The Causes of Acne: A Qualitative Study of Patient Perceptions of Acne Causation and Their Implications for Acne Care

Headnote

The roles of diet, dirt, and sunshine in acne causation and management were examined in this qualitative study and found central to patients' understanding of, and responses to, acne. These perceptions have considerable health and therapeutic implications.

Acne is "one of the commonest diseases to afflict humanity" (Chan & Rohr, 2000) and the cause of considerable psychological morbidity (Mallon et al., 1999). As such, the management of acne is a significant practice issue for dermatologists, dermatology nurse practitioners, family physicians, and other health professionals.

The role of a number of factors - increased sebum production, follicular hyperkeratinization, colonization of the skin with Propionibacterium acnes, and inflammatory changes - in the pathogenesis of acne are well-established (Zouboulis et al., 2005). The importance of genetic and hormonal influences on these factors is also recognized (Bataille, Snieder, MacGregor, Sasieni, & Spector, 2002; Thiboutot, 2004; Zouboulis et al., 2005), as well as stress to some extent (Chiu, Chon, & Kimball, 2003; Polenghi, Zizak, & Molinari, 2002). The roles of diet and unclean or dirty skin in causing acne vulgaris, and the therapeutic efficacy of dietary manipulation, face washing, and sunlight exposure in acne are currently the subject of debate (Magin, Pond, Smith, & Watson, 2005). While these lay health beliefs have often been challenged by medical opinion, and dismissed as myths and misconceptions (Clearihan, 2001; Green & Sinclair, 2001; Landow, 1997; Rasmussen & Smith, 1983), there has been some recent reappraisal of the dietary hypothesis of acne causation (Cordain et al., 2002; Danby, 2005). Recent reviews, however, failed to find convincing evidence either for or against the efficacy of diet, face washing, and sunlight exposure in acne (Magin et al., 2005; Wolf, Matz, & Orion, 2004).

Studies from the United States (Emerson & Strauss, 1972; Rasmussen & Smith, 1983), New Zealand (Pearl, Arroll, Lello, & Birchall, 1998), Britain (Smithard, Glazebrook, & Williams, 2001), Germany (Niemeier et al., 1998), Nigeria (Orafidiya, Agbani, Oyedele, Babalola, & Onayemi, 2002), Saudi Arabia (Al-Hoqail, 2003; Tallab, 2004), and Sweden (Berg, 1989) report a high prevalence of lay belief in the causal or therapeutic roles of diet, cleanliness, and sunlight in acne. These studies have been questionnaire-based surveys citing prevalence of the beliefs in various populations. They have not explored cognitive or social...