Acne-Specific Quality of Life Questionnaire Developed

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To better assess and understand the mindset and quality of life issues for patients with acne, researchers in Europe tested and developed a new questionnaire. The researchers found the 3-factor, 19-item questionnaire developed to be satisfactory based on patient response.¹

Background

Although other guidelines assess quality of life (QoL) in patients with acne vulgaris, Chernyshov et al recognized that each evaluated a different QoL domain.

“It is well-known that acne produces cosmetic disfigurement and patients suffering from visible skin conditions have an increased risk of depression, anxiety, body dysmorphic disorder, feelings of stigmatization, and self-harm ideation,” the researchers wrote.²

Study

Members of the European Academy of Dermatology and Venereology Task Forces on QoL and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa collected data in 9 European countries to form a list of the most relevant topics for acne patients.

The investigators then developed a 46-item prototype based on relevant topics and factor analysis results,³ and asked patients with acne (n = 715) how clear and applicable the topics were. Response rate was from 99.7% to 87.83% with users finding all items to be very clear, but results ranged widely on impact of each item.

After numerous discussions, the investigators replaced 29 items on the list with 4 more impactful items and incorporated 2 additional items, resulting in a 21-item list for another group of patients to complete.. A 4-point Likert scale (never, rarely, sometimes, frequently) was selected as the questionnaires’ scoring system.

The study then split the participants into 2 subsamples, performing an exploratory factor analysis (EFA) on the first, and performing a confirmatory factor analysis (CFA) on the second. For both models, researchers assessed fit using: the Root Mean Square Error of Approximation (RMSEA), with values below 0.05 indicating evidence of absolute fit, values between 0.05 and 0.08 indicating adequacy of the model, and values above or equal to 0.10 indicating poor fit of the model; the Tucker Lewis Index, with values ≥ 0.95 indicating good fit of the model and values of 0.90 and higher an acceptable fit; the Comparative Fit Index, with values ≥ 0.95 indicating good model fit and values of 0.90 and higher an acceptable fit; the Standardized Root Mean square Residual, with values < 0.08 indicating good fit; and the chi-square (χ2) test, with P values greater than .05 indicating an adequate fit to the data.

Clinical Implications

Investigators found that the presence of 3 factors: Socioemotional, Symptoms, and Stigma and Suicidal thoughts.

“Depression, anxiety, stress, decreased self-esteem, suicidal thoughts, and even suicide attempts are too frequent to ignore in these patients,” the investigators wrote. Furthermore, data from a 2023 review suggested that social media adds to the burden of adolescent skin disease, resulting in a negative body image and depression.⁴

Chernyshov et al found that most of the items included in the initial list represented topics from acne-specific and dermatology-specific tools that were not relevant to acne patients, especially for more timely issues. Therefore, they feel the 19-item acne-specific HRQoL may be helpful to further understand and develop a long-term treatment strategy individualized to patients. The researchers noted that QoL assessment in dermatology is a “rapidly developing field with a gradual shift from theory to practice,” and they hope that this questionnaire will be used not only for research but in practice as well.

Data Points

Researchers conducted factor analysis on the final pool of 21 items, with a response rate of 99.73% on the second group of patients (n = 1502). On the first subsample (n = 722), investigators found that EFA suggested a three-factor model that best fitted the data [χ2 (150) = 511.11, P < .001; RMSEA = 0.058, 90% CI = 0.052-0.063; Comparative Fit Index= 0.97; Tucker Lewis Index= 0.96; Standardized Root Mean square Residual = 0.04]. Two items were removed from further analysis due to low factor or cross loadings. Chernyshov et al found that the CFA on the second subsample (n = 776) of the three-factor model with 19 items was a satisfactory fit [χ2 (149) = 664.78, P < .001; RMSEA = 0.067, 90% CI = 0.062-0.072; Comparative Fit Index = 0.95; Tucker Lewis Index= 0.94; Standardized Root Mean square Residual = 0.05].

The first dimension the investigators created, called “Socioemotional,” contained 11 items surrounding the psychosocial aspects of the disease, such as difficulties in social life, emotions as a concern of side effect of medication, lack in self-confidence, etc. The second dimension, “Symptoms,” included 4 symptoms of acne. The third dimension, “Stigma and Suicidal thoughts,” included 4 items as well, 1 of which was on suicide and the others on stigma.

References

1. Chernyshov PV, Sampogna F, Raimondi G, et al. Development of the acne-specific quality of life questionnaire quality of life relevance-acne. JAAD Int.2024;16:9-17. Published 2024 Mar 25. doi:10.1016/j.jdin.2024.03.007
2. Tomas-Aragones L, Marron SE. Body image and body dysmorphic concerns. Acta Derm Venereol. 2016;96(217):47-50. doi:10.2340/00015555-2368
3. Chernyshov PV, Sampogna F, Zouboulis CC, et al. Which health-related quality of life items most affect acne patients?. Dermatology. 2023;239(2):267-272. doi:10.1159/000526602
4. Rieder E, Andriessen A, Cutler V, et al. Dermatology in the social media era: Building awareness of social media’s impact on adolescent skin diseases and mental health. Presented at the 2023 South Beach Symposium Meeting; February 9-12, 2023; Miami Beach, FL. Accessed February 8, 2023. https://www.livderm.org/wp-content/uploads/2023/01/MOPD-2023_Poster-psychodermatology_v3_23Jan23.pdf