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Identifying the Impacts of Acne and the Use of Questionnaires to Detect These Impacts: A Systematic Literature Review



Acne (syn: acne vulgaris) ranks as the most common inflammatory dermatosis treated worldwide. Acne typically affects adolescents at a time when they are undergoing maximum physical and social transitions, although prevalence studies suggest it is starting earlier and lasting longer, particularly in female patients. According to global burden of disease studies, acne causes significant psychosocial impact. Hence, identifying mechanisms to accurately measure the impact of the disease is important. Adopting an approach to harmonize and standardize measurements is now recognized as an essential part of any clinical evaluation and allows for better comparison across studies and meta-analyses.


The Acne Core Outcome Research Network (ACORN) has identified relevant domains as part of a core outcome set of measures for use in clinical studies. One of these is health-related quality of life (HRQoL). The aim of this systematic review was to provide information to inform the identification of the impacts most important to people with acne.


A synthesis of available evidence on acne impacts was constructed from a systematic review of the literature, with searches conducted in the MEDLINE, EMBASE and PsychInfo databases.


We identified 408 studies from 58 countries using 138 different instruments to detect the impacts of acne. Four of the five most commonly used instruments (Dermatology Life Quality Index [DLQI], Cardiff Acne Disability Index [CADI], Acne Quality of Life scale [Acne-QoL], Hospital Anxiety and Depression Scale [HADS] and Skindex-29) do not identify specific impacts but rather quantify to what extent acne affects HRQoL. Other studies identified one or more impacts using open-ended questions or tailor-made questionnaires.


This review serves as a rich data source for future efforts by groups such as ACORN (that include patients and health care providers) to develop a core set of outcome measurements for use in clinical trials.

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The authors acknowledge Helen Weir, HDFT Librarian, and Esther Dell, Penn State Librarian.

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Corresponding author

Correspondence to Alison M. Layton.

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Conflict of interest

Alison Layton: Investigator and consultant for Galderma laboratories, Origimm, Proctor and Gamble, and La Roche Posay. Diane Thiboutot: Investigator and consultant for Galderma Laboratories, Biopharmix, and Cassiopea. Jerry Tan: Advisor, consultant, investigator and/or speaker for Allergan, Bausch, Botanix, Boots/Walgreens, Dermavant, Galderma, L’Oreal, and Novartis. Hayley Smith, Abbey Smith, Heather Whitehouse, Waseem Ghumra, Meenakshi Verma, Georgina Jones, Kathryn Gilliland, Megha Patel, Elaine Otchere, and Anne Eady have no conflicts of interest to declare.


This work was funded by the US National Institutes of Health (NIH), award number 1U01AR065109-01.

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The NIH had no role in the design or conduct of this study, including data collection and analysis and preparation of this manuscript.

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Author contributions

Study concept and design: Anne Eady, Alison Layton, Diane Thiboutot, Jerry Tan. Acquisition, analysis or interpretation of data: Kathryn Gilliland, Anne Eady, Megha Patel, Elaine Otchere, Waseem Ghumra, Hayley Smith, Abbey Smith, Heather Whitehouse, Meenakshi Verma, Georgina Jones, Alison Layton, and Diane Thiboutot. Drafting of the manuscript: Anne Eady, Hayley Smith, Alison Layton. Critical review of the manuscript for important intellectual content: All authors. Statistical analysis: Not applicable. Obtained funding: Diane Thiboutot. Administrative, technical or material support: Kathryn Gilliland. Study supervision: Diane Thiboutot and Alison Layton.

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Smith, H., Layton, A.M., Thiboutot, D. et al. Identifying the Impacts of Acne and the Use of Questionnaires to Detect These Impacts: A Systematic Literature Review. Am J Clin Dermatol 22, 159–171 (2021).

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