Importance: Little is known about the prevalence and magnitude of stigmatizing attitudes of the general public toward individuals with acne.
Objective: To explore the degree of stigma toward individuals with acne and whether these attitudes vary based on characteristics of the individuals with acne or of the survey participants.
Design, setting, and participants: In this cross-sectional internet survey study, 4 stock portraits of adults that varied in sex (male/female) and skin tone (light/dark) were digitally enhanced to have acne (mild/severe). One of these 12 images was randomly presented to survey participants, who subsequently answered questions regarding stigmatizing attitudes with respect to the pictured individual, such as desire for social distance and stereotype endorsement. The survey was administered to a convenience sample of adult respondents in the US who were volunteers on the ResearchMatch platform.
Main outcomes and measures: Prevalence and magnitude of stigma toward individuals with acne.
Results: The survey was completed by 1357 respondents (65.7% completion rate) (mean [SD] age, 42.4 [14.3] years; 918 [67.7%] female, 439 [32.4%] male). Compared to those with no acne, for those with severe acne, participants reported less comfort being friends (adjusted coefficient [95% CI], -0.28 [-0.47 to -0.10]; P = .003), hiring (-0.33 [-0.51 to -0.15]; P < .001), having physical contact (-0.26 [-0.45 to -0.08]; P = .006), dating (-0.44 [-0.74 to -0.14]; P = .004), and posting a photograph together on social media (-0.50 [-0.70 to -0.30]; P < .001). Compared to those with no acne, participants were more likely to rate individuals with severe acne as having poor hygiene (adjusted coefficient [95% CI], -1.04 [-1.46 to -0.82]; P < .001) and being unattractive (-0.89 [-1.12 to -0.67]; P < .001), unintelligent (-0.42 [-0.63 to -0.22]; P < .001), unlikable (-0.36 [-0.56 to -0.15]; P < .001), immature (-0.52 [-0.74 to -0.30]; P < .001), and untrustworthy (-0.40 [-0.61 to -0.18]; P < .001). There was evidence that the effect size of the association of acne with desire to social distance was greater for individuals with dark skin.
Conclusions and relevance: This survey study demonstrates that stigmatizing attitudes toward patients with acne existed across a variety of social and professional scenarios, with severe acne and acne in darker skin tone being associated with a greater degree of stigma. These findings highlight the need to identify approaches to reduce stigmatizing attitudes in the community and for adequate access to care, which might prevent negative downstream effects related to these stigmatizing attitudes.