Effect of Acne Vulgaris on Quality of Life of Teenagers Compared to Parent Perceived Effect on Quality of Life
Condition: Acne; Quality of Life
MeSH terms: Acne Vulgaris
Study type: Observational

Summary: 
      Acne vulgaris is a common problem in the adolescent community. Past research has shown that
      acne affects teenager's self-esteem and mood. However, no research has evaluated the parent
      perception of their teenager's acne in comparison to the severity of acne and the patient's
      own reported quality of life. It is hypothesized that parents of teenagers underestimate how
      much acne vulgaris affects their teenager's skin disease-related quality of life. Also that
      teenager's perception of the severity of their acne is greater versus their parent's
      perception. We believe that increased acne severity based on clinician assessment will
      correlate with worse quality of life. Teenagers between 12 and 17 years old with a diagnosis
      of acne by a pediatric dermatologist will be enrolled in this study. The study consists of 1
      visit, questions regarding demographics, assessment of the teen's acne, the Skindex-Teen
      quality of life survey (modified for parents), and 2 Likert scales will be completed. In
      addition, the clinician will score the teen's acne using the standardized Investigator Global
      Assessment tool. Statistical analysis will compare teen subject answers to the Skindex-Teen
      with their parent's answers. Also analyzed will be the severity of acne and differences
      between the clinician IGA score and Skindex-Teen responses
    

Detailed description: 
      Acne vulgaris is a prevalent problem in the adolescent community, with the literature citing
      prevalence between 35 to 90% at some stage and some studies showing the prevalence of
      comedonal acne approaching 100%. Mean age of onset of acne in girls is 11 years and in boys
      is 12 years. We know that being afflicted with acne places a significant burden on the life
      of a teenager, and studies have shown diminished quality of life and increased presence of
      depressive symptoms in teens with acne. Dalgard et al looked at effects of moderate and
      severe acne on self-esteem and body satisfaction in adolescents. In their study, girls with
      acne reported significantly higher levels of depressive symptoms, greater feelings of
      uselessness, and lower self-attitude, sense of pride, self-worth, and body satisfaction
      compared to girls without acne; a similar tendency was observed in boys. Halvorsen et al
      performed a cross-sectional questionnaire-based study to evaluate psychological effects of
      acne in adolescents aged 18-19 years old. They found that in the 14% of participants who had
      substantial acne- defined as self reported a lot or very much acne, suicidal ideation was
      twice as frequently reported in girls and three times more frequently reported in boys
      compared to subjects of either gender with no or a little acne per patient self report.
      Suicidal ideation was significantly associated with substantial acne with an odds ratio of
      1.80. To our knowledge, there has been no research that evaluates parent perception of their
      teenager's acne in comparison to clinical data points such as investigator global assessment
      or patient-reported quality of life. Nor have there been data comparing investigator global
      assessment of acne with patient-reported Likert scale of acne severity. Magin et al looked at
      108 patients, of whom 41 had acne and assessed difference in clinician evaluation of acne
      severity (using the Leeds method as an indicator of severity) compared to patient assessment
      of acne. They found a moderately poor agreement between objective clinician assessment and
      patient self-assessment of acne severity (weighted kappa 0.35, with 95% CI 0.1981 - 0.5084).
      There have been studies as well showing that patients with acne often underestimate the
      severity of their acne. Smithard A et al studied 317 students aged 14-16 and found that
      students tended to underestimate their acne severity, with only 66% of patients with mild
      acne via Leeds scoring self-determining that they had acne. Demircay et al looked at
      physician's assessment of acne severity, by means of Global Acne Grading System (GAGS)
      scoring of 0 as none, 1-18 as mild, 19-30 as moderate and > 31 as severe acne. Patient's
      assessment of acne severity used a 10-point Likert-type scale. Patients were asked how severe
      their acne was, and 0 denoted "no acne" and 9 denoted "most severe acne that can be
      imagined". Results of the Likert-type scale were analyzed in four groups: 0 = none, 1-3 =
      mild, 4-6 = moderate, 7-9 = severe. No correlation was found between physician GAGS scores
      and any of the patients' own assessments. Smidt et al developed and validated a quality of
      life index for adolescents with skin disease, using the adult-oriented Skindex and Skindex-16
      instruments as models. Skindex-Teen is a 21-item questionnaire, self-administered by the
      patient and generally is able to be completed in 5 to 10 minutes. The instrument inquires
      about the patient's perceptions of his/her primary skin condition during the previous 4
      weeks. Standardized responses consist of 4-category choices relating to frequency with 0
      being never and 4 being all the time. Analysis demonstrated that the refined Skindex-Teen was
      a valid and effective way of measuring the effects of skin disease in adolescents. A Likert
      scale is a type of psychometric scale frequently used in psychology questionnaires. On a
      questionnaire, a Likert scale asks subjects to circle, check or mark the number that most
      closely correlates to their feelings on a scale.

      We speculate that parents of teenagers underestimate how much acne vulgaris affects their
      teenager's skin disease-related quality of life. By having both the teenage patient and
      his/her parent independently complete the Skindex-Teen questionnaire at the same time point,
      we will be able to assess potential differences in how teenagers perceive their acne and how
      their parents perceive the impact of the teen's acne on quality of life and correlate this
      with clinical acne severity.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Subjects will be recruited from the pediatric dermatology clinic at Ann and Robert H. Lurie
        Children's Hospital of Chicago. Teenagers must be between 12 and 17 years old, and have a
        diagnosis of acne by a pediatric dermatologist.