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Stigmatization of Acne
Introduction: Acne vulgaris often develops during adolescence, a critical time in psychosocial development, and has been associated with reduced self-esteem, altered body image, feelings of shame and embarrassment, social dysfunction, and perceived stigmatization. This study aimed to explore perceptions of acne in the general public in order to better characterize the factors leading to its stigmatization.
Methods: Healthy subjects (n=56) were shown images of common skin conditions including acne, psoriasis, eczema, vitiligo, rosacea, herpes (labialis and whitlow), warts, and tinea versicolor, and completed a questionnaire exploring their reactions to the images and perceptions of each condition.
Results: The majority (62.5%) of subjects were upset by the acne images. This level was greater than any other condition aside from herpes, and this difference was statistically significant compared to eczema, vitiligo, rosacea, and tinea versicolor (p< 0.05). Location, color, and open sores were the most commonly reported upsetting features. Over half (55.4%) of subjects believed that acne was caused by poor hygiene, 37.5% thought it was related to diet, and 50% believed it was infectious.
The majority of subjects said they would feel ashamed if they had acne and would find someone with acne unattractive (67.9%). In addition, 41.1% would feel uncomfortable being seen in public with a person with acne, and 44.6% would feel uncomfortable touching them. Only a minority of subjects, however, would exclude them from social events (19.6%), avoid hiring them for a job (14.3%), or separate from a significant other due to the disease (3.6%). Over 80% of subjects felt pity towards acne sufferers, which was significantly higher than for all the other skin conditions except psoriasis (p< 0.05).
Conclusion: Acne can have a profound psychosocial impact on its sufferers and is highly stigmatized. This may be due to its visibility on the face, although images of rosacea were significantly less upsetting to the subjects in this study. It may also be related to common misconceptions about its etiology, such as poor diet or hygiene, and interestingly, the belief that it may be contagious.