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      Evaluation of psychological well-being and social impact of atrophic acne scarring: A multinational, mixed-methods study

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          Abstract

          Background

          Most people with acne are at risk of developing acne scars, but the impact of these scars on patients' quality of life is poorly researched.

          Objective

          To assess the perspective of patients with acne scars and the impact of these scars on their emotional well-being and social functioning.

          Methods

          A 60-minute interview of 30 adults with acne scars informed and contextualized the development of a cross-sectional survey of 723 adults with atrophic acne scars.

          Results

          The main themes identified in the qualitative interviews included acceptability to self and others, social functioning, and emotional well-being. In the cross-sectional survey, 31.6%, 49.6%, and 18.8% of the participants had mild, moderate, and severe/very severe acne scarring. The survey revealed that 25.7% of the participants felt less attractive, 27.5% were embarrassed or self-conscious because of their scars, 8.3% reported being verbally and/or physically abused because of their scars on a regular basis, and 15.9% felt that they were unfairly dismissed from work. In addition, 37.5% of the participants believed that their scars affected people's perceptions about them, and 19.7% of the participants were very bothered about hiding their scars daily. Moreover, 35.5% of the participants avoided public appearances, and 43.2% felt that their scars had negatively impacted their relationships.

          Limitations

          The temporal evaluation of the impact was not estimated.

          Conclusion

          Even mild atrophic acne scarring can evoke substantial emotional, social, and functional concerns.

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          Most cited references14

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use.

            A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) is described. One hundred and twenty patients with different skin diseases were asked about the impact of their disease and its treatment on their lives; a questionnaire, the DLQI, was developed based on their answers. The DLQI was then completed by 200 consecutive new patients attending a dermatology clinic. This study confirmed that atopic eczema, psoriasis and generalized pruritus have a greater impact on quality of life than acne, basal cell carcinomas and viral warts. The DLQI was also completed by 100 healthy volunteers; their mean score was very low (1.6%, s.d. 3.5) compared with the mean score for the dermatology patients (24.2%, s.d. 20.9). The reliability of the DLQI was examined in 53 patients using a 1 week test-retest method and reliability was found to be high (gamma s = 0.99).
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              A clinical evaluation of acne scarring and its incidence.

              Despite scarring being a recognized sequel of acne, the actual extent and incidence of residual scarring remains unknown. One hundred and eighty-five acne patients were included in this study (101 females, 84 males). Patients were selected from acne clinics and their acne scarring was examined. The scarring was quantified according to a lesion count and allocated a score. The type and extent of scarring was correlated to the age and sex of the patient, the site of the acne, the previous acne grade according to the Leeds Technique, acne type (noted in clinic at the original referral time) and duration of acne, before adequate therapeutic measures had been instituted. Results indicate that facial scarring affects both sexes equally and occurs to some degree in 95% of cases. Total scarring on the trunk was significantly greater in males, as was hypertrophic and keloid scarring in these sites (P < 0.05). There were significant correlations between the initial acne grade and the overall severity of scarring in all sites and in both sexes (P < 0.01). Superficial inflamed papular acne lesions as well as nodular lesions were capable of producing scars. A time delay up to 3 years between acne onset and adequate treatment related to the ultimate degree of scarring in both sexes and in all three sites. This emphasizes the need for earlier adequate therapy in an attempt to minimize the subsequent scarring caused by acne.
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                Author and article information

                Contributors
                Journal
                JAAD Int
                JAAD Int
                JAAD International
                Elsevier
                2666-3287
                23 December 2021
                March 2022
                23 December 2021
                : 6
                : 43-50
                Affiliations
                [a ]Western University Canada, Schulich School of Medicine and Dentistry, Ontario, Canada
                [b ]Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
                [c ]Mount Sinai Department of Dermatology, New York, New York
                [d ]Galderma, La Tour-de-Peilz, Switzerland
                [e ]The Dermatology and Skin Care Center of Birmingham, Birmingham, Alabama
                [f ]UTHealth McGovern Medical School, Houston, Texas
                [g ]Austin Institute for Clinical Research, Pflugerville, Texas
                [h ]Hull York Medical School, York University, York, United Kingdom
                [i ]Federal University of São Paulo, São Paulo, Brazil
                [j ]Georgia Dermatology Partners (formerly, Gwinnett Dermatology, PC), Snellville, Georgia
                [k ]Unité Thérapie Cellulaire et Génique, Faculté de Médecine de Nantes, Centre Hospitalier Universitaire de Nantes, Nantes, France
                Author notes
                []Correspondence to: Brigitte Dréno, MD, PhD, Unité Thérapie Cellulaire et Génique, Faculté de Médecine, Centre Hospitalier Universitaire de Nantes, Place Alexis Ricordeau, 44093 Cedex 01, France. brigitte.dreno@ 123456atlanmed.fr
                Article
                S2666-3287(21)00099-7
                10.1016/j.jdin.2021.11.006
                8719008
                35005652
                d54e947b-535a-4c8e-aa10-81d26ef299e9
                © 2021 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 23 November 2021
                Categories
                Original Article

                acne scarring,atrophic scars,mixed methods,population-based survey,quality of life,sem, standard error of the mean

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