The correlation between academic stress, sleep quality, and acne severity: a longitudinal cohort study
Main Article Content
Abstract
Objective: To evaluate the relationship between acne severity, sleep quality, and stress levels in undergraduate students and to create a predictive model for acne severity.
Methods: This longitudinal cohort study was conducted at Isra University Hyderabad on 150 acne-prone undergraduate students. The Perceived Stress Scale, Sleep Quality Scale, and Comprehensive Acne Severity Scale were used for data collection during the non-examination and examination periods, respectively.
Results: The mean age of the study participants was 20.08±1.42 years. A statistically significant rise was observed in perceived stress (p<0.01), sleep quality (p<0.01), and acne severity (p<0.01) during the examination period. A statistically significant association of acne severity was observed with male gender (X2-9.51, p<0.05). A significant positive correlation of acne severity was observed with perceived stress (r=0.95, P<0.01) and sleep quality (r=0.95, P<0.01). Among predictors of acne severity, age (p<0.05), stress score (p<0.05), and sleep score (p<0.05) were found to be significant predictors whereas BMI was found to be non-significant (p>0.05).
Conclusion: Acne is correlated with higher stress levels and poor sleep quality. Young age, high stress, and poor sleep are significant predictors of acne severity. This makes acne breakouts common among students, particularly during periods of examinations.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
Work published in KMUJ is licensed under a
Creative Commons Attribution 4.0 License
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
1. Syed M, Saleem MA, Yousafzai AW. Psychological morbidity and self-esteem in patients of acne vulgaris: data from a tertiary care hospital in Pakistan. Khyber Med Univ J 2020;12(1):34-7. https://doi.org/10.35845/kmuj.2020.19121
2. Zaenglein AL. Acne Vulgaris. New Eng J Med 2018;379(14):1343-52. https://doi.org/10.1056/NEJMcp1702493
3. Mian M, Silfvast-Kaiser A, Paek S, Kivelevitch D, Menter A. A review of the most common dermatologic conditions and their debilitating psychosocial impacts. Int Arch Intern Med 2019;3:18. https://doi.org/10.23937/2643-4466%2F1710018
4. Layton A, Thiboutot D, Tan J. Reviewing the global burden of acne: how could we improve care to reduce the burden? Br J Dermatol 2021;184(2):219-25. https://doi.org/10.1111/bjd.19477
5. Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep 2020;10(1):5754. https://doi.org/10.1038/s41598-020-62715-3
6. Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: a review. JAMA 2021;326(20):2055-67. https://doi.org/10.1001/jama.2021.17633
7. Cortés H, Rojas‐Márquez M, Del Prado‐Audelo ML, Reyes‐Hernández OD, González‐Del Carmen M, Leyva‐Gómez G. Alterations in mental health and quality of life in patients with skin disorders: a narrative review. Int J Dermatol 2022;61(7):783-91. https://doi.org/10.1111/ijd.15852
8. Hammill C, Vaillancourt T. Acne and its association with internalizing problems. Dermatol Rev 2023;4(5):228-38. https://doi.org/10.1002/der2.181
9. Stamu-O'Brien C, Jafferany M, Carniciu S, Abdelmaksoud A. Psychodermatology of acne: Psychological aspects and effects of acne vulgaris. J Cosmetic Dermatol 2021;20(4):1080-3. https://doi.org/10.1111/jocd.13765
10. Yang J, Yang H, Xu A, He L. A review of advancement on influencing factors of acne: an emphasis on environment characteristics. Front Public Health 2020;8:450. https://doi.org/10.3389/fpubh.2020.00450
11. Mohiuddin A. Acne protection: measures and miseries. Dermatol Clin Res 2019;5(1):272-311.
12. Borrel V, Thomas P, Catovic C, Racine P-J, Konto-Ghiorghi Y, Lefeuvre L, et al. Acne and stress: impact of catecholamines on cutibacterium acnes. Front Med 2019;6:155. https://doi.org/10.3389/fmed.2019.00155
13. Jović A, Marinović B, Kostović K, Čeović R, Basta-Juzbašić A, Bukvić Mokos Z. The impact of psychological stress on acne. Acta Dermatovenerologica Croatica 2017;25(2):1133-44.
14. Jusuf NK, Putra IB, Sutrisno AR. Correlation between stress scale and serum Substance P level in acne vulgaris. Int J Gen Med 2021;14:681-6. https://doi.org/10.2147/IJGM.S294509
15. Saric-Bosanac S, Clark AK, Sivamani RK, Shi VY. The role of hypothalamus-pituitary-adrenal (HPA)-like axis in inflammatory pilosebaceous disorders. Dermatol Online J 2020;26(2). https://doi.org/10.5070/D3262047430
16. Clayton RW, Langan EA, Ansell DM, de Vos IJ, Göbel K, Schneider MR, et al. Neuroendocrinology and neurobiology of sebaceous glands. Biol Rev 2020;95(3):592-624. https://doi.org/10.1111/brv.12579
17. Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Invest Dermatol 2017;10:503-6. https://doi.org/10.2147/CCID.S148499
18. Schrom KP, Ahsanuddin S, Baechtold M, Tripathi R, Ramser A, Baron E. Acne severity and sleep quality in adults. Clock Sleep 2019;1(4):510-6. https://doi.org/10.3390/clockssleep1040039
19. Dressle RJ, Feige B, Spiegelhalder K, Schmucker C, Benz F, Mey NC, et al. HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case–control studies. Sleep Med Rev 2022;62:101588. https://doi.org/10.1016/j.smrv.2022.101588
20. Lo Martire V, Caruso D, Palagini L, Zoccoli G, Bastianini S. Stress & sleep: A relationship lasting a lifetime. Neurosci Biobehav Rev 2020;117:65-77. https://doi.org/10.1016/j.neubiorev.2019.08.024
21. Farage MA. Psychological aspects of sensitive skin: a vicious cycle. Cosmetics 2022;9(4):78. https://doi.org/10.3390/cosmetics9040078
22. Aziz F, Khan MF. Association of academic stress, acne symptoms and other physical symptoms in medical students of King Khalid University. Int J Environment Res Public Health 2022;19(14):8725. https://doi.org/10.3390/ijerph19148725
23. Babar O, Mobeen A. Prevalence and psychological impact of acne vulgaris in female undergraduate medical students of Rawalpindi and Islamabad, Pakistan. Cureus 2019;11(9):e5722. https://doi.org/10.7759/cureus.5722
24. Natsuaki MN, Yates TM. Adolescent acne and disparities in mental health. Child Dev Perspect 2021;15(1):37-43. https://doi.org/10.1111/cdep.12397
25. Alotaibi AD, Alosaimi FM, Alajlan AA, Bin Abdulrahman KA. The relationship between sleep quality, stress, and academic performance among medical students. J Family Community Med 2020;27(1):23-8. https://doi.org/10.4103/jfcm.JFCM_132_19
26. Jaber RM, Alnshash BM, Mousa SN, Fayoumi HS, Al-Qaderi LM, Zant AM. The epidemiology of acne vulgaris among adolescents and young adults in Jordan University Hospital. Open J Nurs 2020;10(4):353-66. https://doi.org/10.4236/ojn.2020.104024
27. Lim TH, Badaruddin NSF, Foo SY, Bujang MA, Muniandy P. Prevalence and psychosocial impact of acne vulgaris among high school and university students in Sarawak, Malaysia. Med J Malaysia 2022;77(4):446-53.
28. Branisteanu DE, Toader MP, Porumb EA, Serban IL, Pinzariu AC, Branisteanu CI, et al. Adult female acne: clinical and therapeutic particularities (Review). Exp Ther Med 2022;23(2):151. https://doi.org/10.3892/etm.2021.11074
29. Dréno B, Shourick J, Kérob D, Bouloc A, Taieb C. The role of exposome in acne: results from an international patient survey. J Eur Acad Dermatol Venereol 2020;34(5):1057-64. https://doi.org/10.1111/jdv.16119
30. El Haddad C, Gerbaka N-E, Hallit S, Tabet C. Association between exposure to ambient air pollution and occurrence of inflammatory acne in the adult population. BMC Public Health 2021;21(1):1664. https://doi.org/10.1186/s12889-021-11738-0
31. Bedoyan NH, Al-Yassen AQ. The relationship between body mass index and acne vulgaris–a comparative study. Med J Basrah Univ 2022;40(2):143-50. http://dx.doi.org/10.33762/mjbu.2023.141016.1140
32. Chaudhary S, Ameer A, Sarwar MZ, Naqi SA, Butt AI. A cross-sectional study of body mass index and sleep quality as risk factors to severity of acne. J Pak Med Assoc 2021;71(9):2148-50. https://doi.org/10.47391/JPMA.404
33. Basfar AS, Jawhari AM, Alotaibi MN, Alzahrani ES, Aseeri IA, Atalla AA. Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia. J Fam Community Med 2023;30(2):131-6. https://doi.org/10.4103/jfcm.jfcm_396_22
34. Ibrahim NK, Nagadi SA, Idrees HJ, Alghanemi LG, Essa RI, Gari WS. Acne vulgaris: prevalence, predictors, and factors influencing quality of life of female medical students at King Abdulaziz University, Jeddah. J Dermatol Dermatol Surg 2019;23(1):7-12. https://doi.org/10.4103/jdds.jdds_39_18
35. Zhu J, Peng K, Zhang Y, Bai X, Zhong C, Ye J, et al. Sleep quality, circadian preferences, and mood among patients with acne vulgaris: a case–control study. Sleep Breath 2023;27(5):1997-2003. https://doi.org/10.1007/s11325-023-02777-5
36. Wolkenstein P, Machovcová A, Szepietowski JC, Tennstedt D, Veraldi S, Delarue A. Acne prevalence and associations with lifestyle: a cross‐sectional online survey of adolescents/young adults in 7 European countries. J Eur Acad Dermatol Venereol 2018;32(2):298-306. https://doi.org/10.1111/jdv.14475
37. Sachdeva M, Tan J, Lim J, Kim M, Nadeem I, Bismil R. The prevalence, risk factors, and psychosocial impacts of acne vulgaris in medical students: a literature review. Int J Dermatol 2021;60(7):792-8. https://doi.org/10.1111/ijd.15280