Personification of FTA, Acne Scars Help Define Disease Burden

Jerry Tan, MD

A recent study found that the personification of facial and truncal acne (FTA) and acne scars as an “intruder and unwanted companion” aided young patients in defining the effects these skin conditions had on their self-esteem and emotional capabilities.

Though various studies have considered the psychosocial effects of acne, few have considered the negative effects of acne scarring. Limited evidence suggests that scarring can negativity influence self-esteem and self-confidence, resulting in anxiety, depression, and impaired social functioning.

With the present study, an investigative team led by Jerry Tan, MD, of Western University Canada, utilized the personification exercise, “Letter to my Disease”, to explore the psychosocial burden of FTA and acne scars in affected patients.

The study was conducted in 6 countries including the US, Canada, Brazil, France, Italy, and Germany, with recruitment being done via Survey Healthcare Globus, Reckner, DoxaPharma, Medothic, Latina Health Solution, and Cerner Enviza research panels.

There were 2 qualitative study arms that were featured in a former, mixed-method study, with eligible participants for the AS study arm being 18-45 years old. A total of 60 individuals were enrolled, 30 of whom had active FTA and 30 with acne scars. A majority of individuals in the FTA arm (70%) were 13-25 years old.

Four participants would not complete the exercise, leaving 56 eligible participants.

The Letter to my Disease exercise tasked participants with picturing their acne or acne scars with human traits and characteristics, and addressing the letter with “Dear acne or acne scars”, promoting a conversational style of writing that incorporated second-person pronouns when referencing FTA and acne scars.

Once completed, letters were compiled into 2 distinct data sets that investigators used to complete a thematic analysis, which they considered to be a “powerful, evocative tool for eliciting hidden meanings and emotions”.

The Burden of Acne and Acne Scars

Participants from both the FTA and acne scars arms detailed a variety of psychological complications they experienced in their everyday lives and relationships, among them feeling self-conscious (“I don’t feel beautiful with you and my self-esteem is lower because many others don’t like my looks either”).

Participants also admitted to feeling helpless when dealing with their skin condition, especially when they were unaware of the origin and means to treat it.

In addition to the burden of the condition and the general attitudes and beliefs associated with them, another prevailing theme that investigators noticed was the relationship to the personified condition.

Most individuals, regardless of which group, considered their condition to be an “uninvited companion” that they wished they could rid themselves of.

Tan and colleagues suggested the burdens detailed in this personification exercise be considered when discussing awareness, education, and symptom management for FTA and acne scars.

“Accurate diagnosis, establishing a relationship of trust between the managing physician and the patient, and discussing potential consequences with patients may help reduce frustration and anger,” they wrote.

The study, "Projective Personification Approach to the Experience of People With Acne and Acne Scarring—Expressing the Unspoken," was published online in JAMA Dermatology.