The association of acne with emotional and social well-being extends beyond active acne, as acne scarring can persist long after the cessation of active lesions.

A recent study by Tan et al explored the psychosocial burden of facial and truncal acne (FTA) and acne scars (AS) in a spontaneous manner using qualitative research. Their study assessed perceptions, psychosocial effects of FTA and AS and coping behaviors. It recruited participants via local panels and developed a personification exercise, “Letter to my Disease,” for participants of 2 independent arms, FTA and AS, of an international qualitative study in the form of letter completion. 

It recruited 60 participants for the FTA and AS study. The FTA group comprised 57% women, 70% of participants aged 13 to 25 years and 30% aged 26 to 40 years. Eighty-seven percent of participants, among which showed severe active acne and 13% described moderate active acne. On the other hand, AS group included 60% women, 30% of the participants were aged 18 to 24 years, while 70% were aged between 25 and 45 years. 

Among the recruited 60 participants, 56 (FTA, 28 and AS, 28) completed the projective exercise, "Letter to my Disease" and were analyzed. The study observed spontaneous expression of emotional and physical burden as well as the social stigma associated with their skin condition among participants during the completion of the letter exercise. The results centered around major themes, namely, (1) the burden of the condition, (2) attitudes and beliefs and (3) the relationship to the personified condition.

This study shows that, similar to their skin condition, participants associated acne, through personification, with the feature of an intruder and unwanted companion liable for their poor self-esteem and emotional impairment. The results of the joint analyses of letters (FTA and AS), as a catalytic process and free-expression space, sketch the continuous burden of active acne starting from adolescence and persisting till adulthood and beyond active lesions with AS and emphasize the struggle for self-acceptance.

Source: Tan J, Chavda R, Leclerc M, et al. Projective personification approach to the experience of people with acne and acne scarring—expressing the unspoken. JAMA Dermatol. 2022;158(9):1005-12.