Ali Shields, BS

Credit: Barbieri Lab, Brigham and Women’s Hospital

There are prevalent stigmatizing attitudes aimed at individuals with acne in many different social and professional settings, according to recent findings, with greater stigma being seen in patients with darker skin types and more severe levels of acne.¹

Though there is prior self-stigma research done with the perspective of individuals with acne, the investigators noted that there was little known the general public’s perceptions of acne as well as the prevalence and the magnitude of such attitudes.^2,3

To expand upon this awareness of the public’s stigma toward acne, the new survey-based study was led by Ali Shields, BS, from Brigham and Women’s Hospital’s Department of Dermatology in Boston.

“Understanding stigmatizing attitudes is important because stigma can have a negative impact on the lived experience of those with acne and could adversely affect outcomes such as relationships, education, and employment opportunities,” Shields and colleagues wrote. “This study sought to explore the presence and degree of stigma toward individuals with acne and whether any factors modulate this stigma.”

Background and Findings

The investigators used a cross-sectional Internet-based survey to assess public stigma toward acne. Prior to participation in the survey, participants were given an online fact sheet to fill out detailing the data in the study and provided their consent by agreeing to the survey’s terms.

Qualtrics XM was implemented by the research team and featured 12 digitally enhanced portraits featuring adults. They included 1 male and 1 female that had lighter skin as well as 1 male and 1 female that had darker skin, all of which were obtained from a stock photography website.

Enhancements used by the investigators for the portraits included versions that showed mild and severe acne, and these were determined by board-certified dermatologists. Those involved in the study were randomly presented with 1 of the 12 standardized portraits, and they varied in skin tone, sex, and acne severity.

The participants gave their responses to questions linked to stigmatizing attitudes, including social distancing preferences and stereotype endorsement, in addition to beliefs in commonly-occuring myths about acne. The items used in the team’s survey were adapted from studies on stigma towards patients with either psoriasis or alopecia.

The participants’ responses were measured through the use of a 5-point Likert scale, with lower scores signifying higher levels of stigma.

Overall, the investigators ended up involving 1357 total respondents, with their completion rate being 65.7% and their mean age being 42.4 years. Among these study respondents, 67.7% were reported to be female and 32.4% male.

Participants that had severe acne were found by the research team to have reported lower comfort levels in several different social and professional situations as opposed to those with no acne. These individuals were also shown to be less comfortable in hiring situations (−0.33 [−0.51 to −0.15]; P < .001), with their friendships (adjusted coefficient [95% CI], −0.28 [−0.47 to −0.10]; P = .003), with physical contact (−0.26 [−0.45 to −0.08]; P = .006), with dating situations (−0.44 [−0.74 to −0.14]; P = .004), and with putting photos out on different social media platforms (−0.50 [−0.70 to −0.30]; P < .001).

The investigators found that individuals with severe cases of acne were more likely to be perceived as having poorer hygiene habits (−1.04 [−1.46 to −0.82]; P < .001) and of being unintelligent (−0.42 [−0.63 to −0.22]; P < .001). Additionally, they were believed to be less attractive (−0.89 [−1.12 to −0.67]; P < .001), immature (−0.52 [−0.74 to −0.30]; P < .001), unlikable (−0.36 [−0.56 to −0.15]; P < .001), and generally untrustworthy (−0.40 [−0.61 to −0.18]; P < .001) versus people without acne.

The team’s research suggests that the effects of acne on participants’ desires for social distancing were shown to be more pronounced for individuals with darker skin. These results demonstrate pervasive stigmatizing attitudes towards people with severe acne in many different circumstances.

“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,” they wrote.

References

1. ^{Shields A, Nock MR, Ly S, Manjaly P, Mostaghimi A, Barbieri JS. Evaluation of Stigma Toward Individuals With Acne. JAMA Dermatol. Published online December 06, 2023. doi:10.1001/jamadermatol.2023.4487.}
2. ^{Ra AG, Ho B, Bickerstaffe L, Bewley A. More than skin deep: a survey of real-life experiences of acne vulgaris. Br J Dermatol. 2022;186(1):191-193. doi:10.1111/bjd.20737.}
3. ^{Roosta N, Black DS, Peng D, Riley LW. Skin disease and stigma in emerging adulthood: impact on healthy development. J Cutan Med Surg. 2010;14(6):285-290. doi:10.2310/7750.2010.09053.}