Acne continues to frustrate women into adulthood


By Mardi Chapman

4 Aug 2021

Acne-related concerns continue to negatively affect women’s social, professional, and personal lives, according to a US study.

The qualitative study, published in JAMA Dermatology, involved semi-structured interviews with 50 women aged 18-40 years and with moderate to severe acne.

Many reported prior treatment with topical retinoids (78%), topical antibiotics (43%), combined oral contraceptives (43%), spironolactone (70%), oral antibiotics (62%), and isotretinoin (41%).

Participants reported concerns about their appearance, confidence, mental and emotional health, and many reported cancelling or postponing social interactions due to acne flares.

“I would say it makes me self-conscious about myself and the way I look. It’s impacted me in a professional sense where I feel like I’m not taken seriously [or] professionally in my career because I have acne. It makes me seem younger, in a sense, even though I’m not,” one participant said.

Participants had both positive and negative experiences with dermatologists and several said it took years to find someone who listened to their concerns, was honest about treatments, and helped them find an appropriate treatment regimen.

The study also showed women had issues with various treatments including adverse effects especially related to spironolactone and isotretinoin and concern about the long term effectiveness of oral antibiotics.

Women were generally open to participating in a comparative effectiveness clinical trial if it would help them or others with acne.

“The results of this qualitative study highlight that acne has multifaceted quality-of-life consequences in women,” the investigators said.

“Similar to smaller qualitative studies among adults with acne, themes of depression, anxiety, and social isolation were commonly reported in the study.”

“Future trials to understand the optimal treatment approaches for women with acne are needed to improve outcomes in this population,” they concluded.

Sydney dermatologist and co-chair of All About Acne Dr Jo-Ann See told the limbic Australian dermatologists were definitely seeing patients with hormonal acne and the same frustrations.

“We are definitely seeing hormonal acne. What we are seeing is a group of women who really don’t know why they’ve got it – episodic or chronic adult acne – and they are confused.”

“Part of the problem is the information out there is not good and the treatment can be very entrepreneurial – you have this course of laser or this skin care and you’ll be fixed.”

She said women also falsely blamed their diet or hygiene.

Dr See said safe, long term treatments like spironolactone often flew under the radar.

“What we have found is that there is not a lot of knowledge out there about spironolactone which has been around for a long time, and is a very safe and effective drug. Its onset can be quite slow but it can be a huge gamechanger. It’s cheap and it doesn’t need monitoring.”

Patient perspective important

An editorial in the journal said the increasing prevalence of acne in women reinforced the need to better understand the patient experience and improve acne management.

“Many reported that they were perceived differently as a result of their acne, which contributed to disruption in their personal and professional lives,” they said.

“These findings provide a rationale to explore behavioural strategies to build resilience in these patients.”

They noted the findings were consistent with other studies and there was good reason to integrate more of the patient experience into clinical trials.

“Efforts are underway to adopt a more patient-centred approach to assessing the efficacy of treatments in acne trials and other skin diseases.”

“The development and international adoption of patient-centred outcome measures in clinical trials and practice will not only help ensure that results are meaningful to patients but also greatly facilitate comparative effectiveness research of existing and novel treatments.”

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