Evaluation of Psychological Wellbeing and Social Impact of Combined Facial and Truncal Acne: a Multi-national, Mixed-Methods Study

Jerry Tan; Stefan Beissert; Fran Cook-Bolden; Rajeev Chavda; Julie Harper; Adelaide Hebert; Edward Lain; Alison Layton; Marco Rocha; Jonathan Weiss; Brigitte Dréno

doi:10.1007/s13555-022-00768-0

Evaluation of Psychological Wellbeing and Social Impact of Combined Facial and Truncal Acne: a Multi-national, Mixed-Methods Study

Dermatol Ther (Heidelb). 2022 Aug;12(8):1847-1858. doi: 10.1007/s13555-022-00768-0. Epub 2022 Jul 29.

Authors

Jerry Tan¹, Stefan Beissert², Fran Cook-Bolden³, Rajeev Chavda⁴, Julie Harper⁵, Adelaide Hebert⁶, Edward Lain⁷, Alison Layton⁸, Marco Rocha⁹, Jonathan Weiss¹⁰, Brigitte Dréno¹¹

Affiliations

¹ Schulich School of Medicine and Dentistry, Western University Canada, 2224 Walker Rd, Suite 300, Windsor, ON, N8W 5L7, Canada. jerrytan1230@outlook.com.
² Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
³ Mount Sinai Department of Dermatology, New York, 5 East 98th Street, New York, NY, 10029, USA.
⁴ Galderma SA, Zählerweg 10, 6300, Zug, Switzerland.
⁵ The Dermatology and Skin Care Center of Birmingham, 2470 Rocky Ridge Rd # 100, Vestavia Hills, AL, 35243, USA.
⁶ The University of Texas Medical School-Houston, 6655 Travis, Suite 980, Houston, TX, 77030, USA.
⁷ Austin Institute for Clinical Research, 1601 E Pflugerville Pkwy Suite 1101, Pflugerville, TX, USA.
⁸ Hull York Medical School, University Rd, Heslington, YO10 5DD, York, UK.
⁹ Federal University of São Paulo, R. Sena Madureira, 1500-Vila Clementino, São Paulo, SP, 04021-001, Brazil.
¹⁰ Georgia Dermatology Partners, (Formerly, Gwinnett Dermatology, PC), 2383 Pate St., N, Snellville, GA, 30078, USA.
¹¹ Unité Thérapie Cellulaire et Génique, Faculté de Médecine de Nantes, CHU Nantes-Place Alexis Ricordeau, 44093, Cedex 01, France.

Abstract

Introduction: Half of the individuals with facial acne develop truncal acne, but the impact of combined facial and truncal acne (CA) on patients' quality of life is poorly researched.

Methods: A 60-min interview of 30 participants with CA was conducted that formed the basis for a cross-sectional survey of 694 adolescents and adults with CA.

Results: The main themes identified from the qualitative interviews among CA subjects included acceptability to self and others, social functioning and emotional wellbeing. Feelings of embarrassment, self-consciousness and low confidence were experienced often or all the time by over 50% of participants, and were more frequent in those who perceived their acne to be out of control (P = 0.003). Half of patients reported feeling stigmatised because of their CA, and 65.4% believed that others associated their truncal acne with unhealthy or unhygienic habits. Perceived stigma was associated with more feelings of embarrassment (P = 0.005), self-consciousness (P = 0.034) and low self-confidence (P = 0.017). Overall, 64% participants reported that CA interfered with daily life, 46.4% often or always avoided social interaction, 48.6% were often concerned about talking to unfamiliar people and 47.4% were uncomfortable showing affection. Further, 32% and 24.4% participants ≥ 16 years old avoided dating or having romantic/intimate relationships because of their facial and truncal acne, respectively. Social and leisure activities were more frequently negatively impacted among those with perceived uncontrolled CA than among those with controlled CA. Avoiding undressing in front of spouse/partner/friends/relatives was more commonly reported by participants with perceived uncontrolled truncal acne than by those with controlled truncal acne (90.5% versus 80.6%, P = 0.031).

Conclusion: CA is associated with considerable psychological morbidity, with several exacerbating (e.g. perceived stigma) and attenuating factors (e.g. acne being perceived as being under control) that should be accounted for in CA management.

Keywords: Facial acne; Mixed method; Qualitative survey; Quality of life; Quantitative survey; Truncal acne.