People with darker skin tones and more severe acne were likely to face greater stigma.

Individuals with acne face social and professional stigma, and people with darker skin tones and more severe acne are disproportionately more likely to face greater stigma.

These results, published in JAMA Dermatology, highlight the need to identify ways to reduce stigmatizing attitudes and increase access to care to improve the experience of individuals with acne. 

“Our findings show that stigmatizing attitudes about acne can impair quality of life, potentially by affecting personal relationships and employment opportunities,” says study author John Barbieri, MD, MBA, of the Department of Dermatology at Brigham and Women’s Hospital. “Acne is often wrongly perceived as merely a cosmetic issue. It's important that people with this medical problem get access to treatment, just like any other condition.” 

​For this study, Dr. Barbieri and his team obtained stock portraits of four adults, including males and females of either light or dark skin tone. The researchers digitally altered these pictures to create two additional versions of each with mild and severe acne, resulting in a total pool of 12 portraits. They then performed a cross-sectional internet survey of 1,357 participants, who were randomly shown one of the 12 images and asked a set of questions regarding stigmatizing attitudes about the pictured individual. The answer scores for images with acne were compared with the corresponding original image without acne as baseline.  

Participants were less likely to want to be friends, have close contact, or post a photograph on social media with individuals with severe acne, compared to those without acne. Participants reported a greater desire to socially distance themselves from individuals with acne, particularly if the pictured individual had a darker skin tone. 

In addition, respondents were more likely to agree with stereotypes about individuals with severe acne, tending to perceive them as unhygienic, unattractive, unintelligent and untrustworthy. This stereotype endorsement was also higher in individuals with darker skin. 

Participants with past or current acne had less stigmatizing attitudes and only 26.4% believed that acne was a cosmetic issue. Most agreed that acne does not affect only teenagers. 

The study has some limitations. It was not possible to control for comparisons between images with differences in sex or skin tone (for example, female with light skin tone with severe acne versus male with dark skin tone and no acne). Therefore, the results regarding differences by skin tone could be due to other factors and should be interpreted cautiously. The survey population was mostly white and highly educated, limiting the generalizability of the results.  

Further studies are required to better understand if the relationship between darker skin tones and stigmatizing attitudes result from underlying structural racism or other factors.  

“Many insurers poorly cover acne and rosacea treatments, claiming that it’s cosmetic,” Barbieri says. “Our study highlights the need for that narrative to change and for ​​identifying approaches to reduce stigmatizing attitudes in the community.”