Acne and Increased Psychological and Physical Burden

Conceptual of problems on woman skin.
The psychosocial burden of facial and truncal acne and acne scars are investigated.

Patients with facial and truncal acne (FTA) and acne scars (AS) have a considerable psychological and physical burden, according to findings from a study published in JAMA Dermatology.

The analysis included 2 qualitative study arms of patients with FTA and AS who completed a personification exercise called “Letter to my Disease.” The study was conducted in 6 countries: Canada, Brazil, France, Italy, Germany, and the United States.

Participants in the AS arm had moderate to severe atrophic AS on their faces and no active acne on the face for at least 2 years before the study. Those in the FTA arm had moderate to severe active acne on their face, neck, shoulders, chest/ torso, and/or back.

A total of 60 participants were enrolled (30 with active FTA and 30 with AS). Among those in the FTA arm (57%women; 87% with severe acne), 70% were aged between 13 and 25 years, and 30% were aged 26 to 40 years. In the AS arm (60% women), 30% of participants were aged 18 to 24 years and 70% were aged 25 to 45 years.

Of the overall cohort, 56 patients (28 in each group) completed the personification exercise, with the length of their letters ranging from 1 to 20 sentences. The 3 main themes that were observed were burden of the condition, attitudes and beliefs, and relationship to the personified disorder.

Being self-conscious was the most frequently reported psychological effect, and the lingering burden caused by FTA and AS was another recurrent notion. Poor self-esteem was more common among participants in the FTA arm (11 for FTA vs 4 for AS).

Patients with FTA described the helplessness and unfairness of dealing with their disorder, for which they did not know the origin or how to treat or control. Patients with AS expressed a broader range of emotions, which included struggle, annoyance, frustration, sadness, and resentment.

Shame/embarrassment was mentioned by 11 participants in the FTA group and 3 in the AS group. Visible marks were noted by 9 patients in the FTA group and 8 in the AS group. Financial burden was expressed by 5 patients with FTA and 3 with AS. Lack of treatment efficacy was noted by 4 patients in each group.

Regarding coping strategies, 12 participants in the FTA group and 11 in the AS group stated that they attempted to hide their condition. Both groups reported using make-up and clothes to cover their acne or scars as their main method of coping and maintaining a social life.

For both groups, the opinion of others and peer pressure were noted as a main factor of their emotions and choice to adopt concealing strategies at work and school.

Study limitations include the sample size, which did not allow generalization of findings or reporting of potential cultural differences that may exist among the participants. Also, the non-English letters were translated into English, which may have reduced the accuracy and nuance.

“Accurate diagnosis, establishing a relationship of trust between the managing physician and the patient, and discussing potential consequences with patients may help reduce frustration and anger,” stated the researchers.

Disclosure: This study was supported by Galderma. Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Tan J, Chavda R, Leclerc M, Dréno B. Projective personification approach to the experience of people with acne and acne scarring—expressing the unspoken. JAMA Dermatol. Published online July 20, 2022. doi:10.1001/jamadermatol.2022.2742