The Quality of Life Impact of Acne and Rosacea Compared to Other Major Medical Conditions

June 2014 | Volume 13 | Issue 6 | Original Article | 692 | Copyright © June 2014

Nicole D. Cresce BS,a Scott A. Davis MA,a William W. Huang MD MPH,a Steven R. Feldman MD PhDa,b,c

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
cDepartment of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC

BACKGROUND: Acne and rosacea cause significant negative impact on quality of life. There is limited information comparing the health-related quality of life (HRQL) impact associated with acne and rosacea to other patient populations.
PURPOSE: We review available literature to assess the HRQL impact of acne and rosacea and compare them with major medical conditions.
METHODS: A PubMed search identified studies that utilized the Short Form 36 (SF-36), the Dermatology Life Quality Index (DLQI), and the willingness-to-pay (WTP) metric to assess the HRQL impact of acne and rosacea. These data were compared to HRQL values for other diseases.
RESULTS: The HRQL impact of acne is similar to asthma, epilepsy, diabetes, back pain, arthritis, and coronary heart disease using SF-36 data. DLQI scores for acne ranged from 2 to 17.7 and for rosacea ranged from 4.3 to 17.3; the DLQI scores for psoriasis ranged from 1.7 to 18.2. WTP data identified ranged widely for both acne and rosacea.
LIMITATIONS: There was limited broadly generalizable data for acne and rosacea.
CONCLUSIONS: Acne and rosacea impact HRQL to a similar degree as other major medical conditions by indirect comparison to psoriasis, a skin condition causing significant disability, and by direct comparison for acne. In the setting of limited health care resources, allocation should be grounded in the evidence that acne and rosacea are not trivial in their effects.

J Drugs Dermatol. 2014;13(6):692-697.


Acne vulgaris and rosacea can have a profound impact on health-related quality of life (HRQL). A joint project by the American Academy of Dermatology Association and the Society for Investigative Dermatology in 2004 found that acne affects 50.2 million Americans and costs $15 billion per year (including impact on quality of life) and rosacea affects 14.7 million and costs $2 billion.1 Acne and rosacea result in shame, embarrassment and mental stress and are associated with anxiety, social phobia and depression.2-9 Additionally, acne and rosacea patients can be severely affected by social and employment discrimination. 3,10-12
The impact of acne and rosacea needs to be evaluated in the context of finite health care resources.13,14 There is limited information regarding the impact of acne and rosacea compared to non-dermatologic conditions. The present study addresses how the HRQL of acne and rosacea patients compares with the HRQL of other chronic medical conditions.


We identified three measures that can be used to quantify the impact of acne and rosacea to other medical conditions. The first method is a generic HRQL questionnaire that can be used across a broad range of medical conditions.15,16 The SF-36 has been widely used for dermatologic and non-dermatologic conditions.14,17 Another commonly used generic questionnaire is the EuroQol EQ-5D (EQ-5D) which is scored on a scale of 0 (death) to 1 (full health).16 To ensure accurate comparisons, data using these measures are needed from similar populations.
The second method is a dermatology-specific questionnaire to provide a more sensitive assessment of impact on HRQL.13 The Dermatology Life Quality Index (DLQI) is the first and most widely used in this class.13,16,17 The DLQI is scored from 0 to 30 with a higher score indicating greater disability.13,16,17 Skindex is another frequently used dermatology-specific questionnaire. There are several versions that vary in the number of questions asked but are generally scored from 0 to 100 with a higher score indicating greater effect.18
The third method focused on the willingness-to-pay (WTP) metric which determines how much money a patient would be willing to spend to reduce or eliminate their disease.19
PubMed literature searches were performed to identify relevant studies. For acne, the key words acne and quality of life were used. Results were limited to the English language, which produced 311 studies. Sixty-seven results were not acne vulgaris