Combined facial and truncal acne (CA) had significant psychosocial impact in the form of embarrassment and self-consciousness. |
Subjects with CA felt significantly stigmatised, i.e. judged, for their acne and felt as if people were staring at their acne often or all the time, and the perceived stigma was associated with more feelings of embarrassment, self-consciousness and low self-confidence. |
Acne appearance-related concerns, stigma and/or daily life restrictions negatively affected social activities and personal relationships. |
Individuals who perceived that their CA was uncontrolled expressed significantly higher impact on quality of life (QoL). |
Introduction
Methods
Qualitative Survey Procedures
Quantitative Survey Procedures
Results
Sample Demographics and Clinical Characteristics
Qualitative Interviews
Quantitative Survey
Central Themes
Appearance and Emotional Wellbeing
17 years old, male, Brazil: “My problem was my appearance; I started to feel ugly. It soon became a very constant and ugly thing, and it was getting worse over time.”16 years old, female, France: “It soon became something I was ashamed of; one wonders what people will think. Looking into the mirror, I see that it becomes an obsession.”36 years old; female; Brazil: “Horrible, because it appeared in places where [acne] should not exist.”36 years old; female; Italy: “Because I feel estranged with myself, how could I feel comfortable with other people? Even if I’m better, there is always 10% of insecurity.”
17 years old; male; Brazil: “My problem was my appearance; I started to feel ugly.”
15 years old; female; France: “Having acne on my upper back and chest can give me an inferiority complex when I am with friends who don’t have acne.”
16 years old; female; France: “At the first [appointment] I felt intimidated to show all the acne areas on my body, but it went just fine.”
Acceptability to self and others
36 years old; female; Italy: “If there is a business event, I always hope it takes place in the evening – acne is less visible when you are not in broad daylight.”31 years old; female; USA: “I won’t go to the beach or the pool with friends. I won’t wear sundresses in the summer. People have noticed the acne on my back, and I don’t feel comfortable. It’s frustrating and it hits my self-esteem.”36 years old; female; Italy: “In the summer period having acne also on my shoulder and on my back became a big issue. I’m used to go to the beach early in the morning, sunbathing when there’s few people. When I’m enough tanned and my acne is less visible, I can go to the beach also later, when there are people around.”
36 years old; female; Brazil: “Having acne in other places that not the face, is terrible, because people have the impression that we do not treat ourselves and do nothing about it. It hurts a lot!”36 years old; female; Brazil: “When they see the acne in other parts of our body, they tend to think something like that: ‘Look, what a bizarre thing!’”
19 years old; male; France: “My friends made fun of people who had a lot of pimples…”
Sociability and personal relationships
31 years old; female; USA: “The acne on my back is worse but it is easily covered.”13 years old; female; Germany: “The facial acne has a bigger impact, because on the shoulders and the neckline I can hide it.”
31 years old; female; USA: “I wanted to go to the beach with my co-worker, but I didn’t go because of my acne. I was annoyed that it could influence my decision.”36 years old; female; Canada: “I’m not as willing to expose my back, because I don’t have perfect skin, especially during flare ups.”16 years old; female; France: “I had 2 weddings recently, it was difficult to get dressed. What I have learned the hard way that it wasn’t the best idea to wear a dress with an exposed back so now I try to avoid those types of events!”.
25 years old; female; Italy: “In general, facial acne impacts more on my daily life, on my social relationship. Actually, in this summer period, acne on the shoulders is also really important. The shoulders acne is more visible.”37 years old; male; USA: “It’s hard to meet new people. I don’t want them to see me like this.”31 years old; male; Germany: “It has an impact on one’s sexual life, because you are completely naked in a real and in a metaphorical sense; I mean, you have to show yourself as you are; that costs a lot of effort.”25 years old; female; Canada: “Because I’m so self-conscious I don’t get into relationships with men. I’m hesitant to meet new people or go out with friends without all my makeup.”
Daily Life and Leisure Activities
23 years old; female; Brazil: “Having acne is having to have different eating habits than other people, with many restrictions, having to wake up too early to spend almost an hour in front of the mirror cleaning and passing creams, it is very tiring.”
22 years old; female; Brazil: “I pay more attention to my back, parts are difficult to apply; I’m quite stiff, reaching middle of my back, is difficult. It takes me more time to take care of my back than my face.”