Quality of Life Impairment in Singaporean Adolescents With Acne Vulgaris: A Cohort Study Highlighting the Role of Self‐Perception

BACKGROUND/OBJECTIVES: Acne vulgaris is highly prevalent among adolescents and carries significant psychosocial burdens. This study assessed the psychosocial impact of acne and identified factors contributing to reduced quality of life among Singaporean adolescents. METHODS: A cross-sectional study was conducted between August 2023 and October 2025, recruiting patients aged 12-18 years with acne vulgaris seen at KK Women's and Children's Hospital pediatric dermatology clinics. Patient-reported outcomes were measured using the Cardiff Acne Disability Index (CADI) and the Teenager's Quality of Life Index (TQoL). Acne severity was graded by physicians using the Global Evaluation Acne (GEA) scale. RESULTS: Among 100 participants, mean CADI and TQoL scores were 3.77 and 8.89, respectively. Self-perceived acne severity was the highest scoring CADI item but correlated poorly with physician-rated severity (r = 0.334, p = 0.001). The most affected TQoL domain was self-image. CADI and TQoL scores did not differ significantly by age, dermatological comorbidities, nodulocystic lesions, or scarring. Significantly worse scores (p < 0.05) were associated with female sex, acne duration ≥ 2 years, and truncal involvement. A strong dose-response relationship with clinician-graded severity was evident, with scores rising from mild to moderate to severe acne (CADI: 2.85, 4.63, 6.29, p < 0.001; TQoL: 6.36, 11.84, 12.71, p < 0.001). CONCLUSION: Adolescents with acne experience self-image concerns that are poorly aligned with physician clinical assessment. Female sex, longer duration, truncal involvement, and greater clinical severity are key determinants of QoL impairment. These findings highlight the need for timely, effective treatment alongside proactive psychosocial screening to reduce emotional and social burden in high-risk groups.