Incorporating New Medications into Acne Treatment - Episode 3

Impact of Acne Vulgaris on Quality of Life

Dermatologists discuss the impact of acne vulgaris on the quality of life experienced by their patients.

Hilary E. Baldwin, MD: Julie, tell us a bit about the impact of acne on the quality of life with your patients [at the Dermatology & Skin Care Center].

Julie C. Harper, MD: This is a super important thing to talk about when we talk about acne. In the medical world, we’re so quick to talk about these ideas: Are we going to decrease lesions? Are we going to decrease bumps? Are we going to improve the overall appearance of the acne?

You know what? The whole reason we treat acne is because it bothers people. It’s not just to reduce bumps; it’s to improve their quality of life. There is no subset of people who have acne who are not bothered by it.

Now of course, there are going to be some individuals who aren’t as bothered by it as others. That’s just their nature, but I would say that patients in any age group are bothered by this, and all genders are bothered by this. It’s not something that we can isolate to 1 group of people. We have data out there that acne is associated with depression. It’s associated with anxiety, embarrassment, and social withdrawal. In patients in adulthood, we’ve seen more information recently where it can be associated with unemployment or even the perception of being passed over for a job, or staying home and not dating. These are big impacts on quality of life.

I always like to personalize this, and I apologize if you’ve heard me say this before. No, I don’t apologize for that. I’d like to remind us of this: how many zits on your face does it take to mess up your day a bit? If we’re honest, we don’t say, “It’s about 5.” We say, “1.” Remember that when you’re looking at your patients in clinic. I’m totally guilty of part of this. I had an epiphany several years ago. I came out of an examination room, and I guess I was fairly arrogant, and I was like, “I do not understand why that person is not happy. They are a good 60% better.” It then hits you like a ton of bricks: who wants to be 60% better? Who wants to go from 10 lesions down to 4? No, we want to be clear. For the quality life issue, when you’re looking at your patients and seeing acne on them, try to personalize it and realize that this is something that bothers people. You don’t have to have a lot of acne for it to bother you.

Hilary E. Baldwin, MD: That’s extremely true. Fran, what do you see in your practice? Who’s the most psychologically impacted by their acne? Is it the teenager or the adult woman with new onset acne?

Fran E. Cook-Bolden, MD: Hilary, I would normally say that, because of the number of adult women who I see, the adult woman is more impacted. This may be because they feel like saying, “I’m so far from teenage years that there’s no way that this should be happening.” I’m like Julie, and I apologize if I’ve told you this before, but I had a recent episode with my daughter, who’s now 30 years old, who has never had any significant bouts with acne; she had the worst acne ever. It was a real wake-up call for me as the mother of a daughter who had pretty good skin all of her life, and I could see the impact on her and the anxiety it provoked in me.

There is actual collateral damage when you’re dealing with someone who is suffering from acne, whether they just have a few comedones or papules. Just like Julie, we see patients, and we say, “Why aren’t you happy that you’re better?” That’s what I was saying to my daughter: “I’m treating you, and it hasn’t been that long, but you’re getting better.” I could see the impact it was having on her day-do-day function, and that impacted me. Talking about anxiety and being under pressure as the dermatologist, it was out of this world.

I don’t know. Because it is something that is more chronic in women, I definitely think it’s the women who suffer more because it can last so long and be so aggressive in women as you get older, which we don’t see that much in the men.