Racial Differences in Treatment Preferences of Acne Vulgaris: A Cross-Sectional Study

December 2020 | Volume 19 | Issue 12 | Original Article | 802 | Copyright © December 2020

Published online November 25, 2020

Monica Mehta MDa, Roopal V. Kundu MDb

aNorthwestern University Feinberg School of Medicine, Chicago, IL
bNorthwestern University Feinberg School of Medicine, Department of Dermatology, Chicago, IL

Cultural and social constructs may influence a patient’s understanding of their acne vulgaris affecting treatment preferences and valuation. Understanding these differences can better equip healthcare professionals when providing treatment recommendations. The objective of this study was to determine how perception, treatment preferences, and treatment valuation of acne vulgaris vary across different races. This was a cross-sectional study run from June 2017–February 2018. Participants with self-identified acne completed a one-time 31 question online survey distributed through ResearchMatch (national research registry) and campus recruitment. 217 English-speaking participants with self-identified acne who were over 18 years-old attempted the survey, and 3 participants were excluded for failing to complete it. Response rate of this study was 10.5%. Compared to Whites (88%, n=126), East Asians (44%, n=12) (P<0.001) and South Asians (53%, n=16) (P=0.002) were less likely to see a healthcare professional for acne. Compared to Whites (87%, n=125), East Asians (63%, n=17) were less likely to get information from healthcare professionals (P=0.03). East Asians (93%, n=25) used the internet more frequently as a source of information about causes of acne and treatments compared to all other races (P=0.04). Race was not statistically significant as a predictor for willingness to pay (WTP). Whites (27%, n=39) preferred using prescription face washes/creams/gels, while East Asians (41%, n=11), South Asians (60%, n=18), and Blacks (37%, n=7) preferred OTC washes/creams/gels. Differences exist in perception and treatment preferences for acne between races and exploring them may enhance providers’ understanding of their patients’ preferences. Healthcare organizations and professionals may need to utilize the internet and social media to access non-White populations.

J Drugs Dermatol. 2020;19(12):802-806. doi:10.36849/JDD.2020.5488


Because the United States of America is a multicultural and multiracial community, investigating the role culture and race play in perceptions, preferences, and decision making can help physicians provide quality information and recommend effective treatments for acne vulgaris. The literature is rich with examples of how perceptions of health and skin disease burden vary across races and cultures, but limited research has explored differences in preferred treatment attributes.1 This study aims to investigate the differences in people’s understanding of acne, their preferred sources of information about acne, and their treatment preferences.


A cross-sectional study was conducted from June 2017 to February 2018. A one-time 31 item survey was administered with questions regarding demographic information such as age and gender, severity of acne, acne treatment preferences, treatment adherence, racial/ethnic background (participants were able to select more than one race), and perceptions of causes of acne, in addition to a 6 item Willingness to Pay (WTP) discrete choice experiment for evaluating treatment valuation. WTP asks how much money a person would pay for a certain treatment to reduce the burden of disease by a certain percentage.2

The survey was hosted in REDCap, a secure, web-based application and distributed to participants with self-identified acne through two different routes: an online based national research registry ResearchMatch and flyers posted on and around a university’s graduate and undergraduate campuses. ResearchMatch is a national electronic, web-based recruitment tool that was created through the Clinical & Translational Science Awards Consortium in 2009 and is maintained at Vanderbilt University. The database was searched for volunteers who identified as having acne, were 18 years or older, and spoke English. A total of 1,144 individuals were contacted and 121 participants completed the survey. An additional 96 participants were recruited via paper flyers.

Statistical Analysis
Statistical analysis was performed with R. ANOVA and chi-squared tests were performed to determine the relationship between race and the variables detailed in the results section. To assess for knowledge of the causes of acne, participants had to identify all 4 choices provided as causes of acne (bacteria, clogged pores, excess oil, and inflammation) in order to be marked correct; otherwise, the question was marked incorrect. Anova and chi-squared tests were then run to correlate pass rate with race. For the 6 point WTP discrete choice experiment, the correlation between answers was determined to ensure