Shame-fused acne: A biopsychosocial conceptualisation and treatment rationale
Acne is a polymorphic skin disease that tends to be evident on the face (99%) and to a lesser degree the back (60%) and chest (15%). Biological models of acne point to the increased metabolism of androgens in the dermis, in combination with sebaceous gland sensitivity to androgens creating varying degrees of comedones, papules and pustules (‘spots’; Cunliﬀe & Simpson, 1998). The most common form of acne is that of acne vulgaris. This form of acne usually starts in adolescence and frequently resolves by the mid-twenties (Burton, Cunliﬀe & Staﬀord, 1971). Epidemiological research indicates that some degree of acne aﬀects 95% and 83% of 16-year-old girls and boys, respectively (Burton, Cunliﬀe & Staﬀord, 1971). In about 20% of cases, the disease necessitates contact with health services (Munroe-Ashman, 1963). Research indicates an increase in the number of people suﬀering from acne in the adult years. Cunliﬀe and Gould (1997) illustrated that 25% of patients attending a dermatology clinic with acne had an average age of 34 years. There are a number of less common but more severe variants of acne: acne conglobata, acne fulminans and gram-negative folliculitis. These forms of acne are associated with gross disruption of the skin and risk of extensive scarring (Cunliﬀe & Simpson, 1998).