| Background and Purpose:Acne is a chronic inflammatory disease of pilosebaceous unit,its psychological and social impact on teenagers is greater than asthma and epilepsy because of the appearance damage.People with acne tend to be associated with anxiety and depression and the severe patients may cause suicidal behavior.Therefore,the psychological status and treatment of acne patients are increasingly valued by dermatologists.However,the current research is confined to analysis of affecting factors.There is no guiding significance to the objective evaluation index and psychosomatic combination therapy method.This study intends to explore the risk factors for depression in acne patients,to seek objective evaluation indicators for depression in acne patients.It aims at the weak link in the treatment of non-psychiatric psychosomatic in comprehensive hospitals to explore the psychosomatic treatment strategies of acne patients with depression in integrated medical mocde.Methods:This study was divided into two parts.(1)Analysis of risk factors in patients with acne and depression:233 patients with acne that met the conditions were taked into from September 2015 to December 2015,In addition,100 volunteers without acne were recruited at the hospital physical examination center and from nearby colleges and communities during the same period in the recruitment of acne,except for acne,the rest of the exclusion criteria were the same as the acne group.The selected participants were surveyed by trained investigators in accordance with the predetermined implementation.The questionnaire including:?Patients general condition questionnaire(self-command)(content of the patient's gender and age,length of the disease,family economic conditions,food preferences,skin conditions,etc.);?GAD-7 Scale;?PHQ-9 scale.?Qol-A scale.The classification and assessment of acne were performed by the dermatologist or above who specializes in the department of dermatology according to GAGS's scoring system.The exclusion of depression and anxiety in the study subjects was excluded by the psychiatrists or above according to the DSM-IV diagnostic criteria.ELISA(Enzyme-linked immunosorbent assay)was used for the detection of testosterone,estrogen,BDNF,serum IL-6 and TNF-a in all subjects.(2)Effects of Psychological Intervention Combined with Traditional Medicine on Efficacy and Depressive Emotion of Patients with Acne Depression:Cases have been screened by the dermatologist who specializes in the department of dermatology according to the diagnostic criteria of acne and exclusion.The selected patients were randomly divided into 2 groups,the observation group and the control group,40 cases in each group.Grading and symptom scores were implemented according to their condition.The tools required include:?Diagnostic criteria for acne.Diagnostic criteria for Chinese acne treatment guidelines(revised in 2014);?The scoring system of acne GAGS.Besides,a questionnaire survey was conducted among the selected participants by trained investigators in accordance with the predetermined implementation plan.The tools used include:?Patient general condition questionnaire(homemade)(content of the patient's gender and age,length of the course of the disease,family economic conditions,food preferences,skin conditions,etc.);?PHQ-9 scale;?Qol-A scale.Depression and anxiety disorders are eliminated with the help of psychiatrists or above.And complete data entry.According to the results of part 1,the treatment plan was formulated:The oral medication in the control group included 2 times a day,a 0.25g each time Erythromycin Enteric-coated Capsules,and 3 times a day and a 20mg of spironolactone after 2 weeks of continuous withdrawal.In addition,the isovitamin A of 20mg,1 time a day.The acne was given with adapalene gel for external one time for each night,12 weeks in a row,combined with warm water for face-rinsing;avoiding spicy,oily or sweet food,sleeping before 11:30 every night.The observation group:On the basis of the control group,psychological education + group psychotherapy was added to 4 times + individual cognitive behavioral therapy.Doctors who were in charge of psychiatry or above should make plans and train related personnel according to the results of investigate.Both groups were treated for 12 weeks.After 12 weeks,the differences between the two groups were analyzed with acne symptoms,depression scores and quality of life scores.The serum BDNF and IL-6 were detected and the effect was observed.(3)Statistical method:The percentage of the use of classified variables was described according to the analysis of different variables.The mean and standard deviation were used to describe the continuous variables in the normal distribution and the median and quartile intervals(medians,IQR)were used to describe not conform to normal distribution.The difference between the two groups of components was used in Chi square test.The comparison between the two groups was based on the single factor ANVOA variance analysis.The two groups of continuous variables were compared with t test(normal distribution)or the Mann-Whitney U rank sum test(not conform to normal distribution),and the correlation test of the two continuity variables had employed Spearman rank correlation.The logistic regression model was used to study the risk factors for depression in acne patients.Results:(1)A total of 233 acne patients were included in the observation group,among these 160 patients suffered from depression,accounting for 68.67%,of which 44 cases were moderate to severe depression,accounting for 18.89%.100 healthy people without acne were included in the control group,of which 35 cases had mild depression,accounting for 35%,4 cases with moderate to severe depression,accounting for 4%.The PHQ-9 score of acne patients with depression was significantly higher than acne patients without depression mood,volunteers without acne but with depression and healthy controls without acne and depression(F=127.81,P<0.05).Serum BDNF of Acne patients with depression mood were lower than Acne patients without depression mood,volunteers without acne but with depression and healthy controls without acne and depression(F=3.58,P all<0.05).Serum IL-6 of Acne patients with depression mood were lower than Acne patients without depression mood and healthy controls without acne and depression(F=2.28,P<0.05).There was no significant difference in serum TNF-?,testosterone and serum estrogen in three groups(P>0.05).The factors related to depression of acne were selected through Mann-Whitney U test and Spearman correlation analysis.On this basis,binary logistic regression analysis was used.The results showed that the risk factors for depression in acne patients of male included:family history(OR=9.52),be tired of treatment(OR =5.00)and influence interaction with the opposite sex(OR=43.03)(P all<0.05).The risk factors for depression in acne patients of female included:the long course of illness(OR=2.74),sense of constraints(OR=6.20),fear of bad mental status(OR=7.87),fear of ineffective drugs(OR=3.34)and affecting regular interactions(OR=2.37)(P all<0.05).The common risk factors for depression in acne patients both male and female included:insomnia(OR male/female 49.58/2.19),often feels bored(OR male/female 13.40/4.73),dissatisfied of disfiguration(OR male/female 7.25/0.16)(P all<0.05).In addition,PHQ-9 score of acne patients with depression was negatively correlated with serum BDNF(r=0.16,P<0.05)and was positively correlated with serum IL-6(r=0.22,P<0.05).(2)The treatment results showed that:the cure rate in the observation group(87.50%)was higher than that in the control group(67.5%)(x2=4.59,P<0.05).The clinical GSGA score and PHQ-9scoreof observation group were lower,Qol-A score of observation group washigher than that of the control group(t=-2.36,-3.29,3.46,P<0.05),and serum BDNF in the observation group was higher than that in the control group(t=2.04,P<0.05).Both groups of patients suffered from dry mouth side effects during treatment,but the symptom had improved by giving more water and smearing lipstick.4 patients in the observation group experienced stomach discomfort and pain after taking the drug,3 patients in the control group also experienced similar.However,it is recommended that the symptoms would disappear after taking erythromycin enteric-coated capsules after meals.No patients had showed elevated blood lipids and electrolyte imbalance during the treatment.Conclusion(1)Frequently feelings of upset,dissatisfaction with facial discomfort and spending time on treatment boredom are prone to cause depression in both male and female acne patients.The risk factors for depression in male acne patients also include family history,severity illness,influence of coexistence with the opposite sex.The risk factors for depression in female acne patients also includelower age,duration of illness,family history,greasy food,oily skin condition,constant restraint,fear of bad mental state,worrying about the drug efficacy,and the impact on daily social activities.Low levels of serum BDNF and high levels of IL-6 are also risk factors for depression in acne patients.(2)The use of conventional therapy combined with mental health education+group psychotherapy+individualized cognitive behavioral therapy can improve the compliance of patients with acne and depression,improve the efficacy and quality of life,and is worthy of clinical promotion. |
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