Exploring Social Avoidance and Psychosocial Factors in Young Adults with Acne in East China

Acne is highly prevalent among young adults, and in East Asian contexts-where appearance standards, social media exposure, and the cultural construct of "face" (mianzi) are particularly prominent-visible skin lesions may incur amplified social burdens. However, evidence from China remains scarce regarding the key drivers of social avoidance in this population: specifically, whether anxiety, body image disturbance, income level, and lesion distribution exert independent effects, beyond the influence of acne severity itself. This study aims to fill this research gap by examining a sample of young adults with acne from East China.

To investigate social avoidance and its associations with body image disturbance, anxiety, and sociodemographic factors in Chinese young adults with acne.

A cross-sectional study of 201 acne patients (18-29 years) in East China assessed social avoidance (SADS-SA), body image (BIDQ), and anxiety (GAD-7). Pearson correlation analyzed associations among variables, and multivariable linear regression explored independent effects of social avoidance.

Mean social-avoidance score was 5.71±3.79 and correlated with BIDQ (r = 0.343, P < 0.01) and GAD-7 (r = 0.546, P < 0.01). In multivariable models, higher income (≥5000 CNY) was negatively associated with avoidance (B =-2.640; β=-0.288; P = 0.022), whereas combined facial/neck + torso was positively associated with avoidance (B = 1.098; β= 0.122; P = 0.040); torso-only was negatively associated with avoidance (B =-3.889; β=-0.175; P = 0.003). Anxiety showed the strongest independent association with social avoidance (B = 0.330; β= 0.458; P < 0.001), while body image disturbance showed no significant direct association (P = 0.053).

In Chinese young adults with acne, anxiety is strongly associated with social avoidance-not acne severity itself. Higher income acts protectively, and combined facial/neck and torso distribution indicates greater risk. These findings support the integration of brief anxiety screening, targeted psychosocial interventions, and focused care for patients with visible lesions into dermatological care to reduce social avoidance.