amenable to a school-based education programme.
authors.affiliation: Behavioural Sciences Section, Division of Psychiatry, A Floor, Queens Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Smithard
authors.forename: C
authors.initials: C
authors.lastname: Glazebrook
authors.forename: H C
authors.initials: HC
authors.lastname: Williams
mesh_terms: D000152:Acne Vulgaris / Q000453:epidemiology* / Q000523:psychology; D000275:Adjustment Disorders / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011581:Psychological Tests; D000297:Psychology, Adolescent; D012720:Severity of Illness Index; D012737:Sex Factors