Zainab Ansari, Moizza Tahir, Ali Bin Waqar, Huda Kazim, Moiz Majeed Khan, Fatima Hasnat, Zarmeen Khawer, Irfan Ahmed.
Correlation of stress and self-esteem with acne in undergraduate medical students: Multi-center cross-sectional study.
J Pak Assoc Derma Jun ;33(2):484-8.

Objectives: To correlate stress and self-esteem in undergraduate medical students with acne. Study Design: Multicenter cross- sectional study Place and Duration of Study: Medical Students from Army Medical College, Rawalpindi, CMH Lahore Medical College, Rawalpindi Medical University, Sargodha Medical College and Karachi Institute of Medical Sciences were enrolled, for a duration of six months, from November 2021 to May 2022. Method: The study was conducted on 136 medical students fulfilling inclusion and exclusion criteria by non-probability, consecutive sampling technique. Self-esteem was analyzed by validated tool of Rosenberg Self-esteem scale (RSES), Acne disability was measured by Cardiff Acne Disability Index (CADI) and Stress levels were determined by Self Perceived stress scale (PSS-4). Data was analyzed by SPSS-25. Result:  Total of 136 medical students participated in the study. There were 80 (58.8%) females and 56 (41.2%) males. The mean age was 20.2 ± 1.57 years. Fifty-Five students presented with mild acne, 36 with moderate and 45 with severe acne. The mean Cardiff Acne Disability Index score was 5.76 ± 2.593, range 0-12). Seventy-six students (55.07%) had a low, 50 (36.2%) had medium and 10 (7.24%) had high disability index to Acne Vulgaris (AV). Mean Rosenberg self-esteem scale was 10.01 ±3.211 (range 0–27). Stress level secondary to acne was recorded as high in 32.1% of the medical students, moderate in 36.2% and low in 28.3%. Perceived stress scale (PSS)-4 in undergraduates had Mean PSS score of 7.3456 (±2.8854, Range 0-16). There was significant (p<0.007) association between Cardiff acne disability index and perceived stress scale among medical students. Cardiff acne disability index is significantly associated with self-esteem (p<0.001). Conclusion: Rosenberg self -esteem scale and Cardiff Acne Disability Index demonstrated significant correlation between stress and acne and its impact on self -esteem levels. Health Care givers need to recognize effect of acne on self- esteem while devising management strategies and counseling sessions.

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