Evaluation of psychological well-being and social impact of atrophic acne scarring: A multinational, mixed-methods study

Jerry Tan, Stefan Beissert, Fran Cook-Bolden, Rajeev Chavda, Julie Harper, Adelaide Hebert, Edward Lain, Alison Layton, Marco Rocha, Jonathan Weiss, Brigitte Dréno, Jerry Tan, Stefan Beissert, Fran Cook-Bolden, Rajeev Chavda, Julie Harper, Adelaide Hebert, Edward Lain, Alison Layton, Marco Rocha, Jonathan Weiss, Brigitte Dréno

Abstract

Background: Most people with acne are at risk of developing acne scars, but the impact of these scars on patients' quality of life is poorly researched.

Objective: To assess the perspective of patients with acne scars and the impact of these scars on their emotional well-being and social functioning.

Methods: A 60-minute interview of 30 adults with acne scars informed and contextualized the development of a cross-sectional survey of 723 adults with atrophic acne scars.

Results: The main themes identified in the qualitative interviews included acceptability to self and others, social functioning, and emotional well-being. In the cross-sectional survey, 31.6%, 49.6%, and 18.8% of the participants had mild, moderate, and severe/very severe acne scarring. The survey revealed that 25.7% of the participants felt less attractive, 27.5% were embarrassed or self-conscious because of their scars, 8.3% reported being verbally and/or physically abused because of their scars on a regular basis, and 15.9% felt that they were unfairly dismissed from work. In addition, 37.5% of the participants believed that their scars affected people's perceptions about them, and 19.7% of the participants were very bothered about hiding their scars daily. Moreover, 35.5% of the participants avoided public appearances, and 43.2% felt that their scars had negatively impacted their relationships.

Limitations: The temporal evaluation of the impact was not estimated.

Conclusion: Even mild atrophic acne scarring can evoke substantial emotional, social, and functional concerns.

Keywords: SEM, standard error of the mean; acne scarring; atrophic scars; mixed methods; population-based survey; quality of life.

Conflict of interest statement

Dr Tan has acted as a consultant for and/or received grants/honoraria from Bausch, 10.13039/501100009754Galderma, 10.13039/100004319Pfizer, Almirall, Boots/10.13039/100005153Walgreens, Botanix, Cipher, 10.13039/501100009754Galderma, Novan, 10.13039/100004336Novartis, Promius, 10.13039/501100004296SUN, and Vichy. Dr Beissert has acted as an advisor for AbbVie Deutschland GmbH & Co, Actelion Pharmaceuticals GmbH, Allmirall-Hermal GmbH, Amgen GmbH, Celgene GmbH, Galderma Laboratorium GmbH, Janssen-Cilag GmbH, Leo Pharma GmbH, Lilly Deutschland GmbH, Menlo Therapeutics, MSD Sharp & Dohme GmbH, Novartis Pharma GmbH, Pfizer Pharma GmbH, Sanofi-Aventis Deutschland GmbH, and UCB Pharma GmbH and has received speaker honorarium from Novartis Pharma GmbH, AbbVie, MSD, Pfizer, Janssen-Cilag, Roche-Posay, Actelion, GSK, BMS, Celgene, Allmirall, and Hexal-Sandoz. Dr Cook-Bolden has acted as an advisor, consultant, investigator, and/or speaker and has received grants/honoraria from Almirall, Cassiopea, Foamix Pharmaceuticals, 10.13039/501100009754Galderma, and Ortho Dermatologics. Dr Chavda is an employee of Galderma. Dr Harper has acted as an advisor, consultant, and/or speaker and has received honoraria from Almirall, BioPharmX, Cassiopeia, Cutanea, Cutera, Dermira, EPI Health, Galderma, LaRoche-Posay, Ortho Dermatologics, Sol-Gel Technologies, Sun, and Vyne. Dr Hebert has acted as an advisor, consultant, investigator, and/or speaker and has received grants/honoraria from 10.13039/100007819Allergan, Cassiopea, 10.13039/501100009754Galderma, GSK, La Roche-Posay, Novan, Ortho Dermatologics, Ortho Dermatologics, 10.13039/100009857Regeneron 10.13039/100004339Sanofi, and Vyne. Dr Lain has acted as an advisor, consultant, investigator, and/or speaker and has received grants/honoraria from 10.13039/100006483AbbVie, Aclaris Therapeutics Inc, 10.13039/100007819Allergan Inc, Almirall, 10.13039/100004325AstraZeneca, Athenix, Biopelle Inc, BioPharmX, Biorasi LLC, BMS, Brickell Biotech Inc, Cassiopea SpA, 10.13039/100006436Celgene, Cellceutix, ChemoCentryx, Cutanea Life Sciences, Demira, Dow Pharmaceutical Sciences Inc, Dr Reddy's Laboratory, 10.13039/100004312Eli Lilly and Company, Gage Development Company LLC, Galderma Laboratories L.P., 10.13039/501100009754Galderma, Hovione, Kadmon Corporation LLC, La Roche-Posay, Leo Pharma, 10.13039/501100004628MedImmune, Menlo Therapeutics, Moleculin LLC, Neothetics, Nielsen Holdings N.V, 10.13039/100004336Novartis, Othro Dermatologics, 10.13039/100004319Pfizer Inc, Promius Pharma LLC, Sebacia Inc, Sienna Labs Inc, SkinCeuticals LLC, Sol-Gel Technologies, 10.13039/100011110UCB, and Valeant Pharmaceuticals North America LLC. Dr Layton has acted as an advisor, consultant, investigator, and/or speaker and has received grants/honoraria from 10.13039/501100009754Galderma, GSK, L'Oreal, La Roche-Posay, Origimm, Leo Pharma, and Proctor & Gamble. Dr Rocha has acted as an advisor and/or speaker and has received honoraria from Eucerin, Galderma, Johnson & Johnson, and Leo Pharma. Dr Weiss has acted as an advisor, consultant, investigator, and/or speaker and has received grants/honoraria from Almirall, Bausch, Cassiopea, Cutera, EPI Health, Foamix, 10.13039/501100009754Galderma, and Ortho Dermatologics. Dr Dréno has acted as an advisor, consultant, and/or speaker and has received honoraria from BMS, Galderma, La Roche-Posay, Merck Serono, Pierre Fabre, and Sanofi.

© 2021 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.

Figures

Fig 1
Fig 1
Domains affected by acne scars. Self-completion ranking exercise to score impact on a 5-point Likert scale where 1 indicates “no impact at all” and 5 indicates “extreme impact” before the qualitative interview (N = 30).
Fig 2
Fig 2
Percentage of participants who felt embarrassed/self-conscious based on scar severity grade.
Fig 3
Fig 3
Percentage of participants who avoided daily life activities because of their acne scars. ∗P<.05.
Fig 4
Fig 4
Percentage of participants who avoided daily life activities due to embarrassment because of their acne scars. ∗P<.05.

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