Acne anxiety extends to the sports field

“People who suffer from acne are less likely to take exercise or excel at physical games”, Channel 4 news reported today. A study of people from a national acne support group has found that people with acne tend to avoid participating in sports due to anxiety and self-consciousness about their skin.

The psychological effects of skin conditions such as acne should not be underestimated. This finding may be unexpected, but it is plausible considering that those with acne may try to shy away from situations in which they feel their skin will be open to evaluation by others. However, the study is limited by its small size, the age of the participants and its design, which cannot prove that it is the acne that is causing a withdrawal from physical sports. The effects of acne, as with other skin conditions, are very personal to the individual. Those with the condition should be supported with care appropriate to their needs.

Where did the story come from?

Tom Loney and colleagues from the University of Bath carried out the research. No sources of funding were reported. The study was published in the Journal of Health Psychology, a peer-reviewed medical journal.

What kind of scientific study was this?

In this cross-sectional study, information was obtained from acne sufferers and assessed to examine the links between the anxiety of having their skin evaluated by others, their intention to participate in physical sports and their general self-esteem.

The researchers sent questionnaires by post or email to 50 individuals from a national acne dermatological support group (20 males and 30 females with an average age of 33). The questionnaires asked the participants to rate their acne as mild, moderate or severe. They then completed another four assessments that rated different psychological aspects. These included: the dermatological social anxiety (DSA) scale, which assessed their apprehension at having their skin evaluated in social settings; a scale that assessed their intention to participate in sport or exercise; a scale that measured their self-esteem; and the dermatology life quality index, which measured their assessment of the effects that skin disease has on activities and social relationships.

The researchers then used statistical methods to explore relationships between the severity of acne and the other variables assessed. They also looked at the differences between males and females.

What were the results of the study?

The researchers found that acne severity was related to the participants’ level of self-esteem, intention to participate in physical exercise and dermatological quality of life. When the researchers looked at how acne severity was related to DSA level, they found that the level of anxiety was in turn having an effect on the other three measures (e.g., increased severity meant greater social anxiety and therefore less intention to participate in physical sports). There was no difference between responses in males and females.

What interpretations did the researchers draw from these results?

The authors suggest that the extent to which a person with acne is concerned about having their skin evaluated by others has implications for their self-esteem, quality of life and intention to participate in physical sports.

What does the NHS Knowledge Service make of this study?

The psychological effects of skin conditions such as acne should not be underestimated, and although these findings may be unexpected, they are plausible. However, this study has important limitations that restrict the conclusions that can be drawn from it:

• The study is small and only looked at 50 people, therefore the findings cannot easily be generalised to wider populations. The participants are members of a national acne support group with an average age of 33. Compared with a typical adolescent acne sufferer, there may be differences in the extent of their social anxiety about their skin and in their participation in sports or exercise. For example, a school pupil may be more likely to take part in outdoor team sports on a regular basis. Similarly, a person who has joined an acne support group may be more consciously affected by their skin than those who have not.
• The study has a cross-sectional design. This type of design can only examine people at one point in time and cannot prove that one factor causes another. This is particularly applicable to this study. Only a few variables have been assessed, so it cannot be proven that it is the severity of acne or degree of self-esteem that is causing the withdrawal from sports participation.
• The participants were not given a direct clinical assessment by the study’s authors, but were assessed by mailed questionnaire. Self-reporting is likely to lead to considerable variation in responses between the participants and one person’s rating of acne severity may differ to another’s. Similarly, shyness and social anxiety are views that are personal to the individual. However, the authors justify their use of this method by saying, “a patient’s own rating of their disease is more important than physician-reported severity”.
• The study also did not consider how long the participants had had acne, their type of acne, and whether they were using acne treatments at the time of the study and had previous experience with acne treatments. All of these things may have an effect on how an individual views their skin.

Despite its limitations, the study does highlight that people with acne should be supported in whatever way is necessary to enable them to lead as normal and fulfilled a life as possible.

Sir Muir Gray adds...

The psychological effects of skin disease are always underestimated, except by those people who suffer from it.