Facial and Truncal Acne Associated With Psychological Morbidity

More than half of the patients with facial and truncal acne experienced appearance-related concerns that negatively affected their quality of life.

Combined facial and truncal acne (CA) negatively affects patients’ quality of life, including their emotional well-being, acceptability to self and others, and social functioning, researchers reported in findings published in Dermatology and Therapy.

The mixed-methods study evaluated key aspects of the experience, perception, and attitude of patients living with CA.

Participants in the qualitative and quantitative studies were diagnosed with acne by a physician and were currently being followed by a health care professional and receiving prescription treatment for acne. A total of 30 participants with CA were enrolled in 2019 for a 60-minute telephonic semi-structured interview with qualitative researchers. A cross-sectional, quantitative survey of an online respondent panel was conducted in 2019 to 2020 with 694 participants with CA.

Among the 30 participants (5 each in the United States, Canada, Brazil, France, Italy, Germany) in the qualitative interviews, 21 (70%) were aged 18 years and older (median age of 23 years; range, 13-37 years) and 17 (56.7%) were female (33% among children <18 years and 66.7% female among adults 18 years and older). All participants rated their facial and truncal acne as at least moderate.

CA is associated with considerable psychological morbidity, with several exacerbating (eg, perceived stigma) and attenuating factors (eg, acne being perceived as being under control) that should be accounted for in CA management.

A total of 694 patients with different severity levels of facial and truncal acne participated in the quantitative survey; 452 (65.2%) participants were aged 13 to 17 years, of whom 162 (35.8%) were female; 242 (34.8%) participants were aged 18 to 40 years (60.9% female).

The most common recurrent themes from the qualitative interviews related to the psychological effects of CA were reduced self-esteem, poor self-image, self-consciousness, and embarrassment. Among the participants in the quantitative survey, 51.6% and 53.8% often or always felt embarrassed and self-conscious because of their acne, respectively, and 53.5% often or always had reduced self-confidence.

The more frequently that the participants believed that they were judged, the more likely they were to report embarrassment (P =.001), self-consciousness (P =.001), and low self-confidence (P =.001). Those who reported bullying more frequently were embarrassed (P =.005) and self-conscious (P =.034) and had low self-confidence (P =.017) compared with those who did not experience bullying.

Concerns related to acne appearance, stigma, and/or daily life restrictions had a negative effect on patients’ personal relationships — 46.4% of participants often or always avoided social interaction, 48.6% were often concerned about talking to unfamiliar people, and 47.4% were uncomfortable showing affection to others, respectively. In addition, 32.0% and 24.4% participants aged 16 years and older reported avoiding dating or having romantic or intimate relationships owing to their facial and truncal acne, respectively.

Among the participants, 64.1% stated that CA interfered with their daily life, related to the time-consuming routine for their acne care. Participants with uncontrolled truncal acne more frequently reported avoiding undressing in front of their spouse/partner/friends/relatives compared with those who had controlled truncal acne (90.5% vs 80.6%, P =.031).

Study limitations include the cross-sectional design and self-reported acne severity. In addition, the construct validity and reliability of the survey were not evaluated.

“CA is associated with considerable psychological morbidity, with several exacerbating (eg, perceived stigma) and attenuating factors (eg, acne being perceived as being under control) that should be accounted for in CA management,” stated the investigators. “Uncontrolled facial and/or truncal acne negatively impacted the emotional well-being and daily life activities of afflicted individuals.”

Disclosure: This research was sponsored and funded 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.

This article originally appeared on Dermatology Advisor


Tan J, Beissert S, Cook-Bolden F, et al. Evaluation of psychological wellbeing and social impact of combined facial and truncal acne: a multi-national, mixed-methods study. Dermatol Ther (Heidelb). 2022;12(8):1847-1858. doi:10.1007/s13555-022-00768-0