The Prevalence and Burden of Truncal Acne

Acne vulgaris is a common inflammatory skin disorder that imposes substantial psychosocial and quality-of-life burden. While most guidelines focus on facial involvement, acne frequently affects the trunk, which further exacerbates symptoms and impairs health-related quality of life (HRQoL). Emerging evidence suggests that combined facial and truncal acne is associated with greater disease severity and psychological distress, yet real-world data remain limited. This study evaluates the prevalence of truncal acne and the HRQoL burden associated with facial acne alone, truncal acne alone, and combined facial/truncal acne in a large secondary-care cohort.

A retrospective analysis was conducted using an ethically approved UK dermatology database (2001-2020) comprising 2038 patients. Acne severity was assessed using the Leeds photometric scale and subsequently categorized as mild, moderate, or severe disease. All patients completed the Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS).

Among validated cases, 36.3% had facial acne alone, 1.7% truncal acne alone, and 61.9% combined facial/truncal involvement. Patients with combined disease exhibited significantly higher total DLQI scores than those with facial acne alone (p = 0.025). DLQI item analyses demonstrated greater symptom burden (question 1; p = 0.048) and work/study impairment (question 7; p = 0.031) in patients with facial/truncal acne. Total HADS scores were also significantly elevated in this group (p = 0.047), independent of acne severity, indicating increased psychosocial distress.

Our prevalence of truncal acne (63.6%, including both truncal-only and combined facial-truncal disease) exceeds previous reports of approximately 50%. The presence of truncal involvement in addition to facial acne was associated with significantly greater health-related quality-of-life impairment compared with facial acne alone. These findings highlight the need for proactive assessment of truncal acne lesions and guideline recommendations addressing truncal acne. Improved recognition and tailored treatment, potentially including agents suitable for facial and truncal acne, may help mitigate the substantial burden associated with acne.