Young People's Perceptions of Acne and Acne Treatments

Secondary Analysis of Qualitative Interview Data

A. Ip; Muller; A.W.A. Geraghty; A. McNiven; P. Little; M. Santer

Disclosures

The British Journal of Dermatology. 2020;183(2):349-356. 

In This Article

Abstract and Introduction

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.

Introduction

Acne vulgaris (herein 'acne') is a common skin condition affecting up to 95% of adolescents to some extent.[1] It has the potential for substantial effects on quality of life (QoL).[2] Due to its significant impact on QoL and its potential to persist or recur for many years, it can be considered a long-term condition.[2] Despite this, there is a common perception among the lay and medical community that acne is a teenage condition that will go away on its own.[3]

First-line treatments for mild-to-moderate acne are topical preparations including benzoyl peroxide, retinoids and antibiotics.[1] However, nonadherence to these is common for reasons including side-effects, young age, forgetfulness,[4] insufficient knowledge about acne and the use of medication, cost[5] and the need for continuous treatment over several weeks before onset of action.[6] Many people progress to taking oral antibiotics: a recent study found that oral antibiotics were the most commonly prescribed acne treatment in the U.K., and in most cases, a nonantibiotic topical was not prescribed in combination.[7] They found that oral antibiotics alone were prescribed the most during the index consultation (24·9%).[7] Co-prescribing of nonantibiotic topical treatments alongside oral antibiotics is recommended to avoid antibiotic resistance in Propionibacterium acnes (P. acnes ). This is necessary as antibiotic resistance in P. acnes is increasing and has become a public health concern.[8]

To date, most research exploring prescribing patterns in acne[7,9] and adherence to acne treatments has been quantitative.[10–12] Qualitative research would be helpful in exploring perceptions of treatments and reasons for nonadherence but qualitative research on acne has focused mainly on the following: psychological impact,[13,14] psychosocial impact,[15,16] experiences of living with acne,[17–21] causes of acne,[22] sexual life and acne,[23] ambivalence and ambiguity in young people's experience of acne,[24] complementary and alternative medicines for acne[25] and patients' relationships with their doctors.[26] There have been some qualitative studies exploring barriers to adherence to acne treatment,[27] people's views of topical treatments,[21,28] oral antibiotics[29] and perceptions of oral isotretinoin.[30] However, many of these studies were carried out in other countries,[21,27,30] and so may not be applicable to our population, and others were exploring barriers to nonadherence only briefly, as their primary focus was on QoL[28] or the psychological impact of treatment.[30] This qualitative study was carried out to further understand young people's perception of acne and, in particular, their views and concerns about some of the most commonly prescribed acne treatments, including oral antibiotics and topical treatments for acne.

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