Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled Study

Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled Study Elif Nur Alagöz, Mustafa Tosun, Rukiye Yasak Güner, Melih Akyol This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5355398/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Acne vulgaris (AV) is a chronic inflammatory skin condition predominantly observed during adolescence. Interoception accuracy (IAc) refers to the ability to perceive internal bodily states such as hunger and thirst. Since the brain and skin originate from the same embryological layer, the ectoderm, it is hypothesized that skin changes and disorders might affect individual perceptions. The purpose of this study is to evaluate the relationship between IAc and AV. This study included 94 AV patients and 94 sex- and age-matched healthy controls. The participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Dermatology Life Quality Index (DLQI), and heartbeat perception task to assess IAc. The severity of acne was assessed using the Global Acne Grading System (GAGS). Acne patients had lower IAc scores than controls did (P = 0.026). Severe depression or anxiety symptoms were associated with lower IAc scores (P = 0.027, P = 0.046). Acne severity did not significantly affect IAc scores. There was a weak negative connection between the DLQI score and IAc (r = -0.208, P = 0.022), suggesting that lower quality of life is correlated with reduced IAc. Gender significantly influenced IAc. As a result, individuals with acne may have a reduced capacity to accurately perceive internal bodily states, potentially impacting overall well-being. Enhancing interoception might positively contribute to AV treatment and management. Acne Vulgaris Interoception Accuracy Heartbeat perception Figures Figure 1 Figure 2 Figure 3 Introduction Interoception is defined as the cognitive and sensory processes through which the brain perceives, interprets, and integrates signals emanating from within the body. This includes a wide range of visceral sensations, such as hunger, thirst, and afferent signals related to cardiovascular and respiratory functions. Studies have shown that interoception is a multilayered concept encompassing interoceptive accuracy, awareness, and sensitivity [1]. Interoceptive accuracy (IAc) represents how well individuals can perceive and validate their internal physiological signals. This term assesses how sensitively an individual perceives internal signals through objective tests such as heartbeat detection tests [2]. Embryologically, the skin and skin develop from the same layer; the skin plays a critical role in expressing emotions and forming an individual's self-perception and is considered an important mode of communication between external and internal psychic and biological processes [3]. The skin acts as a sensor for detecting environmental events, and some authors even describe it as the "brain on the outside" [4]. The ability to accurately perceive internal signals from the body, known as IAc, is believed to be impaired in numerous mental and physical health conditions [5]. Recent studies have shown that patients with chronic conditions exhibit lower IAc [6]. Atypical interoception has been associated with physical health problems such as diabetes and obesity, as well as psychiatric conditions such as depression and anxiety [7, 8]. Acne vulgaris (AV) is a chronic skin disease characterized by lesions such as papules, comedones, scars, and nodules associated with sebum production and originates in pilosebaceous follicles, especially in the facial area [9]. Approximately 90% of adolescents experience AV, and half of these individuals continue to experience acne symptoms into adulthood [10]. In this study, we aimed to evaluate the effects of skin changes on individuals' interoceptive accuracy in patients with acne vulgaris. Materials and methods Our study was approved by the local Ethics Committee (approval number: 2023-03/61, date: 22.03.2023). This study included 94 age- and sex-matched AV patients and 94 healthy controls who were followed up in our clinic between April 2023 and September 2023. Informed consent was obtained from all participants, who were informed about the study. Patients under eighteen years of age, those with active infections, pregnancy, breastfeeding, obesity, psychiatric disorders, diabetes mellitus, thyroid disease, cardiovascular and cerebrovascular disease, acute or chronic kidney or liver failure, active or chronic inflammatory disease, and other autoimmune diseases were excluded from our study. The demographic information of all the participants was recorded. Quality of life was measured using the Dermatology Life Quality Index (DLQI), and acne severity was measured using the Global Acne Grading System (GAGS). For every participant, information was gathered from the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Beck Depression Inventory This is a self-assessment scale used to identify depressive symptoms and attitudes. It consists of 21 items, each scored from 0 to 3, with the highest possible score being 63. A higher total score indicates an increased severity of depression experienced by the individual. The inventory, developed by Beck et al. [11], has had its validity and reliability established in our country by Hisli [12]. Beck Anxiety Inventory This inventory, consisting of 21 items scored on a quadruple scale (0–3), was used to assess the severity of anxiety symptoms. The responses are aggregated into a single score ranging from 0 to 63, with scores ≥ 8 indicating clinically significant levels of anxiety. The validity and reliability adaptations for the Turkish population were conducted by Ulusoy et al. [13]. Dermatology Life Quality Index The DLQI, a common test specific to dermatological diseases, consists of a total of 10 questions assessing patients’ quality of life. Each question is scored between 0 and 3, with a higher total score being associated with a poor quality of life. A validity and reliability study was conducted by Öztürkcan et al. [14, 15]. Global Acne Grading System The GAGS is a scoring system used to assess acne severity on the basis of the distribution and type of lesions on the body. Patients receive a global acne score ranging from 0 to 44. Acne severity is categorized via this score as follows: "No acne (0 points), mild (1–18 points), moderate (19–30 points), severe (31–38 points), and very severe (> 39 points)." Procedure The participants underwent noninvasive cardiac monitoring with six transepidermal probes placed in the thoracic region. The pulse rates were observed at intervals of 25, 35, 45, and 100 seconds. Unaware of these time durations, the participants were instructed to mentally count their heartbeats during these intervals. Data were collected on both the objectively measured pulse rates, as recorded by the Hwatime H8 Patient Monitor, and the participants' subjective heartbeat counts for each time period. The IAc was determined via the following formula and evaluated with a score ranging from 0–100: ([1−(| actual heartbeat count – participant's estimate |]/actual heartbeat count)*100 Statistical analysis The SPSS software program (version 22.0) was used to evaluate the data gathered for this investigation. The Kolmogorov-Smirnov test was used to determine whether the continuous data distribution was normal. Medians (min–max) are used to display descriptive statistics for quantitative variables. The chi-square test was used to compare categorical ratios. While the Mann-Whitney U test was used to compare two independent groups, the Kruskal-Wallis test was used to compare many independent groups. The Spearman correlation test was applied. To ascertain the influence of different parameters on IAc, multiple linear regression analyses were carried out. 0.05 was used as the significance threshold (p value). Results The characteristics of both groups (n = 94 each) are displayed in Table 1 . Participants' median age was 22.84 years, and there was no statistically significant difference in age, sex, BMI, occupation, or education between the patient and control groups (P > 0.05). Table 1 General characteristics of the patient and control groups. Variable n (%) p* Patient (n = 94) Control (n = 94) Total (n = 188) Age Median (min–max) 22.65 (19–27) 23.03 (20–26) 22.84 (19–27) p > 0.05 Gender Male Female 35 (37.2) 59 (62.8) 37 (39.4) 57 (60.6) 72 (38.3) 116 (61.7) Height Median (min–max) 168.66 (150–190) 170.8 (150–190) 169.73 (150–190) Weight Median (min–max) 62.38 (43–90) 64.08 (43–98) 63.23 (43–98) BMI Median (min–max) 21.87 (16.07–28.73) 21.78 (16.71–29.39) 21.83 (16.0-29.3) Profession Student Employee 89 (94.7) 5 (5.3) 90 (95.7) 4 (4.3) 179 (95.2) 9 (4.8) Graduation status High School University 83 (88.3) 11(11.7) 90 (95.7) 4 (4.3) 173 (92) 15 (8) GAGS score Median (min–max) 16.12 (1–38) - - - GAGS classification Mild Moderate Severe Very Severe 66 (70.2) 23 (24.5) 5 (5.3) 0 - - Acne disease duration (month) Median (min–max) 35.95 (1-180) - - GAGS, Global Acne Grading System; BMI, Body Mass Index. *The level of significance (P value) was accepted as 0.05. While no difference in BDI scores was found between the patient and control groups (P > 0.05), the BAI scores of the patient group were significantly greater than those of the control group (P < 0.05). Individuals in the control group used more tobacco and alcohol than did those in the patient group (P < 0.05). The median GAGS score in the patient group was 16.12. According to the GAGS classification, 70.2% (n = 66) of patients presented mild acne symptoms, 24.5% (n = 23) presented moderate symptoms, and 5.3% (n = 5) presented severe symptoms. In the present study, 29.8% (n = 28) of patients had not received previous treatment, 20.2% (n = 19) had been treated with topical antibiotics and benzoyl peroxide, and 18.1% (n = 17) had received systemic isotretinoin treatment (Table 1 ). A moderate positive correlation was found between acne severity and dermatological quality of life (r = 0.273, P = 0.004), and moderate positive and significant correlations were also found between dermatological quality of life and both BAI and BDI scores (r = 0.376, P < 0.001; r = 0.442, P < 0.001). These findings indicate that as acne severity increases, quality of life decreases, and anxiety and depression levels increase. There was a low-level significant and positive correlation between BAI scores and GAGS scores (r = 0.175, P = 0.0046); similarly, a low-level significant and positive correlation was found between BDI scores and GAGS scores (r = 0.176, P = 0.045). In the patient group, the medium IAc score of the participants was 66.02, whereas in the control group, the medium score was determined to be higher at 72.22. The IAc scores of patients diagnosed with AV were significantly lower than those of the control group (P < 0.05) (Table 2 and Fig. 1 ). Table 2 Comparison of the interoceptive accuracy scores by group. IAc p* Minimum Maximum Medium Patient(n = 94) 0.98 99.21 66.02 0.026 Control (n = 94) 5.55 98.87 72.22 Total (n = 188) 0.98 99.21 69.12 IAc, Interoceptive Accuracy. *The level of significance (P value) was accepted as 0.05. The participants were classified as either good or poor heartbeat perceivers using a cutoff score of 85. In the patient group, 25.5% (n = 24) were classified as good, whereas 74.5% (n = 70) were classified as poor; in the control group, 36.2% (n = 34) were good, and 63.8% (n = 60) were poor heartbeat perceivers. Overall, 30.9% (n = 58) were determined to be good, and 69.1% (n = 130) were poor heartbeat perceivers. Between the two groups in the analysis of "good/poor heartbeat perceivers", no statistically significant difference was found (P > 0.05). In the analysis conducted on all participants (n = 188), a statistically significant difference in IAc scores between males and females was demonstrated (P = 0.008). Compared with women, men had significantly higher IAc scores (P 0.05). No statistically significant difference was observed in the IAc scores concerning treatment methods (P > 0.05). When acne severity was classified as mild, moderate, or severe according to the GAGS score, no statistically significant difference in the IAc score was found (P > 0.05). Although there was no statistically significant difference between the groups, a decline in IAc scores with increasing disease severity is noteworthy (Fig. 3 ). No statistically significant correlation was found between the duration of AV or the GAGS score and the IAc score in the patient group (P > 0.05). The IAc scores of participants who smoked were higher than those of participants who never smoked or quit smoking (P < 0.05). Similarly, the IAc scores of participants who consumed alcohol were higher than those of participants who did not consume alcohol (P < 0.05) (Table 3 ). Table 3 Relationships of tobacco use, alcohol use, BAI, and BDI with interoceptive accuracy. IAc n Minimum Maximum Medium \(\:{\mathbf{p}}^{\mathbf{a}}\) Tobacco Never Used 129 0.98 99.21 67.71 0.004* Quit 6 35.35 86.15 56.47 Currently Using 53 6.67 98.87 74 Alcohol Never Used 141 0.98 99.21 67.45 0.04** Quit 9 44.83 96.14 71.79 Currently Using 38 6.67 98.87 74.68 Beck Depression Severity Minimal depression 119 (63.39) 5.55 99.21 68.91 0.027*** Mild depression 35 (18.62) 0.98 98.87 66.65 Moderate depression 26 (13.83) 6.67 96.21 77.59 Severe depression 8 (4.26) 21.46 78.27 55.5 Beck Anxiety Severity No Anxiety 107 8.01 98.87 70.74 0.046***** Mild Anxiety 50 5.55 99.21 70.75 Moderate Anxiety 19 35.35 95.85 67.62 Severe Anxiety 12 0.98 78.27 50.23 * A significant difference was found between participants who smoke and those who have never smoked with a p value of 0.014, and between participants who smoke and those who have quit with a P value of 0.049 (P < 0.05). ** A significant difference was found between participants who consume alcohol and those who have never consumed alcohol with a p value of 0.034 (P < 0.05). *** A significant difference was found between "Moderate Depression" and "Severe Depression" with a P value of 0.031 (P < 0.05). **** The significant difference between "Severe Anxiety" and "Mild Anxiety" was found to be P = 0.037 (P < 0.05). IAc, Interoceptive Accuracy. aThe level of significance (P value) was accepted as 0.05. In our study, anxiety severity was categorized into four levels on the basis of BAI scores: no anxiety, mild, moderate, and severe. We observed that participants with severe anxiety had significantly lower IAc values than did those with mild anxiety (P < 0.05). Additionally, when IAc across the four groups classified by BDI scores, which reflect depression severity, a statistically significant difference was noted (P < 0.05). Notably, the IAc score decreased significantly from moderate to severe depression (P < 0.05) (Table 3 ). Weak negative correlations were found between the DLQI and IAc (r = -0.208, P = 0.022). As the DLQI score increases (indicating a decrease in quality of life), the IAc score decreases. These correlations are statistically significant for the subscales "symptoms and feelings" (r = -0.208, P = 0.021), "treatment" (r = -0.206, P = 0.023), and "interpersonal relationships" (r = -0.200, P = 0.027). However, no significant correlation was found for the other subscales. No statistically significant correlation was found between the BAI or BDI score and the IAc score (P > 0.05). The multiple linear regression analysis conducted in the patient group is shown. Accordingly, the gender factor was found to have a statistically significant effect on the dependent variable. The IAc value of female patients was determined to be approximately 9.942 units lower than that of male patients (P 0.05) (Table 4 ). Table 4 Multiple linear regression analysis of the IAc variable with tobacco/alcohol use, age, sex, duration and severity of disease, BDI/BAI score, and DLQI score in the patient group. Model Non-Standardized Coefficient (B) Standard Error Standardized Coefficient Beta t \(\:{\mathbf{p}}^{\mathbf{a}}\) (Constant) 85.261 29.798 2.861 .005 Gender* -9.942 4.961 − .223 -2.004 .048 Tobacco Use -5.658 3.355 − .190 -1.687 .095 Alcohol Use 1.022 5.381 .021 .190 .850 BMI .568 .859 .074 .660 .511 Acne Disease Duration (Month) .035 .083 .050 .425 .672 GAGS Score − .356 .326 − .124 -1.090 .279 BAI Score − .420 .329 − .175 -1.277 .205 DLQI Score − .248 .647 − .050 − .384 .702 BDI Score .213 .339 .093 .628 .532 Age − .503 1.264 − .046 − .398 .692 *Male patients = 0, Female patients = 1. BMI, Body Mass Index; GAGS, Global Acne Grading System; BAI, Beck's Anxiety Inventory; BDI, Beck's Depression Inventory; DLQI, Dermatology Life Quality Index. aThe level of significance (P value) was accepted as 0.05. Discussion AV, which commonly emerges during adolescence, is a chronic inflammatory skin disease affecting the pilosebaceous unit [9]. Acne and acne-derived scars can negatively impact individuals' quality of life as much as other chronic systemic diseases can. Moreover, these conditions can lead to psychological challenges such as depression or anxiety [16]. IAc is defined as the objective accuracy in detecting bodily sensations [17]. Individuals with low interoceptive sensitivity may experience difficulties in regulating their emotions [18]. A study conducted in 2009 indicated that, with the exception of age, no other demographic variable has a significant relationship with IAc. In this study, age was found to have a negative effect on IAc, which is associated with the loss of sensitivity of the central nervous system due to aging [19]. However, some studies have not reported a relationship between age and IAc [20]. In our study, we also did not detect such a relationship. This may be due to the limited age range of our sample. When examining the relationship between gender and IAc, it has been determined that men generally have greater interoceptive sensitivity than women do [21]. On the other hand, other studies in the literature have reported no significant difference in interoceptive sensitivity between male and female participants [7, 19]. Men's better perception of heartbeats may be due to the physiological characteristics of the heart [22]. Our findings highlight the importance of the gender factor. Our study revealed that IAc significantly differed according to sex, with women having lower IAc values than men do. This result is consistent with many studies in the literature [20, 21]. Additionally, in our study, a cutoff score of 85 and above for accuracy was accepted as the boundary between good and poor heartbeat perceivers, in reference to previous studies [23]. In this context, the majority of the sample considered good heartbeat perceivers consisted of male participants. According to some studies, interoceptive sensitivity is reduced in overweight and obese individuals, but no such relationship is observed for individuals in the normal weight range [24]. In line with this, a study in 2020 suggested that interoceptive sensitivity is significantly and negatively associated with heart rate and BMI [20]. In addition to these studies, other studies have not reported a relationship between BMI and IAc [9]. Similarly, our study did not observe a statistically significant relationship between BMI and IAc. The reason we did not find a significant result could be that most of the participants were within the normal BMI range, and obese individuals were not included in the study. In this pioneering study, we explored interoceptive senses in AV patients relative to healthy controls. Our findings align with the hypothesis that AV patients exhibit significantly altered interoceptive senses compared with controls. Specifically, the AV group's medium IAc scores were lower, indicating reduced internal insight in these individuals. This study, being the first of its kind, lacks comparative data from the literature. However, considering that interoception is thought to be related to many mental and physical health conditions [5], the cause of this low interoceptive sense in AV patients could be investigated. No significant relationship was found between the GAGS score and IAc, possibly because 89 out of the 94 patients included in the study fell into the mild or moderate acne severity categories. A trend of decreasing IAc from "no acne" to "severe" acne classifications was observed, suggesting that significant results could be obtained in future studies with larger samples. Our study revealed a negative relationship between the DLQI score and IAc score. Additionally, positive relationships were detected between DLQI scores and depression and anxiety inventory scores. A positive relationship was also found between the GAGS score and DLQI score. Therefore, consistent with other studies yielding similar results, we can say that as disease severity increases, individuals' quality of life deteriorates [25]. According to our study, no significant findings were observed between the current treatments and disease durations of patients diagnosed with AV and their IAc. Interoception, which plays a role in emotional processes, is associated with various mental pathologies, with atypical interoception [26]. Despite frequent theoretical emphasis and strong anticipation of the connections between IAc and mental health indicators, a meta-analysis conducted in 2020 failed to find any evidence for such a relationship at a meta-analytic level [27]. However, some studies have reported significant relationships between interoceptive sense, depression, and anxiety. For example, Pollatos et al. associated IAc positively with anxiety and negatively with depression. This study, like previous studies addressing the link between interoception and depression [7, 28], indicates that heartbeat awareness decreases as BDI scores rise from low to moderate levels. Anxiety is considered by some authors to be the most prototypical interoceptive disorder [29]. Despite good theoretical reasons that anxiety should be associated with atypical IAc, empirical evidence is lacking [30]. Many studies suggest that high anxiety is related to higher IAc (especially when measured by the heartbeat method) [7, 17]. Conversely, other studies on IAc and anxiety either reported no relationship 31 or reported the opposite pattern of results [31]. In our study, no relationship was found between the IAc score and anxiety score. According to the classification based on total BAI scores, participants with severe anxiety symptoms had a significantly lower IAc value than did those with no or mild anxiety symptoms. Notably, the IAc values between participants with severe anxiety symptoms and those with mild symptoms were significantly different. Individuals with poor interoceptive capacity show signs of anhedonia, which can lead to emotional and social dysfunctions associated with depression [32]. However, the generally different approach to the concept of time by depressed individuals [33] may lead to low IAc results in heartbeat counting tasks [20]. A study by Dunn et al. [34] revealed increased interoceptive sensitivity in individuals with severe depressive symptoms, but the inconsistency of these findings could be attributed to the small number of participants. In our study, no direct relationship was found between IAc and depression scores; however, it was determined that participants with severe depressive symptoms had significantly lower IAc values than those with moderate symptoms. Studies have demonstrated that individuals with addictions exhibit functional and structural differences in interoceptive brain regions. Our study revealed that smokers have higher IAc values than nonsmokers do, contradicting prior studies that associated tobacco use with low IAc [35]. However, findings that addiction sensitizes the insula could explain the increased IAc in smokers [36]. In the literature, individuals with alcohol use disorder (AUD) have been noted to have lower IAc [37]. One study has shown that alcohol affects insular function even in those who do not meet the criteria for AUD [38]. In our study, participants who consumed alcohol, although not diagnosed with AUD and who were social drinkers, had higher IAc values than nondrinkers did. Our study also revealed that the control group had higher rates of alcohol and tobacco use than did the patient group. This allows us to interpret the relationship between high IAc and alcohol and tobacco use in terms of the presence of individuals in the control group who use more alcohol and tobacco. Limitations Our study included individuals aged 19–27 years. However, this limited age range may not fully represent the general population. In recent years, the concept of interoceptive sensitivity (IS) has been defined across three different dimensions. For this study, we focused solely on the interoceptive accuracy dimension, without incorporating interoceptive sensitivity and interoceptive awareness. Conclusions This study revealed that patients diagnosed with AV have lower IAc scores than healthy individuals do. Other factors, such as the duration or severity of the disease, do not seem to affect IAc, except for sex. Furthermore, individuals with severe depression and anxiety symptoms exhibit lower IAc, but no direct correlation has been established between the scores of these scales and IAc. These findings indicate that factors affecting the quality of life of acne patients involve not only physical appearance but also a diminished internal perception. This study paves the way for further studies in dermatology and underscores the need to investigate the role of interoception in acne treatment more extensively. Declarations Author Contribution Conceptualization, E.N.E., R.Y.G., methodology, M.T, M.A.; software, E.N.E.; validation, M.T., M.A.; formal analysis, R.Y.G.; investigation, M.T.; resources, E.N.E.; data curation, M.T, E.N.E.; writing— original draft preparation, E.N.E.; writing—review and editing, M.T., E.N.E.; visualization, M.A.; supervision. References Höller I, Stenzel JS, Rath D, Forkmann T (2021) Listen to your heart–Ecological momentary assessment of interoceptive accuracy, awareness and sensibility: A pilot study. 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Front Psychol 11:597488. https://doi.org/10.3389/fpsyg.2020.597488 Khalsa SS, Lapidus RC (2016) Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry? Front Psychiatry 7:121. https://doi.org/10.3389/fpsyt.2016.00121 Domschke K, Stevens S, Pfleiderer B, Gerlach AL (2010) Interoceptive sensitivity in anxiety and anxiety disorders: an overview and integration of neurobiological findings. Clin Psychol Rev 30(1):1-11. https://doi.org/10.1016/j.cpr.2009.08.008 Sugawara A, Terasawa Y, Katsunuma R, Sekiguchi A (2020) Effects of interoceptive training on decision making, anxiety, and somatic symptoms. Biopsychosoc Med 14:1-8. https://doi.org/10.1186/s13030-020-00179-7 Quadt L, Critchley HD, Garfinkel SN (2018) The neurobiology of interoception in health and disease. Ann N Y Acad Sci 1428(1):112-128. https://doi.org/10.1111/nyas.13915 Bschor T, Ising M, Bauer M, Lewitzka U, Skerstupeit M, Müller-Oerlinghausen B, Baethge C (2004) Time experience and time judgment in major depression, mania and healthy subjects. A controlled study of 93 subjects. Acta Psychiatr Scand 109(3):222-229. doi:https://doi.org/10.1046/j.0001-690X.2003.00244.x Dunn BD, Dalgleish T, Lawrence AD (2006) The somatic marker hypothesis: a critical evaluation. Neurosci Biobehav Rev 30(2):239-271. doi:https://doi.org/10.1016/j.neubiorev.2005.07.001 Hina F, Aspell JE (2019) Altered interoceptive processing in smokers: Evidence from the heartbeat tracking task. Int J Psychophysiol 142:10-16. https://doi.org/10.1016/j.ijpsycho.2019.05.012 Naqvi NH, Rudrauf D, Damasio H, Bechara A (2007) Damage to the insula disrupts addiction to cigarette smoking. Science 315(5811):531-534. https://doi.org/10.1126/science.1135926 Jakubczyk A, Skrzeszewski J, Trucco EM, Suszek H, Zaorska J, Nowakowska M, Michalska A, Wojnar M, Kopera M (2019) Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder-Different phenomena with different clinical correlations? Drug Alcohol Depend 198:34-38. https://doi.org/10.1016/j.drugalcdep.2019.01.036 Vergara VM, Liu J, Claus ED, Hutchison K, Calhoun V (2017) Alterations of resting state functional network connectivity in the brain of nicotine and alcohol users. Neuroimage 151:45-54. https://doi.org/10.1016/j.neuroimage.2016.11.012 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Nov, 2024 Reviewers agreed at journal 06 Nov, 2024 Reviewers invited by journal 01 Nov, 2024 Editor assigned by journal 30 Oct, 2024 Submission checks completed at journal 30 Oct, 2024 First submitted to journal 29 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5355398","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":376041869,"identity":"a8944f34-a54d-4aee-971e-73bca947292c","order_by":0,"name":"Elif Nur Alagöz","email":"","orcid":"","institution":"Eregli State Hospital","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"Nur","lastName":"Alagöz","suffix":""},{"id":376041870,"identity":"cee80e6c-df8b-4c43-9857-9a1157c72df1","order_by":1,"name":"Mustafa Tosun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYDCCA2wg0kaOn70HzOfhI0ILYwMDQ5qxZM8ZIAeohY1ILYcSN9zIAWthIKiF73hb+oOPew4kbrj59uDjjzl2MmwMzA8f3cCjRfLMsYONM57dMZ55Oy/Z4OC2ZKDD2IyNc/BoMbiR3tjMc+CZbN/tHDOJg9uYgVp42KSJ0HKYseHmGZCWemK0pB0EaVGccIMHpOUwYS1AvyTOnHEAFMg5xgZntx3nYWMm4BdgiBl8+HAAFJVnDB9Ubqu252dvfvgYnxYsgJk05aNgFIyCUTAKsAAAcaRS1Fr6o50AAAAASUVORK5CYII=","orcid":"","institution":"Sivas Cumhuriyet University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Tosun","suffix":""},{"id":376041871,"identity":"2ac9a3a5-74c9-4a09-b2c1-2220e1d98d5e","order_by":2,"name":"Rukiye Yasak Güner","email":"","orcid":"","institution":"Sivas Cumhuriyet University","correspondingAuthor":false,"prefix":"","firstName":"Rukiye","middleName":"Yasak","lastName":"Güner","suffix":""},{"id":376041872,"identity":"12285bd8-67d7-40a8-ace4-5f0d26710cc1","order_by":3,"name":"Melih Akyol","email":"","orcid":"","institution":"Sivas Cumhuriyet University","correspondingAuthor":false,"prefix":"","firstName":"Melih","middleName":"","lastName":"Akyol","suffix":""}],"badges":[],"createdAt":"2024-10-29 15:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5355398/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5355398/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70037822,"identity":"2c40a163-171e-4e1f-b673-52d880d2ec9d","added_by":"auto","created_at":"2024-11-27 17:29:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82359,"visible":true,"origin":"","legend":"\u003cp\u003eMean Interoceptive Accuracy Values of the Patient and Control Groups\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5355398/v1/b98163253d278e36f0226228.jpg"},{"id":70037824,"identity":"210c2708-d187-4d07-9bcd-4ce762051fb4","added_by":"auto","created_at":"2024-11-27 17:29:13","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":73643,"visible":true,"origin":"","legend":"\u003cp\u003eInteroceptive Accuracy Score Comparison by Gender\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5355398/v1/95f237efd5eb5300ca4c88ab.jpg"},{"id":70038438,"identity":"ab0f4800-ce8a-4038-81be-702cde26d4a6","added_by":"auto","created_at":"2024-11-27 17:37:13","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":63130,"visible":true,"origin":"","legend":"\u003cp\u003eAverage Interoceptive Accuracy According to the Acne Severity Level\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5355398/v1/cd1895a0b892da9760babbc3.jpg"},{"id":70039315,"identity":"220633a6-6fb2-4b7d-8c4a-ad5149ea14ab","added_by":"auto","created_at":"2024-11-27 17:45:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":827128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5355398/v1/0727a7f0-475d-42ce-a96b-5a418002bb41.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInteroception is defined as the cognitive and sensory processes through which the brain perceives, interprets, and integrates signals emanating from within the body. This includes a wide range of visceral sensations, such as hunger, thirst, and afferent signals related to cardiovascular and respiratory functions. Studies have shown that interoception is a multilayered concept encompassing interoceptive accuracy, awareness, and sensitivity [1]. Interoceptive accuracy (IAc) represents how well individuals can perceive and validate their internal physiological signals. This term assesses how sensitively an individual perceives internal signals through objective tests such as heartbeat detection tests [2].\u003c/p\u003e \u003cp\u003eEmbryologically, the skin and skin develop from the same layer; the skin plays a critical role in expressing emotions and forming an individual's self-perception and is considered an important mode of communication between external and internal psychic and biological processes [3]. The skin acts as a sensor for detecting environmental events, and some authors even describe it as the \"brain on the outside\" [4].\u003c/p\u003e \u003cp\u003eThe ability to accurately perceive internal signals from the body, known as IAc, is believed to be impaired in numerous mental and physical health conditions [5]. Recent studies have shown that patients with chronic conditions exhibit lower IAc [6]. Atypical interoception has been associated with physical health problems such as diabetes and obesity, as well as psychiatric conditions such as depression and anxiety [7, 8].\u003c/p\u003e \u003cp\u003eAcne vulgaris (AV) is a chronic skin disease characterized by lesions such as papules, comedones, scars, and nodules associated with sebum production and originates in pilosebaceous follicles, especially in the facial area [9]. Approximately 90% of adolescents experience AV, and half of these individuals continue to experience acne symptoms into adulthood [10].\u003c/p\u003e \u003cp\u003eIn this study, we aimed to evaluate the effects of skin changes on individuals' interoceptive accuracy in patients with acne vulgaris.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e Our study was approved by the local Ethics Committee (approval number: 2023-03/61, date: 22.03.2023). This study included 94 age- and sex-matched AV patients and 94 healthy controls who were followed up in our clinic between April 2023 and September 2023. Informed consent was obtained from all participants, who were informed about the study. Patients under eighteen years of age, those with active infections, pregnancy, breastfeeding, obesity, psychiatric disorders, diabetes mellitus, thyroid disease, cardiovascular and cerebrovascular disease, acute or chronic kidney or liver failure, active or chronic inflammatory disease, and other autoimmune diseases were excluded from our study. The demographic information of all the participants was recorded.\u003c/p\u003e \u003cp\u003eQuality of life was measured using the Dermatology Life Quality Index (DLQI), and acne severity was measured using the Global Acne Grading System (GAGS). For every participant, information was gathered from the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eBeck Depression Inventory\u003c/h2\u003e \u003cp\u003eThis is a self-assessment scale used to identify depressive symptoms and attitudes. It consists of 21 items, each scored from 0 to 3, with the highest possible score being 63. A higher total score indicates an increased severity of depression experienced by the individual. The inventory, developed by Beck et al. [11], has had its validity and reliability established in our country by Hisli [12].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBeck Anxiety Inventory\u003c/h3\u003e\n\u003cp\u003eThis inventory, consisting of 21 items scored on a quadruple scale (0\u0026ndash;3), was used to assess the severity of anxiety symptoms. The responses are aggregated into a single score ranging from 0 to 63, with scores\u0026thinsp;\u0026ge;\u0026thinsp;8 indicating clinically significant levels of anxiety. The validity and reliability adaptations for the Turkish population were conducted by Ulusoy et al. [13].\u003c/p\u003e\n\u003ch3\u003eDermatology Life Quality Index\u003c/h3\u003e\n\u003cp\u003eThe DLQI, a common test specific to dermatological diseases, consists of a total of 10 questions assessing patients\u0026rsquo; quality of life. Each question is scored between 0 and 3, with a higher total score being associated with a poor quality of life. A validity and reliability study was conducted by \u0026Ouml;zt\u0026uuml;rkcan et al. [14, 15].\u003c/p\u003e\n\u003ch3\u003eGlobal Acne Grading System\u003c/h3\u003e\n\u003cp\u003eThe GAGS is a scoring system used to assess acne severity on the basis of the distribution and type of lesions on the body. Patients receive a global acne score ranging from 0 to 44. Acne severity is categorized via this score as follows: \"No acne (0 points), mild (1\u0026ndash;18 points), moderate (19\u0026ndash;30 points), severe (31\u0026ndash;38 points), and very severe (\u0026gt;\u0026thinsp;39 points).\"\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe participants underwent noninvasive cardiac monitoring with six transepidermal probes placed in the thoracic region. The pulse rates were observed at intervals of 25, 35, 45, and 100 seconds. Unaware of these time durations, the participants were instructed to mentally count their heartbeats during these intervals. Data were collected on both the objectively measured pulse rates, as recorded by the Hwatime H8 Patient Monitor, and the participants' subjective heartbeat counts for each time period. The IAc was determined via the following formula and evaluated with a score ranging from 0\u0026ndash;100: \u003cem\u003e([1\u0026minus;(| actual heartbeat count \u0026ndash; participant's estimate |]/actual heartbeat count)*100\u003c/em\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe SPSS software program (version 22.0) was used to evaluate the data gathered for this investigation. The Kolmogorov-Smirnov test was used to determine whether the continuous data distribution was normal. Medians (min\u0026ndash;max) are used to display descriptive statistics for quantitative variables. The chi-square test was used to compare categorical ratios. While the Mann-Whitney U test was used to compare two independent groups, the Kruskal-Wallis test was used to compare many independent groups. The Spearman correlation test was applied. To ascertain the influence of different parameters on IAc, multiple linear regression analyses were carried out. 0.05 was used as the significance threshold (p value).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe characteristics of both groups (n\u0026thinsp;=\u0026thinsp;94 each) are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants' median age was 22.84 years, and there was no statistically significant difference in age, sex, BMI, occupation, or education between the patient and control groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of the patient and control groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min\u0026ndash;max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.65 (19\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.03 (20\u0026ndash;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.84 (19\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (37.2)\u003c/p\u003e \u003cp\u003e59 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (39.4)\u003c/p\u003e \u003cp\u003e57 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (38.3)\u003c/p\u003e \u003cp\u003e116 (61.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min\u0026ndash;max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168.66\u003c/p\u003e \u003cp\u003e(150\u0026ndash;190)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170.8\u003c/p\u003e \u003cp\u003e(150\u0026ndash;190)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e169.73\u003c/p\u003e \u003cp\u003e(150\u0026ndash;190)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min\u0026ndash;max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.38\u003c/p\u003e \u003cp\u003e(43\u0026ndash;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.08\u003c/p\u003e \u003cp\u003e(43\u0026ndash;98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.23\u003c/p\u003e \u003cp\u003e(43\u0026ndash;98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min\u0026ndash;max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.87 (16.07\u0026ndash;28.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.78 (16.71\u0026ndash;29.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.83\u003c/p\u003e \u003cp\u003e(16.0-29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (94.7)\u003c/p\u003e \u003cp\u003e5 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (95.7)\u003c/p\u003e \u003cp\u003e4 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e179 (95.2)\u003c/p\u003e \u003cp\u003e9 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGraduation status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (88.3)\u003c/p\u003e \u003cp\u003e11(11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (95.7)\u003c/p\u003e \u003cp\u003e4 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173 (92)\u003c/p\u003e \u003cp\u003e15 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGAGS score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min\u0026ndash;max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.12 (1\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGAGS classification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003eSevere\u003c/p\u003e \u003cp\u003eVery Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (70.2)\u003c/p\u003e \u003cp\u003e23 (24.5)\u003c/p\u003e \u003cp\u003e5 (5.3)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcne disease duration\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min\u0026ndash;max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.95 (1-180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGAGS, Global Acne Grading System; BMI, Body Mass Index.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e*The level of significance (P value) was accepted as 0.05.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhile no difference in BDI scores was found between the patient and control groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), the BAI scores of the patient group were significantly greater than those of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Individuals in the control group used more tobacco and alcohol than did those in the patient group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe median GAGS score in the patient group was 16.12. According to the GAGS classification, 70.2% (n\u0026thinsp;=\u0026thinsp;66) of patients presented mild acne symptoms, 24.5% (n\u0026thinsp;=\u0026thinsp;23) presented moderate symptoms, and 5.3% (n\u0026thinsp;=\u0026thinsp;5) presented severe symptoms. In the present study, 29.8% (n\u0026thinsp;=\u0026thinsp;28) of patients had not received previous treatment, 20.2% (n\u0026thinsp;=\u0026thinsp;19) had been treated with topical antibiotics and benzoyl peroxide, and 18.1% (n\u0026thinsp;=\u0026thinsp;17) had received systemic isotretinoin treatment (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA moderate positive correlation was found between acne severity and dermatological quality of life (r\u0026thinsp;=\u0026thinsp;0.273, P\u0026thinsp;=\u0026thinsp;0.004), and moderate positive and significant correlations were also found between dermatological quality of life and both BAI and BDI scores (r\u0026thinsp;=\u0026thinsp;0.376, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; r\u0026thinsp;=\u0026thinsp;0.442, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings indicate that as acne severity increases, quality of life decreases, and anxiety and depression levels increase.\u003c/p\u003e \u003cp\u003eThere was a low-level significant and positive correlation between BAI scores and GAGS scores (r\u0026thinsp;=\u0026thinsp;0.175, P\u0026thinsp;=\u0026thinsp;0.0046); similarly, a low-level significant and positive correlation was found between BDI scores and GAGS scores (r\u0026thinsp;=\u0026thinsp;0.176, P\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e \u003cp\u003eIn the patient group, the medium IAc score of the participants was 66.02, whereas in the control group, the medium score was determined to be higher at 72.22. The IAc scores of patients diagnosed with AV were significantly lower than those of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the interoceptive accuracy scores by group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eIAc\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient(n\u0026thinsp;=\u0026thinsp;94)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eControl (n\u0026thinsp;=\u0026thinsp;94)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal (n\u0026thinsp;=\u0026thinsp;188)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIAc, Interoceptive Accuracy.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e*The level of significance (P value) was accepted as 0.05.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe participants were classified as either good or poor heartbeat perceivers using a cutoff score of 85. In the patient group, 25.5% (n\u0026thinsp;=\u0026thinsp;24) were classified as good, whereas 74.5% (n\u0026thinsp;=\u0026thinsp;70) were classified as poor; in the control group, 36.2% (n\u0026thinsp;=\u0026thinsp;34) were good, and 63.8% (n\u0026thinsp;=\u0026thinsp;60) were poor heartbeat perceivers. Overall, 30.9% (n\u0026thinsp;=\u0026thinsp;58) were determined to be good, and 69.1% (n\u0026thinsp;=\u0026thinsp;130) were poor heartbeat perceivers. Between the two groups in the analysis of \"good/poor heartbeat perceivers\", no statistically significant difference was found (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn the analysis conducted on all participants (n\u0026thinsp;=\u0026thinsp;188), a statistically significant difference in IAc scores between males and females was demonstrated (P\u0026thinsp;=\u0026thinsp;0.008). Compared with women, men had significantly higher IAc scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNo statistically significant relationships were found between IAc and occupational, educational, or physical parameters (age, weight, BMI) (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eNo statistically significant difference was observed in the IAc scores concerning treatment methods (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). When acne severity was classified as mild, moderate, or severe according to the GAGS score, no statistically significant difference in the IAc score was found (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAlthough there was no statistically significant difference between the groups, a decline in IAc scores with increasing disease severity is noteworthy (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No statistically significant correlation was found between the duration of AV or the GAGS score and the IAc score in the patient group (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe IAc scores of participants who smoked were higher than those of participants who never smoked or quit smoking (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, the IAc scores of participants who consumed alcohol were higher than those of participants who did not consume alcohol (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationships of tobacco use, alcohol use, BAI, and BDI with interoceptive accuracy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eIAc\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMinimum\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMaximum\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMedium\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\mathbf{p}}^{\\mathbf{a}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTobacco\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever Used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrently Using\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAlcohol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever Used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.04**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrently Using\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBeck Depression Severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimal depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (63.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.027***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (18.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (13.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (4.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBeck Anxiety Severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.046*****\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e* A significant difference was found between participants who smoke and those who have never smoked with a p value of 0.014, and between participants who smoke and those who have quit with a P value of 0.049 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e** A significant difference was found between participants who consume alcohol and those who have never consumed alcohol with a p value of 0.034 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e*** A significant difference was found between \"Moderate Depression\" and \"Severe Depression\" with a P value of 0.031 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e**** The significant difference between \"Severe Anxiety\" and \"Mild Anxiety\" was found to be P\u0026thinsp;=\u0026thinsp;0.037 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e\u003cem\u003eIAc, Interoceptive Accuracy.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eaThe level of significance (P value) was accepted as 0.05.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn our study, anxiety severity was categorized into four levels on the basis of BAI scores: no anxiety, mild, moderate, and severe. We observed that participants with severe anxiety had significantly lower IAc values than did those with mild anxiety (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, when IAc across the four groups classified by BDI scores, which reflect depression severity, a statistically significant difference was noted (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notably, the IAc score decreased significantly from moderate to severe depression (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWeak negative correlations were found between the DLQI and IAc (r = -0.208, P\u0026thinsp;=\u0026thinsp;0.022). As the DLQI score increases (indicating a decrease in quality of life), the IAc score decreases. These correlations are statistically significant for the subscales \"symptoms and feelings\" (r = -0.208, P\u0026thinsp;=\u0026thinsp;0.021), \"treatment\" (r = -0.206, P\u0026thinsp;=\u0026thinsp;0.023), and \"interpersonal relationships\" (r = -0.200, P\u0026thinsp;=\u0026thinsp;0.027). However, no significant correlation was found for the other subscales. No statistically significant correlation was found between the BAI or BDI score and the IAc score (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The multiple linear regression analysis conducted in the patient group is shown. Accordingly, the gender factor was found to have a statistically significant effect on the dependent variable. The IAc value of female patients was determined to be approximately 9.942 units lower than that of male patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The effects of all the other variables on the dependent variable were not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis of the IAc variable with tobacco/alcohol use, age, sex, duration and severity of disease, BDI/BAI score, and DLQI score in the patient group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Standardized Coefficient\u003c/p\u003e \u003cp\u003e(B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficient\u003c/p\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\mathbf{p}}^{\\mathbf{a}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e(Constant)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-9.942\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.961\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.223\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-2.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.048\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.850\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcne Disease Duration (Month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.672\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGAGS Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBAI Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDLQI Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.702\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBDI Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e*Male patients\u0026thinsp;=\u0026thinsp;0, Female patients\u0026thinsp;=\u0026thinsp;1.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eBMI, Body Mass Index; GAGS, Global Acne Grading System; BAI, Beck's Anxiety Inventory; BDI, Beck's Depression Inventory; DLQI, Dermatology Life Quality Index.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eaThe level of significance (P value) was accepted as 0.05.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAV, which commonly emerges during adolescence, is a chronic inflammatory skin disease affecting the pilosebaceous unit [9]. Acne and acne-derived scars can negatively impact individuals' quality of life as much as other chronic systemic diseases can. Moreover, these conditions can lead to psychological challenges such as depression or anxiety [16].\u003c/p\u003e \u003cp\u003eIAc is defined as the objective accuracy in detecting bodily sensations [17]. Individuals with low interoceptive sensitivity may experience difficulties in regulating their emotions [18].\u003c/p\u003e \u003cp\u003eA study conducted in 2009 indicated that, with the exception of age, no other demographic variable has a significant relationship with IAc. In this study, age was found to have a negative effect on IAc, which is associated with the loss of sensitivity of the central nervous system due to aging [19]. However, some studies have not reported a relationship between age and IAc [20]. In our study, we also did not detect such a relationship. This may be due to the limited age range of our sample.\u003c/p\u003e \u003cp\u003eWhen examining the relationship between gender and IAc, it has been determined that men generally have greater interoceptive sensitivity than women do [21]. On the other hand, other studies in the literature have reported no significant difference in interoceptive sensitivity between male and female participants [7, 19]. Men's better perception of heartbeats may be due to the physiological characteristics of the heart [22]. Our findings highlight the importance of the gender factor. Our study revealed that IAc significantly differed according to sex, with women having lower IAc values than men do. This result is consistent with many studies in the literature [20, 21]. Additionally, in our study, a cutoff score of 85 and above for accuracy was accepted as the boundary between good and poor heartbeat perceivers, in reference to previous studies [23]. In this context, the majority of the sample considered good heartbeat perceivers consisted of male participants.\u003c/p\u003e \u003cp\u003eAccording to some studies, interoceptive sensitivity is reduced in overweight and obese individuals, but no such relationship is observed for individuals in the normal weight range [24]. In line with this, a study in 2020 suggested that interoceptive sensitivity is significantly and negatively associated with heart rate and BMI [20]. In addition to these studies, other studies have not reported a relationship between BMI and IAc [9]. Similarly, our study did not observe a statistically significant relationship between BMI and IAc. The reason we did not find a significant result could be that most of the participants were within the normal BMI range, and obese individuals were not included in the study.\u003c/p\u003e \u003cp\u003eIn this pioneering study, we explored interoceptive senses in AV patients relative to healthy controls. Our findings align with the hypothesis that AV patients exhibit significantly altered interoceptive senses compared with controls. Specifically, the AV group's medium IAc scores were lower, indicating reduced internal insight in these individuals. This study, being the first of its kind, lacks comparative data from the literature. However, considering that interoception is thought to be related to many mental and physical health conditions [5], the cause of this low interoceptive sense in AV patients could be investigated.\u003c/p\u003e \u003cp\u003eNo significant relationship was found between the GAGS score and IAc, possibly because 89 out of the 94 patients included in the study fell into the mild or moderate acne severity categories. A trend of decreasing IAc from \"no acne\" to \"severe\" acne classifications was observed, suggesting that significant results could be obtained in future studies with larger samples.\u003c/p\u003e \u003cp\u003eOur study revealed a negative relationship between the DLQI score and IAc score. Additionally, positive relationships were detected between DLQI scores and depression and anxiety inventory scores. A positive relationship was also found between the GAGS score and DLQI score. Therefore, consistent with other studies yielding similar results, we can say that as disease severity increases, individuals' quality of life deteriorates [25]. According to our study, no significant findings were observed between the current treatments and disease durations of patients diagnosed with AV and their IAc.\u003c/p\u003e \u003cp\u003eInteroception, which plays a role in emotional processes, is associated with various mental pathologies, with atypical interoception [26]. Despite frequent theoretical emphasis and strong anticipation of the connections between IAc and mental health indicators, a meta-analysis conducted in 2020 failed to find any evidence for such a relationship at a meta-analytic level [27]. However, some studies have reported significant relationships between interoceptive sense, depression, and anxiety. For example, Pollatos et al. associated IAc positively with anxiety and negatively with depression. This study, like previous studies addressing the link between interoception and depression [7, 28], indicates that heartbeat awareness decreases as BDI scores rise from low to moderate levels. Anxiety is considered by some authors to be the most prototypical interoceptive disorder [29]. Despite good theoretical reasons that anxiety should be associated with atypical IAc, empirical evidence is lacking [30]. Many studies suggest that high anxiety is related to higher IAc (especially when measured by the heartbeat method) [7, 17]. Conversely, other studies on IAc and anxiety either reported no relationship \u003csup\u003e31\u003c/sup\u003e or reported the opposite pattern of results [31].\u003c/p\u003e \u003cp\u003eIn our study, no relationship was found between the IAc score and anxiety score. According to the classification based on total BAI scores, participants with severe anxiety symptoms had a significantly lower IAc value than did those with no or mild anxiety symptoms. Notably, the IAc values between participants with severe anxiety symptoms and those with mild symptoms were significantly different.\u003c/p\u003e \u003cp\u003eIndividuals with poor interoceptive capacity show signs of anhedonia, which can lead to emotional and social dysfunctions associated with depression [32]. However, the generally different approach to the concept of time by depressed individuals [33] may lead to low IAc results in heartbeat counting tasks [20]. A study by Dunn et al. [34] revealed increased interoceptive sensitivity in individuals with severe depressive symptoms, but the inconsistency of these findings could be attributed to the small number of participants. In our study, no direct relationship was found between IAc and depression scores; however, it was determined that participants with severe depressive symptoms had significantly lower IAc values than those with moderate symptoms.\u003c/p\u003e \u003cp\u003eStudies have demonstrated that individuals with addictions exhibit functional and structural differences in interoceptive brain regions. Our study revealed that smokers have higher IAc values than nonsmokers do, contradicting prior studies that associated tobacco use with low IAc [35]. However, findings that addiction sensitizes the insula could explain the increased IAc in smokers [36].\u003c/p\u003e \u003cp\u003eIn the literature, individuals with alcohol use disorder (AUD) have been noted to have lower IAc [37]. One study has shown that alcohol affects insular function even in those who do not meet the criteria for AUD [38]. In our study, participants who consumed alcohol, although not diagnosed with AUD and who were social drinkers, had higher IAc values than nondrinkers did. Our study also revealed that the control group had higher rates of alcohol and tobacco use than did the patient group. This allows us to interpret the relationship between high IAc and alcohol and tobacco use in terms of the presence of individuals in the control group who use more alcohol and tobacco.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur study included individuals aged 19\u0026ndash;27 years. However, this limited age range may not fully represent the general population. In recent years, the concept of interoceptive sensitivity (IS) has been defined across three different dimensions. For this study, we focused solely on the interoceptive accuracy dimension, without incorporating interoceptive sensitivity and interoceptive awareness.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study revealed that patients diagnosed with AV have lower IAc scores than healthy individuals do. Other factors, such as the duration or severity of the disease, do not seem to affect IAc, except for sex. Furthermore, individuals with severe depression and anxiety symptoms exhibit lower IAc, but no direct correlation has been established between the scores of these scales and IAc. These findings indicate that factors affecting the quality of life of acne patients involve not only physical appearance but also a diminished internal perception. This study paves the way for further studies in dermatology and underscores the need to investigate the role of interoception in acne treatment more extensively.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, E.N.E., R.Y.G., methodology, M.T, M.A.; software, E.N.E.; validation, M.T., M.A.; formal analysis, R.Y.G.; investigation, M.T.; resources, E.N.E.; data curation, M.T, E.N.E.; writing\u0026mdash; original draft preparation, E.N.E.; writing\u0026mdash;review and editing, M.T., E.N.E.; visualization, M.A.; supervision.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eH\u0026ouml;ller I, Stenzel JS, Rath D, Forkmann T (2021) Listen to your heart\u0026ndash;Ecological momentary assessment of interoceptive accuracy, awareness and sensibility: A pilot study. Int J Environ Res Public Health 18(9):4893. https://doi.org/10.3390/ijerph18094893\u003c/li\u003e\n\u003cli\u003eFerentzi E, Drew R, Tihanyi BT, K\u0026ouml;teles F (2018) Interoceptive accuracy and body awareness\u0026ndash;Temporal and longitudinal associations in a non-clinical sample. Physiol Behav 184:100-107. https://doi.org/10.1016/j.physbeh.2017.11.015\u003c/li\u003e\n\u003cli\u003eOsman OT, Mufaddel A, Almugaddam F, Augusterfer EF (2011) The psychiatric aspects of skin disorders. Expert Review of Dermatol 6(2):195-209. https://doi.org/10.1586/edm.11.10\u003c/li\u003e\n\u003cli\u003eSlominski A (2005) Neuroendocrine system of the skin. Dermatol 211(3):199-208. https://doi.org/10.1159/000087012\u003c/li\u003e\n\u003cli\u003eKhalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS et al (2018) Interoception and mental health: a roadmap. Biol Psychiatry Cogn Neurosci Neuroimaging 3(6):501-513. https://doi.org/10.1016/j.bpsc.2017.12.004\u003c/li\u003e\n\u003cli\u003eLocatelli G, Matus A, James R, Salmoirago-Blotcher E, Ausili D, Vellone E et al (2023) What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neurosci Biobehav Rev 148:105142. https://doi.org/10.1016/j.neubiorev.2023.105142\u003c/li\u003e\n\u003cli\u003ePollatos O, Traut‐Mattausch E, Schandry R (2009) Differential effects of anxiety and depression on interoceptive accuracy. Depress Anxiety 26(2):167-173. https://doi.org/10.1002/da.20504\u003c/li\u003e\n\u003cli\u003eSimmons WK, DeVille DC (2017) Interoceptive contributions to healthy eating and obesity. Curr Opin 17:106-112. https://doi.org/10.1016/j.copsyc.2017.07.001\u003c/li\u003e\n\u003cli\u003eOg\u0026eacute; LK, Broussard A, Marshall MD (2019) Acne vulgaris: diagnosis and treatment. 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Neuroimage 151:45-54. https://doi.org/10.1016/j.neuroimage.2016.11.012\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acne Vulgaris, Interoception, Accuracy, Heartbeat perception","lastPublishedDoi":"10.21203/rs.3.rs-5355398/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5355398/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAcne vulgaris (AV) is a chronic inflammatory skin condition predominantly observed during adolescence. Interoception accuracy (IAc) refers to the ability to perceive internal bodily states such as hunger and thirst. Since the brain and skin originate from the same embryological layer, the ectoderm, it is hypothesized that skin changes and disorders might affect individual perceptions. The purpose of this study is to evaluate the relationship between IAc and AV. This study included 94 AV patients and 94 sex- and age-matched healthy controls. The participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Dermatology Life Quality Index (DLQI), and heartbeat perception task to assess IAc. The severity of acne was assessed using the Global Acne Grading System (GAGS). Acne patients had lower IAc scores than controls did (P\u0026thinsp;=\u0026thinsp;0.026). Severe depression or anxiety symptoms were associated with lower IAc scores (P\u0026thinsp;=\u0026thinsp;0.027, P\u0026thinsp;=\u0026thinsp;0.046). Acne severity did not significantly affect IAc scores. There was a weak negative connection between the DLQI score and IAc (r = -0.208, P\u0026thinsp;=\u0026thinsp;0.022), suggesting that lower quality of life is correlated with reduced IAc. Gender significantly influenced IAc. As a result, individuals with acne may have a reduced capacity to accurately perceive internal bodily states, potentially impacting overall well-being. Enhancing interoception might positively contribute to AV treatment and management.\u003c/p\u003e","manuscriptTitle":"Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 17:29:08","doi":"10.21203/rs.3.rs-5355398/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2024-11-09T11:24:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304858286468845147645746810807319872985","date":"2024-11-06T10:51:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-01T08:28:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-30T17:08:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-30T17:08:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2024-10-29T14:57:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3527c443-22cc-47d8-8536-f7549e5bb7c8","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-11-27T17:29:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-27 17:29:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5355398","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5355398","identity":"rs-5355398","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}