Influential Factors of Depression in Patients with Moderate and Severe Acne.

Acne is one of the most common skin diseases and is frequently associated with depression, social isolation, and suicidal ideation. Some studies have investigated the link of either acne or depression and serum levels of vitamin B12 and folic acid (FA), but none appear to have examined the effect of these vitamins on acne patients with or without depression. This case-control study sought to assess whether serum levels of vitamin B12 and FA could be considered possible predictors for depression and acne severity in patients with moderate and severe acne. Forty patients with acne and 40 age- and sex-matched healthy volunteers were enrolled. Acne severity and depression were assessed according to the Global Acne Grading System (GAGS) and the Arabic version of the Beck Depression Inventory II (BDI-II), respectively. Five milliliters of blood was obtained by clean venipuncture to determine B12 and FA levels by way of double-antibody sandwich enzyme-linked immunosorbent assay. According to GAGS score, moderate acne was the most prominent form of the condition (55%), followed by severe (25%) and very severe (20%). Seventy percent of patients with acne had depression according to BDI-II score versus zero percent in the control group (<0.001). Patients with moderate and severe acne in this study had significantly lower serum levels of vitamin B12 and FA when compared to controls (=0.012 and <0.001) and their levels showed a significant negative correlation with acne severity according to GAGS score. Screening for vitamin B12 and FA deficiency can be particularly relevant in patients with acne to assess depression risk. Folate supplementation should be considered for patients with acne and comorbid depression.