Women with Acne Commonly Experience Depression and Social Isolation

John Barbieri, MD, MBA

A new study sheds light on the mental health burdens and care experiences among women with acne.

“Given the profound association of acne with quality of life, several qualitative studies have sought to understand the lived experience of acne among adolescents,” the investigators wrote.

They noted, however, that few studies have explored the lived experiences and treatment in adult populations, particularly in a large sample size.

As a result, the team, led by John Barbieri, MD, MBA, of the University of Pennsylvania Perelman School of Medicine, performed a qualitative analysis among female participants with moderate to severe acne at both the University of Pennsylvania and a private practice in Ohio.

The Study

Barbieri and colleagues enrolled a total of 50 women with a mean age of 48 years.

The team conducted free listing and open-ended, semistructured interviews over the phone.

“During the free-listing phase, participants were asked to describe the first words that came to their mind regarding acne treatments, treatment success, and adverse effects,” they explained. Results were then used to calculate Smith S for saliency.

The interviews were designed to elicit participants’ experiences with acne and treatment. “Because the Institute of Medicine has prioritized a need for comparative effectiveness research on long-term treatments for acne,” they added, “we additionally asked participants about their perspectives on participating in a theoretical comparative effectiveness trial to guide the design of a future trial.”

Lived Experiences

In the free listing, the most salient terms related to treatment success were clear skin (salience index, 0.67), no scarring (salience index, 0.09), and no acne (0.09). The most salient terms associated with treatment adverse effects were dryness (salience index, 0.67) followed by redness (salience index, 0.21) and burning (salience index, 0.14).

“When describing ways in which acne had affected their lives, participants consistently noted that their blemishes made them highly aware of their appearance,” the team reported.

Patients commonly expressed feelings of self-consciousness, depression, anxiety, and social isolation. Many participants shared that their acne particularly affected their mental health and well-being.

Even more, a common experience among patients was cancelling or postponing social interactions due to feelings of insecurity, especially during a flare-up. Self-esteem was largely impacted, which negatively affected experiences in romantic relations.

Patients also defined successful treatment as having completely clear skin over time or a manageable number of blemishes. While some were concerned with the physical symptoms of acne on their faces, others focused on resolving social and emotional consequences of their condition.

Many patients expressed frustration with finding a dermatologist with whom they could feel comfortable. There were also common frustrations in finding a provider who could identify effective treatments for their acne.

And finally, many patients were open-minded to the idea of participating in a comparative effectiveness clinical trial designed to understand and identify the best treatment regimens for acne. Some indicated they would partake in a study if they knew it would help with treatment and management of their and others' acne.

“The results of this qualitative study suggest that women with acne have strong concerns about appearance and experience mental and emotional health consequences and disruption of their personal and professional lives,” Barbieri and colleagues wrote. “In addition, many patients describe challenges finding effective treatments and accessing care”

As such, they supported the idea of comparative effectiveness clinical trials involving this particular patient population.

The study, “Patient Perspectives on the Lived Experience of Acne and Its Treatment Among Adult Women With Acne: A Qualitative Study,” was published online in JAMA Dermatology.