Depression and anxiety in visible skin diseases affecting the hands and face: a systematic literature review

Visible skin diseases affecting the face and hands-crucial for non-verbal communication and social interaction-can deeply impact psychological well-being. Beyond physical symptoms, their visibility often affects self-esteem and social functioning, contributing to high rates of depression and anxiety. While facial dermatoses have been extensively studied, few investigations have explored the psychological impact of visible localization in other dermatoses.

To estimate the prevalence of depression and anxiety in patients with visible skin diseases, identify associated factors, and better understand their psychological impact.

Following PRISMA guidelines, a systematic search of Medline and Embase was conducted to identify studies assessing depression and/or anxiety in visible skin diseases. A random-effects meta-analysis using Freeman-Tukey transformation estimated pooled prevalences. A qualitative synthesis explored associated factors, quality of life, and suicidal ideation.

Of 6689 articles screened, 41 were included (12,372 patients), mainly with vitiligo, acne, alopecia areata, and rosacea. Thirty-eight studies assessed depression, 32 assessed anxiety, primarily using the Hospital Anxiety and Depression Scale (HADS). Pooled prevalence was 38.0% [95% confidence interval (CI): 31.1-45.2] for depression and 43.6% [36.3-51.1] for anxiety, with high heterogeneity (I² > 97%). Most comparative studies found higher rates versus controls. Associations with disease severity or demographic factors were inconsistent. Over half of the studies reported moderate to severe impairment in quality of life, correlated with anxiety and depressive symptoms. Suicidal ideation ranged from 5.8 to 23.3%.

Visible skin diseases are associated with high rates of depression and anxiety, supporting integrated dermatological and psychiatric care. Future research should clarify causal mechanisms and promote psychodermatology centers to improve outcomes for these vulnerable patients.