Review Highlights Toll of Acne Scars on Patients’ Quality of Life

Acne scarring has no universal cure and can have leave lasting psychosocial effects on patients. A new literature review underscores how this condition is separate from acne vulgaris and requires a comprehensive clinical approach unique from those for active acne.

Findings were published in Clinical, Cosmetic and Investigational Dermatology

The most common skin disease in the United States, around 85% of Americans between ages 12 and 24 years will experience acne vulgaris. In addition, “measured in disability-adjusted life-years, the global burden of disease of acne vulgaris ranks above most dermatological conditions including urticaria, psoriasis, viral and fungal skin diseases, and even melanoma,” the authors wrote.

Although effective, widely available treatment interventions exist for acne and can help control the condition’s physical symptoms.

“Associated maladaptive thought processes, mental illnesses, and avoidant social behaviors are not so easily reversed once established,” the researchers explained, adding many of these effects can be linked with residual acne scarring.

Around 95% of individuals with acne will experience scarring, a permanent disfiguring condition with no universal solution.

To better understand the known psychosomatic impacts of acne scarring and identify gaps in research that preclude proper diagnosis and management of scars, the researchers carried out a PubMed search to identify studies related to acne, acne scarring, and scars in relation to quality of life (QOL).

Thirty-nine papers discussed the effects of acne scaring in relation to QOL, while 23 focused on the psychosocial effects of active acne.

The researchers found “psychosocial distress is first initiated during active acne, but acne scarring can cause unique consequences on patients’ emotional, psychological, and social well-being.” However, “limited availability of high-quality evidence and measurement tools relevant for acne scarring obstructs the development and standardization of effective clinical recommendations.”

Active acne typically begins between ages 14 and 19 years, a time when teens’ developing brains undergo structural and functional changes that can make them more susceptible to developing mental health problems.

Results suggest that acquired disfigurements, as opposed to congenital ones, are more easily managed by coping mechanisms developed during the initial onset of appearance changes.

“Therefore, early effective intervention for active acne is the single best method to prevent acne scar formation, while also mitigating psychological stressors associated with active acne,” the authors wrote.

Psychological dysfunction can also result from the neuromodulatory effects of prescription drugs, like isotretinoin. The medication has been linked with depression, a higher risk for suicide, and bipolar disorder. However, most topical and oral antibiotics do not cause significant psychological disturbances among patients.

The review also found patients with acne and acne scarring experience had increased depressive symptoms, anxiety, and suicidal tendencies.

“Many of these psychiatric comorbidities are characterized by high likelihoods of recurrence, once again suggesting that the resolution of active acne does not represent the cessation of concurrently acquired psychopathological symptoms,” the researchers said.

Data showed that while those with acne tended to exhibit hope for improvement, those with acne scars were more likely to report hopelessness and an unwillingness to accept their condition. Acne scarring is also often dismissed as a superficial cosmetic concern, despite most patients expressing feelings of sadness, annoyance, and persistent worry about their scars.

Both gender and location of scars can affect the extent to which the condition has an impact on patients’ QOL. “Evidence shows that the psychological impact of acne scarring affects females at a disproportionately higher rate compared to males,” the authors noted.

Overall, the review found a lack of high-quality studies addressing the psychosocial and physical management of acne scarring. Current research is also limited by inconsistent methodology and underpowered studies. This leads to inconsistent care for the condition as selection of treatments varies based on provider.

Furthermore, although insurance typically covers treatment for active acne, many treatments indicated for scarring are considered cosmetic procedures and can lead to substantial out-of-network costs for patients.

“With privatized cosmetic institutions as the sole option available for scar treatment, patients are faced with significant financial barriers to treatment access, in addition to further stigmatization for perceived aesthetic vanity,” the researchers said.

They concluded the profound impact of postacne scarring on QOL warrants the condition’s consideration as a primary skin condition, not just a sequelae of acne vulgaris.

Reference

Zhou C, Vempati A, Tam C, et al. Beyond the surface: a deeper look at the psychosocial impacts of acne scarring. Clin Cosmet Investig Dermatol. Published online March 25, 2023. doi:10.2147/CCID.S406235