Study Outlines Teens' Preferences And Trade-offs For Freedom From Acne

Acne vulgaris affects almost all adolescents and has been associated with anxiety, depression, embarrassment and social dysfunction, according to background information in the article. "Reducing the psychosocial impact of acne is considered one of the guiding principles for its clinical management and it is important to measure and evaluate this impact," the authors write.

Cynthia L. Chen, M.D., and colleagues at the University of California, San Francisco, studied 266 teen volunteers with acne from four public high schools in San Francisco. The participants completed written surveys regarding how much of their lifetime they would give up or how much money they would pay to have never had acne, to be 100-percent acne-free from then on, to have 100-percent acne clearance but with visible scarring or to have 50-percent acne clearance. They and their parents also were asked about acne history and severity, and parents were asked about their willingness to pay since they typically bear the cost of their children's acne treatment.

The researchers' used teens' responses to the time trade-off question to calculate their current acne state utility score. This was done by dividing the participants' reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average score for the current acne state was 0.961; 100-percent clearance received a higher score (0.978) than 50-percent clearance (0.967) and 100-percent clearance with scarring (0.965).

On the willingness-to-pay analysis, the teens reported they would pay a median (midpoint) of $275 to have never had acne, $100 to be 100-percent cleared of acne, $10 for 50-percent clearance and zero for 100-percent clearance with scarring. Parents said they would pay a median of $250 for their child to never have had acne, $100 for 100-percent clearance, $100 for 50-percent clearance and zero for 100-percent clearance with scarring.

Adolescents who rated their acne as more severe reported a willingness to trade more time and money for acne clearance than those with less severe acne.

"Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients' expectations of therapy," the authors write. "Randomized, blinded, placebo-controlled trials have shown that three to four months of conventional acne therapy, including topical benzoyl peroxide, topical retinoids and oral antibiotics, typically produces reductions in lesion counts in the 40 percent to 60 percent range."

"It has also been suggested that the incidence of scarring from facial acne approaches 95 percent," they continue. "Thus, adolescents' marked preference for total clearance over partial (50 percent) clearance or clearance with scarring suggests that physicians must weigh high patient expectations against these clinical data regarding efficacy and risk of sequelae."