Projective Personification Approach to the Experience of People With Acne and Acne Scarring-Expressing the Unspoken.

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.