ORIGINAL CONTRIBUTION Oxidative stress and psychiatric morbidity in patients with facial acne Sara M. Awad MD 1 | Hanan Morsy MD 1 | Ayat A. Sayed PhD 2 | Nahed A. Mohamed PhD 2 | Ghada M. Ezzat PhD 2 | Mostafa M. Noaman MD 3 1 Faculty of Medicine, Department of Dermatology and Venereology, Assiut University, Assiut, Egypt 2 Faculty of Medicine, Department of Medical Biochemistry, Assiut University, Assiut, Egypt 3 Faculty of Medicine, Department of Neuropsychiatry, Assiut University, Assiut, Egypt Correspondence Sara M. Awad, Department of Dermatology and Venereology, Assiut University Hospital, Assiut, Egypt. Email: saramawad@gmail.com Summary Background: Acne vulgaris is a common cosmetic problem that is frequently associ- ated with psychosocial disturbances as well as increased oxidative stress. However, oxidative stress and psychological aspects have been studied separately in acne. Objective: To evaluate the relationships between oxidative stress, anxiety, depres- sion, and quality of life in acne patients. Methods: Sixty patients with facial acne and 40 age- and sex-matched healthy indi- viduals were included in the study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) was mea- sured by the Cardiff Acne Disability Index. Disease severity was assessed using the Combined Acne Severity Classification. The serum levels of zinc and malondialde- hyde (MDA) and total antioxidant capacity (TAC) were measured in patients and healthy subjects. Results: The mean HADS scores for anxiety and depression were higher in patients than controls (P<.001 for both). Acne patients showed higher serum MDA and lower TAC and serum zinc levels compared with control subjects (P=.019, P<.001, and P=.028, respectively). Anxiety and depression scores did not correlate with oxidative stress parameters. Patients with moderate/severe acne had worse anxiety scores than mild acne (P=.048), and higher anxiety scores were associated with poorer quality of life (r=.436, P=.001). Conclusion: Our results indicate that the high levels of anxiety and depression in patients with facial acne were not related to oxidative stress. Anxiety was more common than depression and was directly related to QoL impairment. KEYWORDS acne vulgaris, anxiety, depression, oxidative stress 1 | INTRODUCTION Acne vulgaris is one of the most common skin diseases affecting mil- lions of patients worldwide. Although not life-threatening, it can lead to significant cosmetic disfigurement. In addition, acne vulgaris is fre- quently associated with impaired quality of life and psychiatric prob- lems, such as depression and anxiety. Higher levels of depression and anxiety have been observed in acne than in general population. There might be common pathophysiologic factors that promote the development of acne and increase the risk of depression and anxiety in acne patients. 1,2 Oxidative stress as shown by increased reactive oxygen species (ROS) and impaired antioxidant system has been suggested to play a role in the pathogenesis of acne vulgaris. 3 Importantly, lipid peroxidation has been considered a match that lights an inflammatory cascade in acne. 4 It has been established that Accepted: 22 May 2017 DOI: 10.1111/jocd.12366 J Cosmet Dermatol. 2017;1–6. wileyonlinelibrary.com/journal/jocd © 2017 Wiley Periodicals, Inc. | 1