What Acne Patients Don't Know Can Scar Them

From the WebMD Archives

April 2, 2001 -- Patients with acne harbor a surprising amount of misinformation about the disease -- most of it from television, magazines, or friends. And those wrong ideas can hurt them.

In a recent issue of the Journal of the American Academy of Dermatology, Jerry K.L. Tan, MD, reports on the beliefs and perceptions of 78 patients referred to his Windsor, Ontario, dermatology practice for treatment of acne.

"We found that many patients correctly identified hormones and heredity as primary factors in causing acne, but patients often had inaccurate ideas about the role of diet and of skin hygiene. We were also somewhat surprised to find that many had unrealistic ideas about how long acne treatment was likely to take and about what the results of treatment were likely to be," Tan tells WebMD.

Patients who had been referred from family physicians for acne treatment were given a self-administered questionnaire at the beginning of the first office visit, before meeting with medical personnel. The survey inquired about beliefs on the causes and aggravating factors of acne, sources of information, beliefs about treatment, and the impact of acne on the patient's self-image, interpersonal relationships, work, or school activities.

Tan and colleagues found that 64% of patients thought hormones caused acne, while 38% blamed genetic factors. However, 32% of patients blamed diet, and 29% blamed poor skin hygiene, both common misconceptions about the cause of acne.

"This is important because although proper cleansing is important, overcleaning and scrubbing cause inflammation and contribute to the problem," Tan says. "Patients who put excess emphasis on dirt are likely to cleanse often and to use abrasive cleansing agents that can cause additional problems."

The study found that family physicians were the most frequent source of acne information, but magazines and television accounted for a substantial amount of information and misinformation.

"Fifty-eight percent of our patients said the information they had about acne was inadequate. That points to the need for better, community-based education programs and for better brochures and patient information materials," Tan says.

Dermatologist Paul Bujanauskas, MD, tells WebMD that he too has noticed that many patients have misconceptions about acne when they first come in for their office visit. Still, some arrive with a lot of questions. Either way, it's easy to tell patients what they need to know.

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"Sometimes, it takes a few minutes, but pretty much, you can set them straight," he says. Bujanauskas is a clinical assistant professor of dermatology at Jefferson Medical College of Thomas Jefferson University and a dermatologist at Thomas Jefferson University Hospital, both in Philadelphia.

Although 49% of study patients believed that acne was curable, nearly half expected treatment to take less than six months, and 31% expected treatment to take less than four weeks.

"We clearly have some work to do in terms of providing patients with realistic information in this area," Tan says.

Indeed, Arthur M. Coddington, MD, medical director of the Tier Acne Clinics in upstate New York, tells WebMD, "We have a similar experience on this side of the border. Patients are often surprised when I tell them not to come back for two months after the first visit, since it will take that long to be able to evaluate their progress. Many are also very disappointed to learn that we cannot cure acne, we can only control it."

Despite the fact that this study was done in Canada, where medical care is accessible and universally available without direct cost to the patient, Tan was surprised to find that 75% of patients had waited more than one year before seeking medical attention for their acne.

Coddington says the same applies to U.S. patients. "Many patients procrastinate for an amazing length of time before seeking treatment," he tells WebMD. "Access to care seems to be less a contributing factor than the idea that if they just wait a little longer, they will get over it."

"We need to get out the message that delaying acne treatment can have deleterious effects in terms of scarring," Tan says.

Bujanauskas has had similar experiences. "Most often, too much time has elapsed between the time patients start having problems and when they come in to the dermatologist," he says. So by the time they seek treatment, their acne may have progressed beyond the early stages and has developed redness and inflammation.

Another advantage of seeking treatment early in the game is a financial one. According to Bujanauskas, insurance companies are often more willing to pay for a teen's acne treatment than an adult's. But if the adult has a history of going to the dermatologist for acne care during his or her teen years, it may be less of a struggle to get the coverage, he says.

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With reporting by David Flegel, MS.

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