Atrophic Acne Scars and Patients’ Social Functioning and Emotional Well-Being

Atrophic acne scars can have a substantial, negative affect on patients’ quality of life and social functioning, according to study findings published in the Journal of the American Academy of Dermatology.

The mixed-method study used qualitative interviews and a quantitative survey of patients in the United States, Canada, Brazil, France, Italy, and Germany from 2019 to 2020. Eligible participants were aged 18 to 55 years with mild to severe facial atrophic acne scars.

A total of 30 patients (5 from each country) participated in the 60-minute telephone semistructured interview—70% participants were aged 25 to 45 years, and 60% were women. Among the 723 patients (51.6% women) who participated in the quantitative survey, 12.7%, 71.8%, and 15.5% were aged 18 to 24, 25 to 45, and 46 to 55 years, respectively.

The patients began to have atrophic acne scars at a mean age of 19.1 years (standard error of the mean [SEM], 0.39) and had scarring for a mean of 15.7 years (SEM, 0.35). Also, 31.6%, 49.6%, and 18.8% of participants had mild, moderate, and severe/very severe scarring, respectively.

In the qualitative interviews, reduced self-esteem and self-consciousness were recurrent themes expressed, along with ugliness/beauty. Self-esteem was the domain most affected by acne scars (3.57 on a Likert scale of 1 [no impact at all] to 5 [extreme impact), followed by hygiene habits (3.43) and finances/expenses (3.03).

Among participants in the quantitative survey, 51.8% thought that they were unattractive owing to their acne scars, and 25.7% felt ‘‘extremely’’ or ‘‘much less’’ attractive than others. Regarding their level of embarrassment/self-consciousness, among patients with severe acne, 20.1% responded “very much,” 27.2% responded “a lot,” and 34.5% responded “a little.” Among those with mild acne, 6.2% responded “very much,” 13.4% responded “a lot,” and 48.5% responded “a little.”

In addition, 8.6% of participants from the quantitative survey believed that their work life was ‘‘very much/extremely’’ affected, and 15.9% thought that they had been unfairly dismissed from work or passed over for a job.

Among other findings, 32.9% of participants in the quantitative survey reported receiving negative comments owing to their acne scars, 8.3% reported being verbally and/or physically abused because of their scars on a regular basis, and more than 37.0% of the participants thought that their scars affected people’s perception of them. Also, 19.7% felt ‘‘very’’ or ‘‘extremely’’ bothered and tried to hide their scars with clothes, hairstyle, or makeup, 35.5% responded that their scars prevented them from engaging in activities that they like to do, and 43.2% thought that their scars had a negative impact on their relationships.

Participants in the interview stated that the appearance of their scars, stigma, and daily life restrictions adversely affected their emotional well-being, with 1 participant responding, “It bothers me a lot and makes me sad.”

Overall, 36.2% of the survey responders reported having no control over their scars, and 28.4% thought that nothing could be done to improve the appearance of their scars.

Potential study limitations include the lack of assessment of the survey’s construct validity and reliability, and recruitment relied on self-reported scar severity.

“Acne scar management remains challenging, and scars may remain an indelible and permanent feature after acne,” the researchers commented. “Therefore, effective therapies aimed at reducing the development of acne scarring are integral to prevent the associated debilitating psychosocial effects that may arise from acne scars.”

Disclosure: This research 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 disclosures.


Tan J, Beissert S, Cook-Bolden F, et al. Evaluation of psychological well-being and social impact of atrophic acne scarring: a multinational, mixed-methods study. JAAD Int. 2021;6:43-50. doi:10.1016/j.jdin.2021.11.006