PracticalDermatology

Despite the emotional burden of acne, adherence to acne medications is notoriously poor and a major reason why treatment plans fail.¹

Primary adherence hurdles include a lack of knowledge about acne, confusion about how to use prescribed treatments, weak physician-patient relationships, fear of side effects, and medication costs. Secondary adherence hurdles include lack of efficacy, complicated regimens, adverse reactions, lifestyle factors, and psychiatric comorbidities.

Presentations at the American Academy of Dermatology 2021 VMX meeting called attention to the importance of personalized acne treatment plans that consider the psychological profile of patients as a means of boosting adherence and optimizing results.

This starts with taking a new approach to the consultation, according to new recommendations from The Personalizing Acne: Consensus of Experts (PACE) group.²

During acne consultations, patients and physicians should discuss long-term treatment expectations, potential sequelae such as scarring, use of cosmetics, moisturizers, hair products, and sunscreen, plus choice of treatments. These discussions should be influenced by factors including the specific burden of disease and treatment tolerability. This approach may help set and manage expectations, improve treatment satisfaction, and increase adherence.

The PACE group also stresses the importance of independent truncal acne assessment and personalization of treatment goals, due to the added psychological burden of truncal acne.

Acne management in certain patient subgroups requires special attention. Younger children, patients with darker skin phototypes, pregnant or breastfeeding women, athletes, patients with or at risk for psychiatric conditions, or those with medication-induced acne should be addressed accordingly, the PACE guidelines state.

In general, the psychological state of an acne patient has a significant impact on compliance, treatment outcome, and overall wellbeing.

A study performed by Johnson & Johnson consumer health, also presented at the 2021 VMX Meeting, has shed light on the psychological profile of different populations of acne patients.³ In the study, acne patients were asked specific questions about how acne made them feel in an attempt to understand the psychological profile of the acne patient. This approach gets to the heart of the matter quickly. Asking participants questions like, “What is the worst thing about having acne?” can reveal key insights that infer underlying psychological states.

Investigators reported that teenaged females tended to report more sadness about acne, while males reported anger. However, feelings shifted in females with age. Adult women reported feelings of anger about having acne, similar to the pattern seen in teenage boys. Moreover, patients who were more focused on the social aspects of acne, such as avoiding events and feeling embarrassed, tended to be more anxious than those who report being concerned with the health aspects of acne.

These studies not only point toward the importance of understanding the acne patients’ mindset but also help guide us in how to better approach and treat patients according to their psychological state. Meeting acne patients where they are psychologically could help target underlying issues, design personalized solutions including behavior modification, which will lead to better adherence.

1. Moradi Tuchayi, Sara et al. “Interventions to increase adherence to acne treatment.” Patient Preference and Adherence. 2016; 10:2091-2096. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067002/

2. Tan J, Alexis A, Baldwin H, et al. “Gaps and recommendations for clinical management of truncal acne from the Personalising Acne: Consensus of Experts panel.” JAAD International. 2021;5:33-40. https://www.sciencedirect.com/science/article/pii/S2666328721000535

3. Coubart A, Richtmyer M, Gardner W, et al. “Profiling Acne Sufferers: From Acne Types/Severity to Impact on Personal and Social Life.} Presented at: American Academy of Dermatology 2021 VMX