1

Chapter I

INTRODUCTION

Background of the Study

We all experience problems with self-esteem at certain times in our lives especially during our teens when we're figuring out who we are and where we fit in the world. One of the factors that affect the self-esteem of teenagers these days is how they look when they face the mirror

(Fulton, 2002). The great majority of people will probably experience the inconvenience and embarrassment of having a pimple or two at some time in their lives. A small but significant minority, however, will by experience a the severe case agony of and the

wretchedness dermatological 2002). Acne

caused

full-blown acne

condition

called

vulgaris

(Fulton,

vulgaris

is

common

follicular

disorder

affecting susceptible hair follicles, most commonly found on the face, neck, and upper trunk. It is characterized by comedones (ie, primary acne lesions), both closed and open,

and by papules, pustules, nodules, and cysts. Acne is the most commonly encountered skin condition in adolescents and young adults between ages 12 and 35. Both genders are

affected equally, although onset is slightly earlier for girls. This may be because girls reach puberty at a younger age than boys. Acne becomes more marked at puberty during adolescence the because of the the endocrine sebaceous glands glands and that are

influence

secretions

functioning at peak activity. Acne appears to stem from interplay of genetic, hormonal, and bacterial factors. In most cases, there is a family history of acne (Brunner and Suddarth, 2004). According to Canadian Dermatology Association, acne

affects about 90% of adolescents and 20-30% of adults aged 20 to 40 years globally. In the by Philippines, is the

extrapolated

population

affected

acne

86,241,697

based on US Census Bureau, International Data Base, 2004. Acne 100% of prevalence the entire statistics population guide reveal is affected that with almost this

disease. It is considered as one of the most widespread skin diseases in the United States. This skin condition develops prevalently in puberty and until the early 20's Statistically, 85% of teenagers are likely to suffer from

acne outbreaks between the ages 12 to 24. The American Dermatologists Association stated that a maximum of 11% of all acne sufferers seek medical assistance and acne is

regarded as a social taboo (The Acne Guide, 2006 - 2011). Acne is not contagious. Ultimately, acne is due to the over excretion of the sebaceous glands found in the middle layer of the skin or the dermis and not by dirt, improper hygiene or an unhealthy diet (The Acne Guide, 2006 - 2011). Adolescents nowadays tend to be more conscious about their physical looks and end up affecting their social

relationship and self-image because of acne vulgaris. Living emotionally five or more years with during acne can be

devastating,

especially

adolescence.

Between the ages of 12 and 20, the appearance of acne can seem like a social misfortune for which that person alone has been selected. To a teenager, acne can be one of the worse teens recent things feel that ever happened. and lowers Acne frequently makes A

embarrassed of

their

self-esteem. that

survey

British

teenagers

found

the

emotional toll can be significant: 39% of teenagers with acne claimed they 55% avoided of 11 going to 18 to school because said of

embarrassment;

year-olds

acne

prevented them from having a boyfriend or girlfriend; 32%

indicated acne stopped them from making friends (Jancin, 2004). Because of widespread information and advancement of healthcare adolescents particularly should have in the field of dermatology, in dealing

sufficient

knowledge

with acne and they should be able to cope up emotionally with the disease because of the fact that it is a very common disease and a high percentage of people globally are experiencing it. It should not affect the adolescents

outlook in life and they should give more value and focus to their inner characteristics and not to their outside appearance or looks. Despite the fact that acne is very common to

adolescents and different studies had been conducted with regards to the skin disorder, many still wrongly perceive acne not only the adolescents but as well as their parents. Their psychosocial life as well is being affected. A preliminary survey was done last May 7 and 9, 2011 among high school adolescents in Iloilo City affected with acne vulgaris. This is with regards as to their perception on acne vulgaris and their level of self-esteem. There are a total of 25 respondents (10 males and 15 females). We categorized their perception as normal, ignore, bothersome

and

burdensome.

Their

level

of

self-esteem

was

further

categorized as very high, high, low and very low. Results showed that there are 8% of the respondents who have

burdensome perception with very low self-esteem; 20% of the respondents have bothersome perception with low self-

esteem; 8% of the respondents have bothersome perception with high selfesteem; with 20% low of the respondents 32% high of have the

ignorable

perception have of high the

self-esteem; with

respondents esteem; with 4%

ignorable

perception have of

self-

respondents 4%

ignorable the

perception have the

very

self-esteem; with normal high

respondents and very 4% of

normal

perception have

self-esteem; with

respondents esteem.

perception

high

self-

Summing up, a total of 64% of the respondents have their perception related to their level of self-esteem

while 36% of the respondents shows the opposite. The results needs further study in a large population so that it can be proven on acne that there is a relationship of self-

between esteem.

perception

vulgaris

and

level

Perception

and

level

of

self-esteem

of

adolescents

with regards to acne vulgaris varies. Socio-economic status

of the adolescent may possibly affect their perception and level of self-esteem. Specifically, age and sex of the

respondent can be the plausible causes why perception and level of self-esteem are affected.

Statement of the Problem

This

study

will

be

conducted

to

determine

whether

there is a significant relationship between perception and self-esteem of high school adolescents with acne vulgaris in Iloilo National High School (INHS) 2010 - 2011.

Specifically, questions:

it

sought

answers

to

the

following

1. What is the perception on acne vulgaris of affected high school adolescents in INHS? 2. Do high school adolescents with acne in INHS differ in their perception when categorized according to age, sex and socio-economic status? 3. What is the level of self-esteem of high school

adolescents with acne in INHS?

4. Do high school adolescents with acne in INHS differ in their level of self-esteem when categorized according to age, sex and socio-economic status? 5. Are the perceptions and self-esteem level of adolescents with acne relate with each other?

Hypotheses of the Study

Based

on

the

stated

objectives

of

the

study,

the

following hypotheses are thereby presented.

1. There is no significant difference between age, sex, socio-economic status and perception of high school

adolescents with acne vulgaris. 2. There is no significant difference between age, sex, socio-economic status and self-esteem level of high school adolescents with acne vulgaris. 3. There is no significant relationship between perception and self-esteem among high school adolescents with acne

vulgaris.

Theoretical Framework

In KING'S

this

study

the

researchers THEORY.

adapted The

the

IMOGENE focus of

INTERACTING

SYSTEMS

central

Kings framework is man as a dynamic human being whose perceptions of objects, persons, and events influence his behavior, social interaction, and health. Kings conceptual framework system includes its three own interacting distinct systems and systems of with each and

having

group

concepts

characteristics. interpersonal

These

include

personal The

systems, personal

systems,

social

systems.

system that King speaks of refers to the individual. The concepts within the personal beings system and fundamental self, in

understanding

human

are

perception,

body

image, growth and development, time, and space. King (1981) viewed perception as the most important variable because perception influences behavior. King summarized the

connections among the concepts in the following statement: An individuals perceptions of self, of body image, of time influence the way he or she responds to persons,

objects, and events in his or her life. As individuals grow and develop through the life span, experiences with changes in structure and function of their bodies over time

influence their perceptions of self. Interpersonal systems involve refers individuals to two as interacting with one as another. dyads, King three as

individuals triads, and

interacting four or

individuals small or

more

individuals associated

large

groups.

The are

concepts

with

interpersonal communication,

systems role and

interaction, The

transaction, and

stress.

interactions

transactions that occur between the nurse and the client, or the dyad, represent an example of an interpersonal

system. Verbal exchanges include both spoken and written communication, while nonverbal communication includes such things as appearance, distance, facial expressions, posture and touch. The third and final interacting system in Kings model is the social system. Social systems are groups of people goals, within a community and or society Social and that share common a

interests, for

values.

systems

provide

framework

social

interaction

relationships,

and

establish rules of behavior and courses of action. Examples of social systems include the family, the school, and the church. It is within these organizations that individual's beliefs, attitudes, values and customs are formed (King, 1971; 1981; Seiloff, 1991).

10

This age, sex

research and with

focused

on

the

variables of

perception, high school High

socio-economic acne vulgaris

status in

adolescents

Iloilo

National

School 2010 - 2011 which can greatly affect their level of self-esteem. Our society places a great emphasis on ideals of physical perfection. This ideal demonstrates not only a slim figure, but perfect skin. It is only natural that this is reflected, even if subconsciously, in the way we think about ourselves, and the way we believe others measure us. Low sufferers, during self-esteem especially teen is often a problem acne age, with acne

those

whose At this

first we

appeared are most

their

years.

influenced by our peers. Their opinions, and thoughts, tend to matter more, as it is with our friends (and 'enemies') that we begin to define a clearer sense of our own

identity.

Conceptual Framework

The research paradigm (refer to Figure 1) shows the variable variables. and In the this flow study of relationship among and these Self-

entitled

Perception

esteem of High School Adolescents with Acne Vulgaris in

11

Iloilo National High School 2010 - 2011, the main concern is the relationship (independent of were between high on school acne adolescents vulgaris and The and were

perception their

variable)

level

self-esteem categorized These

(dependent according

variable). to age, sex

respondents

socio-economic

status.

categorizing

variables

hypothesized to influence respondents perception on acne vulgaris and their level of self-esteem.

Antecedent Variables

Independent Variable

Dependent Variable

Age Sex Socio-economic status

Perception on Acne Vulgaris

Level of Self-esteem

Figure

1:

Schematic between

diagram the

showing

the

assumed and

relationship

antecedent,

independent

dependent variables.

12

Definition of Terms

The following key terms used in this study are defined conceptually and operationally to ensure a clearer

understanding of the study.

Independent Variable Perception is recognition and conceptually defined of as the conscious that

interpretation

sensory

stimuli

serve as a basis for understanding, learning, and knowing or for motivating a particular action or reaction (Mosby's Medical Dictionary, 2009). In this study, this refers to the ideas or the

coherent view of the respondent on acne vulgaris. There are eighteen (18) items assessing the perception towards acne vulgaris according to the respondent. It is divided into three dimensions namely: a) social life, b) studies and c) family concern. It is further categorized as: normal,

ignorable, bothersome and burdensome.

Dependent Variable Self-esteem is conceptually defined as confidence and satisfaction in oneself (Merriam-Websters Collegiate

13

Dictionary, 2005). In this study, it is used the same as the conceptual definition. There are twenty five (25) statements assessing the self-esteem of the respondent having acne. It is

further categorized as: very low, low, high and very high.

Antecedent Variables Age is conceptually defined as the length of time

during which a being or thing has existed (The New Oxford American Dictionary, 2005). As used in this study, this refers to the age of the respondents from their last birthday. The ages of the

respondents were grouped into three: (1) 12 - 14 years old (early adolescence); (2) 15 17 years old (middle

adolescence); and (3) 18 - 20 years old (late adolescence).

Sex

is

conceptually

defined

as

the

sum

of

the

structural, functional, and behavioral characteristics of organisms that are involved in reproduction marked by the union of gametes and that distinguish males and females (Merriam-Websters Collegiate Dictionary, 2005). As used in this study, this refers to the one marked by the respondent on the demographic profile. It is further

14

classified as male or female.

Socio-economic status is conceptually defined as the position of an individual on a social-economic scale that measures such factors as education, income, type of

occupation, place of residence, and, in some populations, heritage and religion (Mosby's Medical Dictionary, 2009). In this study, this refers to what the respondent

declared as monthly family income. It is categorized into two: low income if family income per month is P6,882 and below; and high income if family income per month is P6, 883 and above.

Other Terms Acne Vulgaris refers to a common, multifactorial

follicular disorder that affects pilosebaceous follicles, primarily of the by face, both neck, and upper and trunk. It is

characterized

non-inflammatory

inflammatory

lesions (Black and Hawks 8th edition, 2008). As used in this study, it is used to refer to the skin disorder present in a respondent commonly called as

pimples, blackheads and whiteheads by adolescents and in

15

which

one

considers

it

having

an

effect

on

social

functioning.

Adolescent refers to a young person who has undergone puberty but who has not reached full maturity (American Heritage According Dictionary to Erik of the English Stages Language, of 2007).

Eriksons

Psychosocial

Development, these are the group aging from 12 - 20 years old. In this study, this refers to the high school

adolescent students of Iloilo National High School Academic Year 2010 - 2011 ages 12 - 20 years old.

Significance of the Study

The people

study are

is

very

essential and

in

varying

groups in

of the

who

directly

indirectly

involved

study conducted by the group.

To the Respondents (Adolescents with Acne Vulgaris), for them to be knowledgeable about acne vulgaris and how it affects their level of self-esteem. It will also help them to perceive acne vulgaris positively which will encourage

16

them

to

enhance them to

their

level

of

self-esteem. contributory

This to

will acne

enable

identify

factors

vulgaris and how to cope with it.

To the Parents, this study will serve as a guide and basis to help them provide their child with the tools that will enable them to help build their childs self-esteem to meet the challenges presented to them through their daily life. Adolescents, being dependent on their parents especially financially, parents must be informed of helping their

child seek medical treatment. Children derive strength from their parents' values and attitudes therefore, this study could keep parents to become a role model to the child and influence the personality of a teenager.

To the Guidance Counselor and Teachers, the study serves as a vehicle for understanding students having self-esteem

problems. Teachers relationship with the student is very important in developing self-esteem. It also plays a

crucial part in keeping and understanding student develop his or her positive self-image. They could make an effort to learn about the home environment and the childs

17

interest

outside

of

school

and

strongly

encourage

the

childs productivity.

To the Dermatologists and other Health Care Professionals, to guide and give clear, appropriate health teachings to the teenagers- most especially those affected with acne- to let them better understand all about acne vulgaris and the importance to seek early medical treatment and compliance to its purposes. It is not only about health teaching but as well for these health care professionals to look after the psychosomatic problems in addition to the medical

treatment of acne itself.

To the Department of Health, they may document results of the study and may serve as basis for developing health programs specific in maintaining the psychosocial health of the population especially the adolescents. Health programs must not only be towards health education but as well as activities strengthening interpersonal relationships and

increasing productivity of the population.

To the Future Researchers, the end result of this study will serve as reference and basis for them if they wish to

18

undergo similar studies regarding acne vulgaris. This could also provide concrete facts that are beneficial to the

nursing field. In addition, it could improve or can be use in further researches related to this study in order to develop a more comprehensive and effective research paper.

Scope and Limitation

This study determined the significant difference of personal factors age, sex and socio-economic status to the perception on acne vulgaris and level of self-esteem of the respondents as well as the relationship between the

perception on acne vulgaris and the level of self-esteem of the same respondents. The respondents of this study will be the high school adolescents with acne vulgaris in Iloilo National High School academic year 2010 - 2011 aging 12 20 years old. Although this does not provide an objective measure of the severity of their condition, the focus of this study is to determine the perception on acne vulgaris and their

level of self-esteem. The scope of this research therefore only requires

that the participants must suffer from acne on the face

19

wherein it is highly visible or in the body and which they personally feel as having a significant impact on their lives. The number of subjects who will be involved in this study will be a total of 100 high school adolescents

affected from INHS A.Y. 2010 - 2011. The sampling technique used is non-probability, purposive sampling. The descriptive-correlational approach focused on how perception on acne vulgaris is related to the level of

self-esteem among high school adolescents of INHS A.Y. 2010 2011 utilizing the one-shot survey design. The

independent variable in this study is the perception on acne vulgaris among high school adolescents of INHS A.Y. 2010 - 2011 and the dependent variable of this study is the level of self-esteem among high school adolescents of INHS A.Y. 2010 - 2011. Age, sex and socio-economic status are

the antecedent variables. The researchers developed a self-made questionnaire about perception on acne vulgaris and the modified version of Sorensen Self-Esteem Test (2006) by Marilyn J. Sorensen, Ph.D. based on the researchers specific objectives.

Attached to this questionnaire is an information sheet to gather demographic profile of the respondents.

20

The

descriptive

statistics

will

use

the

frequency

distribution and percentage. All Statistical data will be done using the Statistical Package for Social Sciences

(SPSS).

21

Chapter II

REVIEW OF RELATED LITERATURE AND STUDIES

Related Literature

Acne Vulgaris Acne vulgaris is a common, multifactorial follicular disorder that affects pilosebaceous follicles, primarily of the face, neck and upper trunk. It is characterized by both non-inflammatory influences may and inflammatory clients lesions. Genetic and

determine

susceptibility

severity of disease (Black and Hawks, 2008). Acne vulgaris is a skin disease that affects 60-70% of Americans at some time during their lives and majority, about 85%, of the population between ages 12 and 25. Twenty percent will have severe acne, which results in permanent physical and mental scarring. This disease may present with open or closed comedones and by inflammatory papules,

pustules, and nodules. It affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back (Black and Hawks, 2008; Fulton and Elston, 2011).

22

The

principal of the

abnormality

in

acne

is The

impaction cause of

and the

distention

pilosebaceous

unit.

hyper-proliferation of keratinocytes and the abnormalities of differentiation that and desquamation to are the unknown. It is of

likely

hyper-responsiveness

stimulation

sebocytes and follicular keratinocytes by androgen leads to hyperplasia of the sebaceous glands and seborrhea that

characterize acne (James, 2005). Propionibacterium acnes colonizes the follicular duct and proliferates in teenagers with acne. This organism

probably contributes to the development of inflammation. With this combination of factors present, the follicular epithelium is invaded by lymphocytes; it ruptures, and

sebum, microorganisms, and keratin are released into the dermis. cells Neutrophils, and lymphocytes, produce the and foreign-body giant

accumulate and

erythematous

papules, of

pustules,

nodular

swellings

characteristic

inflammatory acne (James, 2005). Blackheads appear as small, usually flat, spots with centers darkened by exposure to air; whiteheads are similar lesions develop without into the color. Both types of pimples Cysts, can or

swollen,

tender

inflammations.

nodules, associated with severe cases of acne, are firm

23

swellings below the skins surface that become inflamed and sometimes infected (Tacio, 2010). Methods include lesion of measuring grading and the based those severity on that of acne vulgaris

simple

clinical require

examination, complicated

counting,

instruments such as photography, fluorescent photography, polarized measurement light of photography, production. video The microscopy, two commonly and used

sebum

measures are grading and lesion counting (Adityan et al., 2009). Grading is a subjective method, which involves

determining the severity of acne, based on observing the dominant lesions, and evaluating estimating the the presence extent or of absence of

inflammation,

involvement

(Adityan et al., 2009). Lesion counting involves recording the number of each type of acne lesion and determining the overall severity (Adityan et al., 2009). Photography has also been used as a method of

measuring acne severity. Drawbacks of this approach include the following: 1) Does not allow palpation to ascertain the depth of involvement.

24

2) Small lesions are often not visualized. 3) Maintaining constant lighting, distance between the patient and camera, and developing procedure is difficult (Adityan et al., 2009). Fluorescence and polarized light photography have some advantages over normal color photography in estimating the number of comedones and emphasizing erythema; however, the disadvantages involvement include the problems for such more as excessive time

and

need

complicated

equipment

(Adityan et al., 2009). Although acne vulgaris has plagued humankind since

antiquity, the need for grading acne vulgaris was felt when the therapies available for treating acne increased in the 1950s. Probably, the first person to use a scoring system for such disease was Carmen Thomas of Philadelphia. She used lesion counting in her office notes, starting in the 1930s. Several systems for grading the severity of acne currently exist (Adityan et al., 2009). Assessment of the severity of acne vulgaris continues to be a challenge for dermatologists. No grading system has been accepted universally. An ideal grading system would 1) Be accurate and reproducible. 2) Capable of documentation for future verification.

25

3) Be simple to use by the clinician over serial office visits. 4) Be less time consuming. 5) Be less expensive and simple. 6) Reflect subjective criteria, i.e., psychosocial

factors (Adityan et al., 2009). Acne, pimples, zits, spotsno matter how you call it, these blemishes can create unnecessary and permanent marks on delicate skin. Your skin starts to become oily that blocks pores and produces domicile for unwanted dirt and bacteria redness, to build up. and Skin recovers but normally often, after acne the

swelling

irritation,

scars

result. This is when Philippine dermatologists recommend that you take action (David, 2010). Production of acne may be caused by one or a

combination of the following factors: genetics, hormones, chemical reactions by the body to medicines taken, use of cosmetics irritation, (either as oil-based as or not), stress, factors physical such as

well

environmental

temperature, heat, and pollutants (The Acne Guide, 2006 2011).

26

Adolescent Stage The permissive factor for the expression of the

disease in adolescence is the increase in sebum production by sebaceous glands after puberty. Small cysts, called

comedones, form in hair follicles due to blockage of the follicular orice by retention of keratinous material and sebum. The activity of bacteria (Proprionobacterium acnes) within the comedones releases free fatty acids from sebum, causes inammation within the cyst, and results in rupture of the cyst as from wall. result the An of cyst. inammatory extrusion The of foreign-body oily and reaction

develops debris

keratinous seen in

earliest

lesions

adolescence are generally mildly inamed or noninammatory comedones on the forehead. Subsequently, more typical

inammatory lesions develop on the cheeks, nose, and chin. The most common location for acne is the face, but

involvement of the chest and back is common.

Regardless of

the severity, acne may affect a patients quality of life (McCall and Lawley, 2008). Each person holds an image of the physically perfect person in mind and evaluates his or her appearance against this ideal. Much of the research on body image has been conducted on adolescents as this developmental period is

27

not only one of great physical change but also the time that teens begin to subject themselves to (often painful) scrutiny. The changes of puberty and resulting sexual

maturation often make adolescents feel self-conscious and awkward about their bodies. Adolescent girls appear to be particularly vulnerable to developing a negative body

image. They tend to ignore other abilities and focus on appearance lowered as evidence and of worthiness with for consequent psychiatric

self-esteem

increased

risk

disorders, including eating disorders (Weinshenker, 2002). The awareness changes of experienced and during puberty reactions bring to new them.

self

others'

Adolescents learn through experimentation to interact with others in more role the adult in rate ways. peer of Physical maturity plays an

important

relations. The body changes for

beginning adolescents

of puberty and

varies tremendously. How easily adolescents deal with those changes will partly reflect how closely their bodies match the well-defined stereotypes of the "perfect" body for

young women and young men. Adolescents who do not match the stereotype may need extra support from adults to improve their feelings of comfort and self-worth regarding their physique (Perkins, 2008).

28

Age Acne is the most common disease affecting up to 85% of the population between the ages 12 and 25 and affects most teenagers but frequently continues into adulthood. Although there are more than 2 million visits to office-based

physicians per year for patients in the age range of 15 to 19 years, the mean age at presentation for treatment is 24 years, with 10 percent of visits taking place when patients are between the ages of 35 and 44 years (Black and Hawks, 2008; James, 2005). Almost all teenagers (nine out of ten) suffer from outbreaks of pimples, making acne one of the most

widespread skin disorders (Tacio, 2010). Adolescence can be an awkward time and acne can

magnify this and compromise social confidence (AldermanOler, 2009). Research suggests that 85% of teens will have acne during their adolescent years. Filipino teens dont get an exception (Karl, 2010). Acne is largely a curse of adolescence. Acne commonly arises during puberty and tends to be worse in teenagers with oily skin, notes The Medical Advisor: The Complete

29

Guide to Alternative and Conventional Treatments (Tacio, 2010). The skin lesions of acne usually diminish in the early twenties, but some unlucky people will carry the condition well into their thirties, forties and beyond (Gonzales,

2010).

Sex According to Gonzales (2010), acne affects both sexes in equal number but the condition is usually more severe in males as well as according to Tacio (2010), acne occurs in both sexes, however, teenage boys tend to have the most severe cases. Acne is caused by several factors that potentiate each other. One of the major cause which is related to sex is sebum overproduction by the sebaceous glands, which may be largely due to the influence of the male hormones that are produced in increased amounts during puberty by the adrenal glands of both sexes. Others major causes are

hypercornification or inability of the skin to wash out fast enough dead cells causing the pores that serve as

passageway for sebum to clog; and proliferation of bacteria (P. acnes) that thrive on the sebum and which causes

30

inflammation in the sebaceous gland and surrounding tissue (Gonzales, 2010). Acne affects each gender differently. In order to

successfully treat acne, it is important to know how acne affects boys and girls differently. In finding a successful acne treatment, it depends upon knowing what acne is and how it affects both boys and girls (Sawyer, 2009).

Socio-economic status Acne respects no-one. It crosses class and cultural lines and affects people of all ages and socioeconomic

groups. It is not just something that teens have to deal with. Acne is a skin condition that can cause scarring both to the body and to the psyche. There are more than 17 million people in the United States alone who are sufferers (Esteves, 2009). Remarkably was the 80 percent higher level of suicidal thoughts in the substantial acne group, independent of

depression, ethnic background, and family income (Bures, 2010).

Perception and Acne Vulgaris Acne affects how we perceive ourselves. It affects

31

how others perceive us. And it affects how we perceive how other people perceive us, Feldman said (MCcracken and

Grohol, 2011). Stress related acne problems arise due to excessive stressful conditions mostly in the later ages of your life. This is the most important skin problem among men and

women. Most of men and women think that they have just left their acne problems with their age behind in the teenage years. But the fact remains the same that if you are living in more stressful conditions there are higher chances of acne problems affecting you. Acne and other common skin problems can be therefore effectively controlled if you

control your stress and anger (Jones, 2008). Steve Feldman, M.D., a professor of dermatology from Wake Forest University Baptist Medical Center, conducted a systematic review of the published research literature to arrive at this conclusion. acne to They be a found that while most many

teenagers

consider

cosmetic

problem,

others report that acne has a significant impact on their self-esteem and quality of life, often leading to anxiety, depression 2011). and suicidal thoughts (MCcracken and Grohol,

32

Since acne occurs so frequently in adolescence, this make them fear how they are viewed by their peers. Selfesteem and self-worth can be affected when kids are afraid of being judged by their colleagues. Teens put up with so many anatomical changes that can make them feel dirty. Its a particularly vulnerable time when kids worry about being accepted, and about the way they look (Acne Clearup, 2004 - 2009). Some parents can trivialize the teens fears.

Attitudes like I went through it youll go through it and itll go away. But when that first serious breakout happens acne typically gets worse before it gets better the teen may rationally agree that its probably a passing phase. However, while its going away, the teenager remains

afraid of being judged by his peers, and serious selfesteem issues can result. These unsettling feelings about self-image can sabotage a young person already confused by this gateway to adulthood. This is a time in a teens life when he/she should get out and be involved in peer

activities but fear of being different is strong (Acne Clearup, 2004 - 2009). Dr. Ritvo and the AARS asked thousands of teens and adults to offer their first impressions of teens based

33

entirely on photos of their face-one without acne and one digitally enhanced with acne. What they found was that

teens with acne are more likely than teens without acne to be perceived as shy (39% vs. 27%), nerdy (31% vs. 17%), and lonely (23% vs. 13%). Meanwhile, teens without acne are more commonly perceived as self-confident (42% vs. 25%), happy (50% vs. 35%), and leaders vs. followers (49% vs. 29%). "We were expecting the results of the study to show that having acne would be difficult for teens, which it does, but what I found most distressing was the extent to which acne can really skew the way society perceives teens. We live in a very visual society and based on the survey results, unfortunately people do make snap judgments about teens with acne," said Dr. Ritvo. "The results illustrate the fact that unfortunately, acne does play a role in how teens are viewed by both their peers and adults. So, what starts as a purely medical condition can have other

implications" (Pantin, 2009).

Perception and Age Acne is a much bigger problem than a facial blemish for most teens. New research finds that depression and

other psychological disorders may be more prevalent in ado-

34

lescent acne patients (MCcracken and Grohol, 2011). Many folks are convinced that moisturizing isn't

essential for the acne prone skin. This is in reality a common perception. The actuality is that even acne prone skin needs a moisturizing routine. Many acne sufferers

avoid the use of moisturizer fearing that it would add on the oil levels of the skin (Pearl et al., 1998). Selecting the correct moisturizer can avoid such an issue. In contrast to common principles moisturizing is

terribly necessary for the acne prone skin. Almost all of the acne sufferers go through some sort of acne remedy or the other which regularly makes the skin awfully dry (Pearl et al., 1998).

Perception and Sex One recurring problem throughout history has been one of perception, but today much of our trouble is not the perception between different countries or cultures, it is one concerning the difference between female perception and male perception. other, which is Both sexes claim not to understand each understandable considering the vast

differences in how males and females are raised in western culture, as well as other physical and psychological

35

differences. perceptions of

Although the

female may

perception be

and

male

world

irreconcilable,

understanding the source of these problems will help to understand some of the differences (Patterson, 2007). Women and men commonly get take issues completely

differently but there are several scientific reasons why male and female perceptions are different. A recent

discovery is that women actually have more rods and cones in their eyes than men. This allows women to see more

detail, which partially explains why men sometimes see an ordinary room, while women see complete filth (Patterson, 2007). Of all the visual skills possessed by humans, face recognition imaging network is arguably have the most that developed. the Past brain

studies for face

shown

brain's regions

cortical in visual

perception

includes

cortex that process the identification of individuals as well as social cues, such as gaze direction and speechrelated movements; the amygdala and insula, where facial expressions are processed; and regions in prefrontal cortex and the reward circuitry, where the assessment of facial beauty is processed. Numerous studies have shown that the neural response to faces is modulated by cognitive factors

36

such as familiarity, attention, memory, visual imagery, and emotion. For example, recent empirical evidence indicates that emotional faces (e.g., happy, fearful, or angry faces) evoke stronger neural activation than neutral faces,

presumably as a result of their biological importance. It is currently unknown, however, whether the response to

faces is modulated by gender or sexual orientation (Kranz et al., 2006). Other studies show that college men rank "good looks" and "good body" as first and second factors in date

selection, while college women listed intelligence as the most important characteristic sought in a boyfriend

(Bersheid, Dion, Walster, and Walster, 1981). Schulman and Hoskins (1986) studied the perceptual

processes in rating the appearance of male versus female faces. Findings revealed that the female faces were judged with more scrutiny and discrimination. The results from

these studies demonstrate that women are more likely to be judged by their physical appearance. Physical appearance is a central feature of role

expectations for women (Freedman, 1984), and attractiveness stereotypes are stronger for females than for males

(Wallston and O'Leary, 1981).

37

Emphasis

on

appearance

is

especially

strong

among

women because an attractive appearance is deemed essential to the feminine gender role. If women are more likely to be judged by their physical attractiveness, then facial acne on females might be judged with more scrutiny than facial acne on males. The current study will explore how gender affects the social-perception that facial of acne. is a This more paper heavily

hypothesizes

appearance

weighted element of a females (versus a males) social identity. Facial acne on females will be judged with more scrutiny than facial acne on males, regardless of a

respondent's gender. It is predicted that both male and female respondents will not tolerate high levels of acne severity in the female photo series. Meanwhile, male and female respondents will tolerate higher levels of acne

severity in the male photo series (Krawczuk, 1997).

Perception and Socio-economic status It is an imaginative extension of thought that conceives of poverty as an agent of pollution. This conception extends the physical environment to a social dimension to include living human beings. Environment that includes man is certainly polluted by the existence of poverty which

38

means

insufficient

needs

at

the

most

physical

level

of

hunger (Gandhi, 1991). I think each individual has their own perception or beliefs regarding money and their financial situation is a reflection of that perception or beliefs (Riviera, 2009). The universe will always reflect back to us what we believe - If we believe in the "premise of scarcity", that is exactly what we will perceive in our world, so in that sense yes it will be true in your world. However, once we begin to challenge limited beliefs like this, our

perception of the world begins to change and hence what is true for us changes accordingly - we can then change this "premise of scarcity" to one of abundance (Riviera, 2009). Parents need to understand that even mild acne may have a profound impact on the way their teen feels about themselves. Helping with treatment and support can go a long way in protecting and repairing a teen's self-esteem (Palmer, 2009).

Self-esteem and Acne Vulgaris Self-esteem is all about how much people value themselves, the pride they feel in themselves, is important and how

worthwhile

they

feel.

Self-esteem

because

39

feeling

good

about

yourself

can

affect

how

you

act.

person who has high self-esteem will make friends easily, is more in control of his or her behavior, and will enjoy life more (Lyness, 2009). Self-esteem is an individuals generalized sense of worth and value, or how a person regards self. The level of self-esteem at any given moment can be influenced by many factors. Individuals make decisions on what life factors (e.g., physical attributes, skills, social accomplishments) they deem important and calculate self-esteem on the basis of their achievement of the factors they value most highly. Self-esteem varies over time depending on the situation, the environment and an individuals level of development and overall self-confidence (Delaune and Ladner, 2006). Self-esteem acceptance and is built on two principles: is selfbasic,

self-concept.

Self-acceptance

primitive and shared by most other living things. It is unconditional and is required before self-esteem can for a

develop. Self-acceptance is not a denial of a need change, improvement, or evolutionit is simply

recognition that you are (Splane, 1994). Your self-concept develops from self-acceptance. Selfconcept encompasses your beliefs, convictions, concerns,

40

everything you like about yourself, everything you dont like, your capabilities, skills, talents, as well as your limitations (Splane, 1994). From self-concept grows self-esteem. Self-esteem means accepting resorting yourself to in all of your many facets, without or

self-repudiation,

self-oppression,

deception of yourself or others (Splane, 1994). The social, psychological, and emotional impairment

that can result from acne has been reported to be similar to that associated with epilepsy, asthma, diabetes, and

arthritis. Patients evaluated at tertiary care centers are prone to depression, social withdrawal, anxiety, and anger and are more likely to be unemployed than persons without acne. Scarring can lead to lifelong problems in regard to self-esteem. The direct cost of acne in the United States is estimated spent to on exceed $1 billion per acne year, with $100

million 2005).

over-the-counter

products

(James,

Self-confidence esteem.

encourages teens

the

development

of

selfself-

Unfortunately,

frequently

lack

confidence when they suffer repeated acne flare-ups. They never feel confident that they will "look good." That

41

explains why the effects of acne can eat into and possibly destroy, the growing layers of self-esteem (Langart, 2008). Acne is not only unsightly, it could also be

embarrassing and that lowers the self-esteem of those who have them (Betchay, 2008).

Self-esteem and Age Teens typically invest tremendous energies in physical appearance and social status and often fail to see their positive traits if they feel deficient in these areas.

Adolescents often cannot separate their opinion of their own body image, for instance, from their overall self-

concept (Delaune and Ladner, 2006). Millions acne and its of adolescents worldwide effects, are plagued low with self-

psychological

including

esteem and lack of confidence. Until recently, acne was thought to have genetic and a hormonal basis and was

directly attributed to the two. Recent research, though, has revealed new insights into adolescent acne and its

causes (Gilani, 2010). While acne is a physical problem, it also affects

teens psychologically. Even if the acne is relatively mild, it may have a big impact on self-esteem and self-

42

confidence. But the more severe the acne, the greater the emotional toll it takes on the teen. A New Zealand study has shown teens with severe acne at risk for depression and suicide attempts (Palmer, 2009). Teenagers with acne tend to have a poor body image. It's normal for sufferers to feel self-conscious or

embarrassed about their skin. Boys in particular might feel uncomfortable undressing in the locker room if acne is

present on the body. Teens may be unwilling to participate in sports, such as swimming, because of embarrassment about their skin (Palmer, 2009). To some teenagers, having acne is a nightmare. Surely, it lowers a teenagers self-esteem to express themselves freely and confidently to their families, friends, or to anyone. It certainly carries with it physical, as well as, emotional scars made by self-consciousness and

embarrassment that made some don't even want to get out of their rooms (Tacio, 2010). Body image is how someone feels about his or her own physical appearance. For many people, especially those in their early teens, body image can be closely linked self-esteem. That's because as kids develop into to

teens,

they care more about how others see them (Lyness, 2009).

43

Some teens struggle with their self-esteem when they begin puberty because the body goes through many changes. These changes, combined with a natural desire to feel

accepted, mean it can be tempting for people to compare themselves with others. They may compare themselves with the people around them or with actors and celebs they see on TV, in movies, or in magazines (Lyness, 2009). Coincidently, the peak age of depression and low selfesteem coincides with the transition from elementary to

junior high school. This age may have an inability to deal with the new social demands as well as academic demands of a new school (Davila, et. al., 1995). Think about the sort of magazines that interest teens. They usually like to look at magazines that have pictures of sports stars or Hollywood celebrities. Each of the

pictures in those magazines shows an acne-free face. Teens soon begin to feel that no one with acne is apt to enjoy a celebrity status. Teens with acne can feel that they lack all prospects for an exciting and rewarding life (Langart, 2008). That possibility emphasizes the importance of selfesteem. It underlines the benefits that can come from a

44

public

readiness

to

identify

and

to

tackle

acne-related

psycholgical problems (Langart, 2008). Adolescence is a turbulent time for any teenager.

We've all heard about how hormones wreak havoc on a teen's mood and how peer pressure influences a teen's decisionmaking abilities. But in the midst of all this, adolescence is also a time lead of identity the development. most Granted, teen peer off

pressure

can

even

well-balanced

track, and those whacky hormones are certainly something to contend with. However, good self esteem is something you can actually have control over. Building self esteem in adolescents confidence will needed quite to literally, into give them the self

develop

loving,

responsible,

well-adjusted adults (Palmer, 1999). There are many such reasons for low self-esteem of adolescents. If proper care is not given, the low self esteem gradually will lead to many physical and mental

ailments. It is important to bring up the adolescents with high self-esteem (Koenig, 2008). Low causes of self-esteem problems in in adolescents our society, may be one to of the

according

Lilian

Katz, author of "How Can We Strengthen Children's SelfEsteem?" Causes of low self-esteem are still under debate,

45

but

some

of

the

common

theories

include

peer

opinions,

stereotyping, judgment of outward appearance and prejudice. Parents, educators and other adults in children's lives can help boost self-esteem (Mayne and Egan, 2010). Helping adolescents and adults to build self-esteem follows on from the widely acclaimed Helping Children to Build Self-Esteem. It is filled with simple, practical and innovative ideas for supporting the development and

maintenance of healthy self-esteem. Based on the author's clinical experience, the easy-to-use photocopiable activity sheets encourage participants to draw on existing skills and to develop new approaches to building confidence and feelings of self-worth. These exercises are suitable for work with individuals and with groups, and will prove an indispensable aid to building self-esteem in adolescents and adults (Plummer, 2004). The development of a sense of selfwho am Iis a major, if not the most important, developmental task of adolescence. The self-concept is an amalgamation of an

individuals physical, emotional, social, intellectual and educational traits. The self-concept is an objective

statement of a teens personal traits. Self-esteem is the value an adolescent applies to the self-concept. Am I

46

special, important; am I am a failure? The adolescent will chose some traits that are value-laden and develop selfesteem from these particular characteristics (Wrye, 2011). Every teen needs to pass through psychosocial

development during adolescence in order to have a realistic view of self. A task of this developmental process is to achieve a realistic and positive self-image. The teen then develops self-esteem from this self-image (Wrye, 2011).

Self-esteem and Sex Self esteem is the one important factor required by anybody to succeed in life. It is a well proven concept that if you can build self-esteem at your adolescent period it will last all through your life. Adolescence is one

period in which boys and girls faces with many problems and issues. It is necessary that adolescents self-esteem to be at top to face the problems faced with adolescent period. Many teenagers will have low self esteem and it is

imperative to know major reasons for low self esteem and find out ways and means to combat the low self esteem. It is highly advisable to make dedicated efforts to bring up the self esteem (Koenig, 2008).

47

Women's identities have gotten a bad rap. We are told that women think badly of themselves, and they have self-confidence. Women's identities, are fragile no and

conflicted: at work they feel like frauds and at home they feel worthless. Women are ambivalent over whether they want to be feminine or masculine, and ping-pong back and forth between the two gender roles. One day they are all

gentleness, caring, and frills and the next day they are all assertiveness, self-promotion, and pantsuits (Nolen-

Hoeksema, 2010). Self-esteem is defined as the measure of how much we like and approve of ourselves. With the onset of

adolescence, in both boys and girls, self-esteem quickly becomes the quintessential struggle between our internal confidence and our external influence. It is tied directly to the beliefs and images we have about ourselves, and

though men and women's issues with self-esteem aren't very different in nature, the reasons why those issues develop in the first place are (Reilly, 2010). Gender socialization creates expectations for the way men and women behave, think and feel about themselves. And while women draw much of their identity from their family and personal relationships, men tend to think of themselves

48

as

free-agents,

independent

of

those

ties

that

bind.

Therefore, a man's self-esteem develops quite differently than a woman's because he doesn't put too much stock in what those around him think. He relies mostly on the

discourse itself. As for a woman, she'll go out of her way to please others, and she will still struggle to count herself worthy (Reilly, 2010).

Self-esteem and Socio-economic status New research indicates that the behaviors are not the result of low self-esteem, but rather the result of social rejection which leads to low self-esteem. In other words, self-esteem does not cause a person to behave a particular way, it is the result of poor social relationships (Davila, et. al., 1995). Depression and self-esteem may be viewed as a vicious cycle. The inability may lead to to relate positively which in social to

situations

low

self-esteem

leads

depression. The depression then leads to further inability to relate with others or be fully accepted in social groups which then adds to the feelings of low self-esteem (Davila, et. al., 1995).

49

healthy

level

of

individual

self-esteem

is

the

foundation for emotional, physical and social well-being. People who value themselves and who recognize their own skills are likely to live fulfilling and rewarding lives and will tend to attract genuine liking and respect from others. Conversely, low levels of self-esteem have been

linked with such personal and social concerns as school failure, depression, social anxiety, violence and substance abuse (Plummer, 2004). One study has shown that unemployment rates are higher in both women and men with acne, showing that people with acne are discriminated against. Though our society has been learning not to discriminate against people who are

physically challenged, no one speaks up for the miseries of acne (Redmond, 2007). Self-esteem may be impacted by socioeconomic or

immigration status. Teens whose families are homeless have been shown to be at higher may risk be for low self-esteem. for certain

Positive

self-esteem

promoted

adolescents who have immigrated by supporting successful adjustment and adaptation to the new country. Increasing connectiveness to peers will enhance the maturing process that friendship allows. Research has shown that teens who

50

immigrate to the United States, but return to their country of origin during vacations may suffer from self-esteem

issues because of fractured relationship with peers in both countries (Wrye, 2011). In addition to immigrant and homeless youth,

adolescents who are raised in affluent families may also be at high risk for low self-esteem. Teens whose parents are successful, ambitious and committed to social, professional and recreational pursuits may suffer low self-esteem. Due to the busy outside the home schedule, there is no time for family centered activities and little time to nurture the adolescent-parent relationship. Money becomes a substitute for parents time (Wrye, 2011). Adolescents who are raised in this environment present a faade of confidence, but may be totally insecure. There is low regard for the teens private self. Teens may not develop a true value system family, that peers reaps or rewards other from social

relationships

between

contacts. As a result, they may not be able to pass through the developmental steps in order to have a positive selfesteem. involved Some in of risky these privileged adolescents substance become abuse,

behaviors

including

promiscuity or delinquency. Others may become depressed or

51

suicidal. All of these factors can contribute to continuing low self-esteem (Wrye, 2011).

Review of Related Studies

Acne Vulgaris According to the study of Clearihan (2001) entitled Acne. Myths and management issues, acne is one of the commonest dermatological problems, experienced by

approximately 80% of Western adolescents. If left untreated it can be the source of significant physical sequelae and psychological problems. Prevalence studies show that acne is not just a problem of youth but for some, it persists into middle age. According to the study of Yan (2006) entitled Current concepts in acne management, acne vulgaris is a nearly universal phenomenon among adolescents in the western world and continues of to remain problematic for a significant and

proportion

adults.

During

adolescence,

emotional

physical changes must be successfully integrated into the emerging sense of self, and skin disorders such as acne, which alter that self-image, may engender distressing

feelings of embarrassment, shame, and disgust. While most

52

patients

eventually

achieve

spontaneous

remission,

approximately one quarter of teenagers will show evidence of permanent acne scarring by 18 years of age. According to the study of Stathakis (1997) entitled Descriptive epidemiology of acne vulgaris in the

community, acne is a common skin condition. No universally accepted standardized classification system for acne

vulgaris exists, although there is a strong need for it. Thus, the clinical definition of acne has been unclear in many studies. The reported prevalence of acne varies from 35 to over 90% of adolescents at some stage. In some

studies the prevalence of comedones approaches 100% in both sexes during adolescence. According to the study of Nijsten (2007) entitled

Acne is prevalent but use of its treatments is infrequent among adolescents from the general population, Despite the high prevalence of acne, its treatments were used

infrequently; 13% had used topicals and 5% systemic drugs. Among oral adolescents antibiotics who were used most therapy, often benzoylperoxide used. Although and the

likelihood of having used treatment increased significantly for both number of retentional and inflammatory lesions (P < or = 0.03), only a quarter of those with 20 or more

53

papules and/or pustules had used topical treatment, and 10% systemic therapy. Multivariate logistic regression models demonstrated that girls were about twice as likely to have used topical agents (adjusted OR = 2.30 [95%CI = 1.37, 3.87]). Those with more inflammatory lesions on the face and with more extensive acne on the chest and back were about three times more likely to have used topical and/or systemic acne therapy. According to the study of Del Rosso (2006) entitled Management of truncal acne vulgaris: current perspectives on treatment, disorders acne vulgaris is one of the most common by dermatologists in the clinical

encountered

setting. Although it is well recognized that the back and chest may be affected in many patients, little data exist regarding the prevalence, grading, and treatment of truncal acne vulgaris. Results of clinical studies suggest that as with facial acne vulgaris, combination therapy is optimal. This article discusses clinical challenges related to the management of truncal acne vulgaris, a system for rating disease severity, and recommendations regarding the use of topical and systemic therapies.

54

Perception According to the study of Al-Hoqail (2003) entitled Knowledge, vulgaris, beliefs five and perception and of youth toward acne

hundred

seventeen

students

(73.9%)

responded to the questionnaire. Male and female responders were 267 (51.6%) and 250 (48.4%). More than half of them reported that they suffered from acne 276 (53.4%). Three quarters (76%) of the sample considered psychological

conditions contribute to occurrence of acne, 72.1% believed that diet is one of etiologic factor. Only 15.9% reported that acne is an infectious disease. Sixty-two percent

believed that acne is not a serious problem, while 56.7% consider it as both a cosmetic and health problem. According to the study of Ali et al. (2010) entitled Beliefs and perceptions of acne among a sample of students from Sindh Medical 55.9% College, Karachi, while of the were 630 non-

respondents,

were

sufferers

44.1%

sufferers. Of all, 67.0% of the affected believed it to be relieved by frequent face washing and that they should seek treatment, whereas 79.84% students believed in seeking

dermatologist's advice regarding treatment. Mass media was the most common source of information. As to the cause, 21.7% students believed that hereditary factors and 20.1%

55

thought environmental factors are the major cause of acne. In diet, soft drinks (29.2%) were considered the major

exacerbating factor. The most significant emotional impact of acne on medical students was embarrassment (26.2%). According to the study of Kellet and Gawkrodger (1999) entitled The psychological and emotional impact of acne and the effect of treatment with isotretinoin, shows that recent research, however, has illustrated that "the

conception about acne needs to be changed from that of a troublesome complaint, to that of a disorder, which has the potential to cause great damage, perhaps even in the long term, to the emotional functioning of the patient."

Self-esteem According to the study of Fton-Danou (2010) entitled Psychological visible clinical impact of acne acne vulgaris, induces a through its

aspect,

significantly

impaired body image which is not correlated to clinical severity. This diminished body image and the resulting

psychosocial behaviour must be considered to optimize the treatment. In addition, depressive disorders related to

bodily concern are frequently observed during adolescence period and faced with these bodily transformations, acne

56

can be a source of anxiety. It is therefore important to spot the symptoms of depression and indeed treat them if they are persistent, because they impair "self-image" and have an influence on the wish to "take care of oneself". According to the study of Do (2009) entitled

Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents, there was a prevalence of acne in 78.9% of the study samples, with 10.2% of students having moderate-to-severe acne. Acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social

impairments. The longer the acne persisted, the more stress the students felt. The degree of stress and extent of selfimage impairment were related to subjective severity more than objective grading. According to the study of Dalgard (2008) entitled

Self-esteem and body satisfaction among late adolescents with acne: results from a population survey, our response rate was 80%. The prevalence of acne was 13.5%. Girls and boys with acne had significantly more depressive symptoms, lower self-attitude, more feelings of uselessness, feelings of pride, lower self-worth, and lower fewer body

satisfaction than those without acne. In a regression model

57

adjusting for body mass index and depressive symptoms, acne explained significantly poor self-attitude for boys only

(odds ratio 2.07 [confidence interval 1.10; 3.88]) and poor self-worth for girls only (odds ratio 1.88 [confidence

interval 1.23; 2.88]). According to the study of Dunn et al. (2007) entitled Acne in adolescents: quality of life, self-esteem, mood, and psychological disorders, qualitative review of the

selected articles revealed that the presence of acne has a significant Depression impact and on self-esteem and quality of are life. more

other

psychological

disorders

prevalent in acne patients and acne treatment may improve symptoms of these disorders. According to the study of Kellet and Gawkrodger (1999) entitled The psychological and emotional impact of acne and the effect of treatment with isotretinoin, shows that although extremely most acne sufferers about are highly skin sensitive and some

embarrassed

their

condition,

researchers have found that the impact of acne may be even greater on women than it is on men. This is supported by a study done by Hsu and reported in Hanstock and OMahony (2002) on found Perfectionism, acne and appearance concerns, physical attractiveness seem to be more

that

58

important to women than men as women rely more on social experiences and appraisal to define their self-concept. According to Krejci-Manwaring et. al. (2006) in his study Social sensitivity and acne: the role of personality in negative social consequences and quality of life, it is likely that the gender differences found in these studies are related to wider social and cultural forces in Western society that places great emphasis on womens appearance. However, it is important to remember that regardless of gender, greater acne severity is associated with greater negative social impact. According to the study of Kellet and Gilbert (2001) entitled perspective Acne: with a a biopsychosocial focus on shame, and say evolutionary that during

adolescence the awareness of body image and body ideal are particularly intensified. It becomes extremely important

during this time to look attractive to others. As girls and boys enter their teenage years, one of their most important concerns often becomes constantly looking beautiful or attractive. to the They ideal

compare

themselves

expressions of beauty as seen in magazines. A smooth and flawless skin is coveted as it symbolises perfection in itself it defines beauty and implies success.

59

Summary of Findings of Related Studies

Acne is one of the commonest dermatological problems, experienced by approximately 80% of Western adolescents

(Clearihan, 2001). The reported prevalence of acne varies from 35 to over 90% of adolescents at some stage Stathakis (1997). Despite the high prevalence of acne, its treatments were used infrequently Nijsten (2007). According quarters (76%) to of the the study of Al-Hoqail considered (2003), three

sample

psychological

conditions contribute to occurrence of acne, 72.1% believed that diet is one of etiologic factor, only 15.9% reported that acne is an infectious disease, 62% believed that acne is not a serious problem, while 56.7% consider it as both a cosmetic and health problem. According to the study of Ali et al. (2010), 67.0% of the affected believed it to be relieved by frequent face washing and that they should seek treatment, whereas 79.84% students believed in seeking dermatologist's advice

regarding treatment. Mass media was the most common source of information. As to the cause, 21.7% students believed that hereditary factors and 20.1% thought environmental

60

factors are the major cause of acne. In diet, soft drinks (29.2%) were considered the major exacerbating factor. The most significant emotional impact of acne on medical

students was embarrassment (26.2%). According adolescence, to the study and of Yan (2006), changes during must be

emotional

physical

successfully integrated into the emerging sense of self, and skin disorders such as acne, which alter that selfimage, may engender distressing feelings of embarrassment, shame, and disgust. According depressive frequently to the study of to Fton-Danou bodily (2010), are faced

disorders observed

related

concern and

during

adolescence

period

with these bodily transformations, acne can be a source of anxiety. It is therefore important to spot the symptoms of depression and indeed treat them if they are persistent, because they impair "self-image" and have an influence on the wish to "take care of oneself." According to the study of Do (2009), acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social impairments. The longer the acne persisted, the more stress the students felt.

61

According to the study of Dalgard (2008), girls and boys with acne had significantly more depressive symptoms, lower self-attitude, more feelings of uselessness, feelings of pride, lower self-worth, and lower fewer body

satisfaction than those without acne. In a regression model adjusting for body mass index and depressive symptoms, acne explained significantly poor self-attitude for boys and poor self-worth for girls only. According to Krejci-Manwaring et. al. (2006), it is impor-tant to remember that regardless of gender, greater acne severity is associated with greater negative social impact. According to the study of Kellet and Gawkrodger only

(1999), shows that although most acne sufferers are highly sensitive and extremely embarrassed about their skin

condition, some researchers have found that the impact of acne may be even greater on women than it is on men. This is supported and by a study done by Hsu found and reported in

Hanstock

OMahony

(2002),

that

physical

attractiveness seem to be more important to women than men as women rely more on social experiences and appraisal to define their self-concept.

62

According to the study of Dunn et al. (2007) revealed that the presence of acne has a significant impact on selfesteem and quality of life. Depression and other

psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders. According to the study of Kellet and Gilbert (2001), during adolescence, the awareness of body image and body ideal are particularly intensified. It becomes extremely important during this time to look attractive to others.

63

Chapter III

METHODOLOGY

This area,

chapter

describes the

the

research used,

design, validity

study and

population,

instrument

reliability of the questionnaire, data gathering procedure, data processing and statistical treatment and analysis.

Research Design

descriptive-correlational

research

design

will

be

used in this study. The descriptive research design is a method of research that describes a situation or a given state of affairs in terms of specified aspects or factors (David, 2005) while correlational procedures, according to Cohen (1988), are statistical techniques for determining relationship between pairs of scores. The present study

focuses on determining the perception and self-esteem of high school adolescents with acne vulgaris in Iloilo

National High School 2010 2011. A one-shot survey This design is will be to employed in this the

investigation.

intended

determine

64

respondents

demographic

profile,

perception

on

acne

vulgaris and level of self-esteem of adolescents with acne vulgaris, and explain the relationship of these variables. The antecedent variables are age, sex and socio-economic status. The independent variable is perception on acne

vulgaris while the dependent variable is level of selfesteem of adolescents with acne vulgaris.

Study Area and Population

The respondents of this study will be a total of 100 high school adolescents (12 20 years old) of Iloilo

National High School 2010 - 2011. The purposive sampling method will be employed in the selection of the subjects who will be the samples of the study. In this method, also refer to as judgement sampling, sample elements judge to be typical, or representative, of the identified variables of a study, are chosen from the population (Blalsdell, 2002). According to Blalsdell, the purposive sampling method has been useful in attitude and opinion surveys. The researchers will personally produce and distribute the questionnaires and manage their

administration. The respondents will be given an assurance

65

that

the

data

collected

will

be

kept

with

maximum

confidentiality. In the choice of samples, the levels of personal

variables are determined as follows: As to age, the respondents are group as young

adolescents (12- 14 years old), middle adolescents (15- 17 years old) and late adolescents (18- 20 years old). With sex, as male and female; with socio-economic status, low income (monthly family income of P6, 882 and below) and high income (monthly family income of P6, 883 and above).

Data Gathering Instrument

The researchers-made questionnaire for perception and a modified Sorensens self- esteem test are developed based on the specific objectives of the study. Both instruments used have negative statements listed. The questionnaire

consisted of three (3) parts. Part I elicit information on demographic profile of the respondents to include their

name, age, sex, and socioeconomic status. Part II will assess on the perception of the respondents on acne

vulgaris. It consists of eighteen (18) items. It has three (3) dimensions namely: a) social life, b) studies and c)

66

family concern with six (6) items each. The responses to each item is scaled using a four-point Likert scale with 4= strongly disagree, 3= disagree 2= agree, 1= strongly agree. The scores for perception questionnaire of

adolescents are interpreted to mean that the higher the score, the normal acne vulgaris is being perceived by the respondents. Part III will assess the level of self-esteem of the respondents. It consists of 25 items. The responses to each item is scaled using a four- point Likert scale with 4= never, 3= sometimes 2= often, 1= always. The scores for self- esteem questionnaire of adolescents are interpreted to mean that the higher the score, higher the self- esteem of the respondents. The scaling of scores for perception on acne vulgaris is as follows: Mean Score Description Interpretation the

3.26 4.00

Normal

The perceive

adolescents acne as

normal and that it is part of growing up. They have an

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accepting towards acne. 2.51 3.25 Ignorable The pay and no

attitude their

adolescents attention have a

disregarding attitude their poses on towards acne. no It

problem selves.

their

They still do not accept it as part of growing up. 1.76 2.50 Bothersome The adolescents

view their acne as somewhat uncomfortable, inconvenient annoying. 1.0 1.75 Burdensome The view adolescents acne as an and

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troublesome

and

pose as a problem to self. It gives a distressing and

frustrating concept to self.

The scaling of scores for the level of self-esteem is as follows:

Mean Score

Description

Interpretation

3.26 4.00

Very high

The

adolescents

have important and superior to their regards self-

worth. 2.51 3.25 High The have adolescents moderate/ regards or to

normal

their self-worth. 1.76 2.50 Low The adolescents

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have to

weak their

regards self-

worth. 1.0 1.75 Very low The have inferior to their adolescents poor and

regards self-

worth.

Validity and Reliability of the Questionnaire

In order to assure appropriateness, meaningfulness and usefulness of the inferences that may be drawn by the

researcher from the data obtained from the questionnaires, the validity of the questionnaires had to be evaluated by a jury of 4 members for each type of questionnaire. Both the perception on acne vulgaris and modified Sorensens self esteem test as research instruments, will be tested for consistency, These will stability, be validated dependability by a and predictability. sociologist,

psychologist,

nurse and dermatologist. After validation, suggestions and comments will be made and will be incorporated in the final

70

revision of the survey tool.

It will be pilot test among

20 high school adolescents affected in Iloilo City National High School who will not be included among the actual

respondents of the study. The pre-tested test tool will then Alpha be subjected test to for

reliability reliability.

using

Cronbachs

method

Data Gathering Procedure

Before seek

conducting from

the the

survey, school

the

researchers of

will

permission

principal

Iloilo

National High School.

A formal communication letter will

be prepared, signed by the leader of the researchers and noted by the adviser stating the purpose of the study. During the process of gathering the data, the

researchers will introduce their self to the respondents and explain the purpose of their study. The respondents are given the choice to participate or not. The respondents are guaranteed of the confidentiality of the information upon approval. The participants will be given an ample time to answer the questionnaire.

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Data Processing

The questions gathered.

researchers to To ensure prepare analysis,

will the the

tally

the of the

answers the

to

the

completeness data and

information for and

information encoding

statistical

categorization,

tabulation will be performed. All statistical analysis will be done using the Statistical Package for Social Sciences (SPSS) software. The result of the study will be presented in tabular form for analysis and discussion of the result. A preliminary survey was done last May 7 and 9, 2011 among high school adolescents in Iloilo City affected with acne vulgaris. This is with regards as to their perception on acne vulgaris and their level of self-esteem. There are a total of 25 respondents (10 males and 15 females). We

categorized their perception as normal, ignore, bothersome and burdensome. Their level of self-esteem was further

categorized as very high, high, low and very low. Results showed that there are 8% of the respondents who have

burdensome perception with very low self-esteem; 20% of the respondents have bothersome perception with low self-

esteem; 8% of the respondents have bothersome perception

72

with

high

self-esteem; perception have of high the with

20% low

of

the

respondents 32% high of

have the

ignorable

self-esteem; with

respondents esteem; with 4%

ignorable

perception have of

self-

respondents 4%

ignorable the

perception have the

very

self-esteem; with normal high

respondents and very 4% of

normal

perception have

self-esteem; with

respondents esteem.

perception

high

self-

Summing up, a total of 64% of the respondents have their perception related to their level of self-esteem

while 36% of the respondents shows the opposite.

Statistical Treatment and Analysis

The

data

to

be

gathered

for

this

study

will

be

subjected to both descriptive and inferential statistics.

Mean. The mean was used to describe the respondents profile, perception on acne vulgaris and their level of self-esteem. T-test. analyzing This kind of statistical in the tool was used on in

the

differences

perception

acne

73

vulgaris and level of self-esteem when they are group by age, sex, socio-economic status. ANOVA. The analysis of variance was utilized to

determine the differences in the perception of adolescents in acne vulgaris, as well as their level of self-esteem, when they are group by socio-economic status. Pearsons R Correlation. This statistical tool was

used to determine the relationship between the perception on acne vulgaris and their level of selfesteem. The level of significance is set as 0.05 since the study is

descriptive and non-experimental.