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Hughes O, Bewley A. Is it really ever 'just acne'? Considering the psychodermatology of acne. Br J Dermatol 2023; 189:i11-i16. [PMID: 37903071 DOI: 10.1093/bjd/ljad251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 11/01/2023]
Abstract
Acne can create a significant burden for people of all ages. However, the psychological consequences might often be overlooked. This review comments on recent evidence in the field of psychodermatology, to highlight the importance of considering a person's mental health in the treatment of acne. A range of presenting issues are discussed, and cases of underserved patients needing additional considerations are highlighted. This article considers how the psychological sequelae can contribute to the pathogenesis of acne, and discusses how psychotherapeutic approaches can be of benefit to people experiencing appearance-related distress. Importantly, attention is paid to the need for clinicians to assess a patient's wellbeing alongside their physical symptoms. In doing this, early intervention can be facilitated if psychological comorbidities are present, with referral to appropriate specialist services, where available. To improve treatment outcomes, the skin and the mind must be addressed together in a multidisciplinary approach to dermatology care.
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Affiliation(s)
- Olivia Hughes
- School of Psychology, Cardiff University, Cardiff, UK
| | - Anthony Bewley
- Barts Health NHS Trust and Queen Mary University of London Medical School, London, UK
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2
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Adkins K, Overton PG, Moses J, Thompson A. Investigating the Role of Upward Comparisons and Self-compassion on Stigma in People With Acne: Cross-sectional Study. JMIR DERMATOLOGY 2023; 6:e45368. [PMID: 37632940 PMCID: PMC10335155 DOI: 10.2196/45368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The use of image-laden social media is hypothesized as being implicated in psychological distress in individuals with conditions affecting their appearance. However, relatively little is known about the mechanisms involved in this relationship. OBJECTIVE This cross-sectional study examined the relationship between photo-orientated social media use and feelings of stigmatization in adults with acne, and tested whether upward skin comparisons mediate and self-compassion moderates this relationship. METHODS Adults (N=650) with acne symptoms completed web-based measures of social media use (daily Facebook or Instagram use, Facebook function use), self-compassion, skin appearance comparisons, and internalized stigmatization. RESULTS Moderated-mediation and mediation analyses indicated that there was a significant indirect effect of Facebook photo use on stigmatization, mediated by upward appearance comparisons (estimation of indirect effect 11.03, SE 5.11, 95% CI 1.19-21.12). There was no significant relationship between Instagram use and feelings of stigmatization (estimation of indirect effect 0.0002, SE 0.005, 95% CI -0.011 to 0.009), yet upward appearance comparisons predicted feelings of stigmatization (B=0.99, P<.001). Self-compassion did not moderate the indirect or direct relationships between photo-orientated social media use and stigma. However, self-compassion was negatively correlated with upward appearance comparisons and feelings of stigmatization in both Facebook and Instagram users. CONCLUSIONS The way that individuals engage with social media, and in particular make appearance comparisons, should be considered when working with individuals with skin-related distress. Interventions aimed at boosting self-compassion and reducing appearance comparisons may provide avenues for protecting against feelings of stigma.
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Affiliation(s)
- Kate Adkins
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Paul G Overton
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Julia Moses
- Department of History, University of Sheffield, Sheffield, United Kingdom
| | - Andrew Thompson
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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3
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Tan J, Beissert S, Cook-Bolden F, Chavda R, Harper J, Hebert A, Lain E, Layton A, Rocha M, Weiss J, Dréno B. Evaluation of Psychological Wellbeing and Social Impact of Combined Facial and Truncal Acne: a Multi-national, Mixed-Methods Study. Dermatol Ther (Heidelb) 2022; 12:1847-1858. [PMID: 35904707 PMCID: PMC9357600 DOI: 10.1007/s13555-022-00768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Half of the individuals with facial acne develop truncal acne, but the impact of combined facial and truncal acne (CA) on patients' quality of life is poorly researched. METHODS A 60-min interview of 30 participants with CA was conducted that formed the basis for a cross-sectional survey of 694 adolescents and adults with CA. RESULTS The main themes identified from the qualitative interviews among CA subjects included acceptability to self and others, social functioning and emotional wellbeing. Feelings of embarrassment, self-consciousness and low confidence were experienced often or all the time by over 50% of participants, and were more frequent in those who perceived their acne to be out of control (P = 0.003). Half of patients reported feeling stigmatised because of their CA, and 65.4% believed that others associated their truncal acne with unhealthy or unhygienic habits. Perceived stigma was associated with more feelings of embarrassment (P = 0.005), self-consciousness (P = 0.034) and low self-confidence (P = 0.017). Overall, 64% participants reported that CA interfered with daily life, 46.4% often or always avoided social interaction, 48.6% were often concerned about talking to unfamiliar people and 47.4% were uncomfortable showing affection. Further, 32% and 24.4% participants ≥ 16 years old avoided dating or having romantic/intimate relationships because of their facial and truncal acne, respectively. Social and leisure activities were more frequently negatively impacted among those with perceived uncontrolled CA than among those with controlled CA. Avoiding undressing in front of spouse/partner/friends/relatives was more commonly reported by participants with perceived uncontrolled truncal acne than by those with controlled truncal acne (90.5% versus 80.6%, P = 0.031). CONCLUSION CA is associated with considerable psychological morbidity, with several exacerbating (e.g. perceived stigma) and attenuating factors (e.g. acne being perceived as being under control) that should be accounted for in CA management.
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Affiliation(s)
- Jerry Tan
- Schulich School of Medicine and Dentistry, Western University Canada, 2224 Walker Rd, Suite 300, Windsor, ON, N8W 5L7, Canada.
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Fran Cook-Bolden
- Mount Sinai Department of Dermatology, New York, 5 East 98th Street, New York, NY, 10029, USA
| | | | - Julie Harper
- The Dermatology and Skin Care Center of Birmingham, 2470 Rocky Ridge Rd # 100, Vestavia Hills, AL, 35243, USA
| | - Adelaide Hebert
- The University of Texas Medical School-Houston, 6655 Travis, Suite 980, Houston, TX, 77030, USA
| | - Edward Lain
- Austin Institute for Clinical Research, 1601 E Pflugerville Pkwy Suite 1101, Pflugerville, TX, USA
| | - Alison Layton
- Hull York Medical School, University Rd, Heslington, YO10 5DD, York, UK
| | - Marco Rocha
- Federal University of São Paulo, R. Sena Madureira, 1500-Vila Clementino, São Paulo, SP, 04021-001, Brazil
| | - Jonathan Weiss
- Georgia Dermatology Partners, (Formerly, Gwinnett Dermatology, PC), 2383 Pate St., N, Snellville, GA, 30078, USA
| | - Brigitte Dréno
- Unité Thérapie Cellulaire et Génique, Faculté de Médecine de Nantes, CHU Nantes-Place Alexis Ricordeau, 44093, Cedex 01, France
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4
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Tan J, Chavda R, Leclerc M, Dréno B. Projective Personification Approach to the Experience of People With Acne and Acne Scarring-Expressing the Unspoken. JAMA Dermatol 2022; 158:1005-1012. [PMID: 35857307 PMCID: PMC9301587 DOI: 10.1001/jamadermatol.2022.2742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The association of acne with emotional and social well-being is not limited to active acne because acne scarring can extend long after cessation of active lesions. Objective To explore the psychosocial burden of facial and truncal acne (FTA) and acne scars (AS) in a spontaneous manner using qualitative research. Design, Setting, and Participants This qualitative study recruited participants via local panels. A personification exercise, "Letter to my Disease," was developed for participants of 2 independent arms, FTA and AS, of an international qualitative study in the form of letter completion. Main Outcomes and Measures Study outcomes comprised perceptions, psychosocial effects of FTA and AS, and coping behaviors. Results A total of 60 participants were recruited for the FTA and AS study. Among participants with FTA, 17 were women (57%), 21 (70%) were aged 13 to 25 years, and 9 (30%) were aged 26 to 40 years. Twenty-six (87%) participants had severe active acne and 4 (13%) had moderate active acne. Among participants with AS, 18 were women (60%), 9 (30%) were aged 18 to 24 years, and 21 (70%) were aged between 25 and 45 years. Of these 60 participants, 56 (FTA, 28 and AS, 28) completed the projective exercise, "Letter to my Disease," the analysis of which is presented in the current study. During completion of the letter exercise, participants spontaneously expressed emotional and physical burden as well as the social stigma associated with their skin condition. Three major themes emerged, namely, (1) burden of the condition, (2) attitudes and beliefs, and (3) relationship to the personified condition. Conclusions and Relevance Consistent with their skin condition, participants associated acne, through personification, with the character of an intruder and unwanted companion responsible for their poor self-esteem and emotional impairment. The findings of the joint analyses of letters (FTA and AS), as a catalytic process and free-expression space, outline the continuous burden of active acne starting from adolescence and then continuing into adulthood and beyond active lesions with AS, and highlight the struggle for self-acceptance.
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Affiliation(s)
- Jerry Tan
- Western University Canada, Schulich School of Medicine and Dentistry, Windsor, Ontario, Canada
| | - Rajeev Chavda
- Galderma SA Rue d'Entre-deux-Villes 10, La Tour-de-Peilz, Switzerland
| | | | - Brigitte Dréno
- Nantes Université, Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
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5
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Ip A, Muller I, Geraghty AWA, Platt D, Little P, Santer M. Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research. BMJ Open 2021; 11:e041794. [PMID: 33526498 PMCID: PMC7853035 DOI: 10.1136/bmjopen-2020-041794] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs). DESIGN Systematic review and synthesis of qualitative papers. METHODS Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings. RESULTS A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people's experience of acne and HCPs' attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was 'trivialised' by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others. CONCLUSIONS People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use. PROSPERO REGISTRATION NUMBER CRD42016050525.
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Affiliation(s)
- Athena Ip
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Ingrid Muller
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adam W A Geraghty
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Duncan Platt
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Miriam Santer
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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6
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Duru P, Örsal Ö. The effect of acne on quality of life, social appearance anxiety, and use of conventional, complementary, and alternative treatments. Complement Ther Med 2020; 56:102614. [PMID: 33197675 DOI: 10.1016/j.ctim.2020.102614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/25/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of acne among university students and also assess the effects of acne on quality of life, social appearance anxiety, and use of conventional, complementary, and alternative treatment methods. DESIGN AND SAMPLE This cross-sectional study was conducted on 1007 students (98.24 %) of a university located in the Central Anatolian Region of Turkey. MEASUREMENTS The study used "the CAM Questionnaire" to determine students' CAM use, "the Acne Quality-of-Life Scale" to investigate students' quality of life and "the Social Appearance Anxiety Scale" to measure their social anxiety, along with a questionnaire that asked about some acne-related characteristics and conventional, complementary, and alternative treatment methods. RESULTS The prevalence rate of acne among the study sample was 65.4 %. The participants' perceived acne severity and acne's impacts on their lives were inversely proportional to their quality of life (respectively; r = 0.400; 0.327, for each p < 0.001) and directly proportional to their social appearance anxiety (respectively; r = 0.276; 0.302, for each p < 0.001). Acne distress accounted for 19 % of the change in acne quality-of-life scores (β = 0.186; p < 0.001), which in turn caused 61 % of the change in social appearance anxiety scores (β = 0.615; p < 0.001). CONCLUSIONS The students whose quality-of-life had deteriorated due to acne had higher social appearance anxiety. Social appearance anxiety had a minor effect on complementary and alternative medicine use, which was affected mainly by acne distress.
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Affiliation(s)
- Pınar Duru
- Faculty of Health Sciences, Department of Public Health Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Özlem Örsal
- Faculty of Health Sciences, Department of Public Health Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey.
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7
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Prior J. Understanding how young people perceive acne and acne treatments. Br J Dermatol 2020; 183:208-209. [DOI: 10.1111/bjd.18954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. Prior
- Kingston University Kingston upon Thames KT1 1LQ UK
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8
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Ip A, Muller I, Geraghty AWA, McNiven A, Little P, Santer M. Young people's perceptions of acne and acne treatments: secondary analysis of qualitative interview data. Br J Dermatol 2019; 183:349-356. [PMID: 31701523 PMCID: PMC7496424 DOI: 10.1111/bjd.18684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
Abstract
Background Acne vulgaris is a common skin condition affecting approximately 95% of adolescents to some extent. First‐line treatments are topical preparations but nonadherence is common. A substantial proportion of patients take long courses of oral antibiotics, associated with antibiotic resistance. Objectives This study aimed to explore young people's views and experiences of acne and its treatments. Methods We report a secondary thematic analysis of interview data collected by researchers in the Health Experiences Research Group (HERG), University of Oxford. A total of 25 transcripts from young people aged 13–24 years with acne were included. Results Acne is often perceived as a short‐term self‐limiting condition of adolescence and this appears to have implications for seeking treatment or advice. Participants widely perceived topical treatments as being ineffective, which seemed related to unrealistic expectations around speed of onset of action. Many participants felt they had tried all available topical treatments, although were unsure what was in them or unaware of differences between cosmetic and pharmaceutical treatments. They had concerns around how to use topicals ‘properly’ and how to avoid side‐effects. They were also concerned about the side‐effects or necessity of oral treatments, although few seemed aware of antibiotic resistance. Conclusions People with acne need support to manage their condition effectively, particularly a better understanding of different topicals, how to use them and how to avoid side‐effects. Unrealistic expectations about the onset of action of treatments appears to be a common cause of frustration and nonadherence. Directing people towards accessible evidence‐based information is crucial. What's already known about this topic? There is a common perception that acne is a short‐term condition that will resolve without treatment. Previous research has shown that nonadherence to topical treatments is common and that oral antibiotics are the most commonly prescribed treatment for acne in the U.K. Further research is needed to understand how young people perceive acne treatments and the implications of this for treatment adherence and self‐management.
What does this study add? People often said they had tried all available topical preparations for acne, but seemed confused between cosmetic and pharmaceutical treatments. People seemed unsure how to use topical treatments ‘properly’ or how to avoid side‐effects. This was rarely discussed with health professionals. People's perception of acne as a short‐term condition appeared to influence their expectations around onset of action of treatment and their views about its effectiveness and necessity.
What are the clinical implications of the work? The perception of acne as a short‐term condition has implications for self‐management and motivation to seek and adhere to treatments. Providing advice about onset of action of treatments and how to prevent side‐effects is crucial, including directing people towards accessible, written, evidence‐based information. People's confusion about the different topical treatments available may be alleviated by such information, or by encouraging photos or other recordings of treatments tried and for how long.
Linked Comment: Prior. Br J Dermatol 2020; 183:208–209. Linked Comment: Prior. Br J Dermatol 2020; 183:208–209. Plain language summary available online
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Affiliation(s)
- A Ip
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - I Muller
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - A W A Geraghty
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - A McNiven
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, U.K
| | - P Little
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - M Santer
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
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9
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Claudel JP, Auffret N, Leccia MT, Poli F, Dréno B. Acne from the young patient's perspective. J Eur Acad Dermatol Venereol 2019; 34:942-947. [PMID: 31715036 DOI: 10.1111/jdv.16067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/31/2019] [Indexed: 12/21/2022]
Abstract
Acne may significantly impact quality of life, self-esteem and self-worth. The aim of this paper was to provide an overview of the knowledge and perception of acne and its risk factors in adolescents and young adults. The most critical issues reported for an optimal management of this specific population were identified. A PubMed literature review of results from patient-oriented surveys published between 2007 and 2018 was conducted. Two different types of survey were used: those using either validated questionnaires or specifically developed questionnaires. No consistency or directly comparable data with regards to age, onset, duration, severity and treatment of acne and by whom and where data were collected were observed. Acne affected female patients psychologically more than male patients. The majority referred to their treating physician in order to obtain information, and all surveys pointed out that specific treatment programs would allow to increase awareness about acne. Beliefs, traditions and economic factors continue to impact the perception of and treatment choices for acne in almost all countries and cultures, maintaining the improvement of awareness about acne a major global health challenge. In conclusion, identifying, considering and managing the patient's concerns about acne may improve the young patient's well-being and thus decrease additional healthcare expenses for emerging psychological comorbidities. This can be achieved by creating substantial and structured awareness through local and global information campaigns via the treating physicians, Internet, social networks and education.
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Affiliation(s)
| | | | - M-T Leccia
- Department of Dermatology, Allergology and Photobiology, CHU A Michallon, Grenoble, France
| | - F Poli
- Private Practice, Paris, France
| | - B Dréno
- UF Dermato-cancérologie, Inserm U1232, CIC Biothérapie Inserm 05031, CHU Nantes-Hôtel-Dieu, Nantes, France
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10
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Gabes M. Appearance in acne: an often‐overlooked concept. Br J Dermatol 2019; 181:1121-1122. [DOI: 10.1111/bjd.18365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Gabes
- Department of Medical Sociology Institute of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
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11
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McNiven A. 'Disease, illness, affliction? Don't know': Ambivalence and ambiguity in the narratives of young people about having acne. Health (London) 2018; 23:273-288. [PMID: 29552892 DOI: 10.1177/1363459318762035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The popular characterisation of acne as a mundane and insignificant feature of adolescence sits at odds with academic studies showing the detrimental impacts of the condition on people of various ages. Drawing from in-depth qualitative interviews with 13- to 25-year olds living in England, this article will consider some of the tensions between two messages about acne through the ambiguities in young people's narratives. Consistent with existing literature on skin conditions and visual differences more broadly, participants in the study recounted ways in which acne negatively shaped their lives socially and emotionally. However, there were topics around which participants' accounts held nuances and complications, in relation to: understandings held about acne causes; uncertainty as to whether acne was a medical concern/problem; and comparisons to other people's acne or broader health experiences. In attending to these aspects, this article will explore how different and potentially conflicting meanings are negotiated by young people, producing ambiguous and ambivalent experiential accounts about living with acne.
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12
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Prior J. Qualitative study of online discussion forums about acne. Br J Dermatol 2017; 177:616. [PMID: 28940278 DOI: 10.1111/bjd.15761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Prior
- School of Behavioural Sciences, Kingston University, Penrhyn Road, Kingston-Upon-Thames, KT1 2EE, U.K
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13
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Santer M, Chandler D, Lown M, Francis NA, Muller I. Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums. Br J Dermatol 2017; 177:751-757. [PMID: 28218972 DOI: 10.1111/bjd.15398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acne vulgaris is common and can significantly impair quality of life, yet little is known about patients' understanding of acne and its treatments. Oral antibiotics are widely used for acne despite concerns about antibiotic resistance. People are increasingly turning to online discussion forums for advice, and information on these sites may influence health beliefs and treatment adherence. OBJECTIVES To explore understandings about the use of oral antibiotics for acne and advice shared among messages posted on online forums. METHODS We systematically searched for online forums and identified four where acne was frequently discussed. Discussion threads relating to oral antibiotics were analysed thematically. RESULTS We extracted 136 pages of data comprising 65 discussions among 294 participants. We found a wide range of perceptions around effectiveness of antibiotics for acne and concerns about adverse effects. The delayed onset of action of antibiotics was a source of frustration and compounded dissatisfaction with healthcare providers, who were perceived by people as 'fobbing them off' with prolonged courses of ineffective treatment. Advice ranged from when to ask for or insist on referral to use of costly cleansers. Forum posts related to a wide range of severities, from 'spots' to severe acne, which may make it confusing for users to assess appropriateness of information. CONCLUSIONS Online forums offer opinions that could confuse patients, or lead to early abandonment of treatments, challenging consultations and patient dissatisfaction. Users expressed frustration about the delayed onset of action of antibiotics for acne, perceptions of only temporary effectiveness and adverse effects.
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Affiliation(s)
- M Santer
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - D Chandler
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - M Lown
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - N A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, U.K
| | - I Muller
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
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