patients write letter to their acneResearchers exploring the emotional and physical impacts of acne and acne scarring found that asking participants to write a letter to their acne revealed the continuous burden of the condition from the teen years into adulthood and the struggle for self-acceptance.

“Writing a letter to their condition opened up a free expression space where people could be spontaneous about their experiences with acne and retrace their path,” Dr. Jerry Tan, lead researcher of the study and Windsor, Ontario-based dermatologist said.

The research paper (1), published recently in the Journal of the American Medical Association, set out to explore the psychosocial impact of acne on patients with facial and truncal acne as well as those with acne scarring. “Very few studies have looked at the impact of acne scarring and this can extend for a lifetime”, Dr. Tan added.

The international study recruited participants from six countries including Canada and the USA. People with active acne on the face, neck, shoulders and/or back comprised one arm of the study. Most had moderate to severe acne and were aged 13-25. Those with acne scarring made up the second arm of whom none had active acne and most were aged 25-45.

The letters revealed the lingering burden of acne with feelings of self-consciousness and lower self-esteem being commonly reported. “I can’t go out in public without makeup. I’m afraid of people pointing it out and making me self-conscious,” said one participant.

A lack of control over acne caused frustration and feelings of powerlessness. “I cry sometimes because you come and go as you want. At the completely wrong times, as well.”

In fact, many respondents saw acne as an intruder and unwanted companion responsible for disrupting their lives. This is reflected in comments such as: “I didn’t choose to have you, you still came however, and I still don’t want you” and “Why me? I don’t think I’ve done anything to deserve you being in my life.”

Those in the acne scarring group mentioned negative self-image often. “At first, I thought that you would disappear quickly and leave no traces, unfortunately this was not the case. Now I look at what remains, and I am overwhelmed at the sight.”

Most participants used makeup and clothing to hide their acne or acne scars. The opinions of others and peer pressure was the main reason to conceal their acne or scars. “I find myself avoiding big crowds because I am self-conscious about what people might think when they see my skin.”

Many were angry about the cost and inconvenience of self-treatment and care. “I wash my face 4 times a day and still look dirty. I look unclean. I look unpretty” and “I’m fighting against you, but this is expensive.”

Others complained about treatment. “How is it possible that nowadays there are efficient treatments for cancer and other serious diseases while acne for that ages has been troubling teenagers and adults can’t be successfully cured?

“The personification approach (through the writing of letters) defines the persistence of psychological and social disability owing to acne and acne scarring similar to those in other chronic medical conditions such as asthma and diabetes,” Dr Tan said.

“Understanding a patient’s emotional response to chronic conditions can help physicians target relevant information to address patient concerns, manage treatment expectations and develop healthy coping skills,” he added.

(1) Jerry Tan, MD; Rajeev Chavda, MD; Marjorie Leclerc, MA; Brigette Dreno, MD, PhD.; Projective Personification Approach to the Experience of People with Acne and Acne Scarring – Expressing the Unspoken. JAMA Dermatol. 2022;158(9):1005-1012. doi:10.1001/jamadermatol.2022.2742.