This study, published in Dermatology and Therapy (2022), investigates the psychological and social impacts of combined facial and truncal acne (CA) using a mixed-methods approach.
Study Overview
• Objective: To evaluate the psychological wellbeing and social impact of CA in adolescents and adults.
• Methods:
• Qualitative Phase: 60-minute interviews with 30 participants with CA to identify themes, conducted in 2019 across the USA, Canada, Brazil, France, Italy, and Germany.
• Quantitative Phase: A cross-sectional survey of 694 participants with CA (2019–2020), using validated health-related quality of life (HRQOL) scales like the Dermatology Life Quality Index (DLQI) and Comprehensive Acne Quality of Life (CompAQ).
• Participants were aged 13–40, diagnosed with acne by a physician, and receiving prescription treatment. Acne severity was self-assessed using a modified Investigator Global Assessment (IGA) scale.
• Compliance: The study adhered to ethical guidelines (e.g., Helsinki Declaration, GDPR) with informed consent obtained.
Key Findings
1. Psychological Impact:
• Over 50% of participants frequently or always experienced embarrassment (51.6%), self-consciousness (53.8%), and low self-confidence (53.5%) due to CA.
• These feelings were significantly worse in those perceiving their acne as uncontrolled (P=0.003 for embarrassment).
• Common themes included reduced self-esteem, poor self-image, and feeling unattractive or ashamed.
2. Social Impact and Stigma:
• Stigmatization: 50% felt judged or stigmatized, with 65.4% believing others associated truncal acne with unhealthy/unhygienic habits. Perceived stigma correlated with increased embarrassment (P=0.005), self-consciousness (P=0.034), and low self-confidence (P=0.017).
• Social Avoidance: 64% reported CA interfered with daily life, 46.4% avoided social interactions, 48.6% were concerned about talking to strangers, and 47.4% felt uncomfortable showing affection.
• Romantic Relationships: Among participants ≥16 years, 32% avoided dating due to facial acne, and 24.4% due to truncal acne.
• Behavioral Adaptations: Participants hid acne with clothing and hairstyles and avoided activities like swimming or beach outings to prevent exposure.
3. Impact of Acne Control:
• Participants with controlled acne (perceived as partially or completely under control) reported significantly less embarrassment (48.6% vs. 71.0% for uncontrolled facial acne, P=0.004; 48.7% vs. 72.8% for truncal acne, P=0.003) and fewer disruptions in social/leisure activities.
• Those with uncontrolled truncal acne were more likely to avoid undressing in front of others (90.5% vs. 80.6%, P=0.031).
4. Daily Life and Leisure:
• CA care routines were time-consuming (average 17.9 min/day for facial acne, 15.4 min/day for truncal acne), with complexity increasing with acne severity (P<0.05).
• Participants adapted by avoiding certain foods, beverages, or sun exposure to manage acne risk factors.
Conclusions
• CA is associated with significant psychological morbidity, including embarrassment, self-consciousness, and low self-esteem, exacerbated by perceived stigma and societal judgment.
• Uncontrolled acne amplifies negative impacts on emotional wellbeing and social functioning, while perceived control mitigates these effects.
