Morphological Profile of Facial Acne Scars and Their Correlation With Body Image Concern and Scar-Specific Quality of...

Introduction Acne scarring represents a permanent structural sequela of acne vulgaris and is predominantly characterized by atrophic morphological patterns. Beyond cosmetic disfigurement, facial acne scars may contribute to significant psychosocial distress, including body image disturbance and quality-of-life impairment. Limited data are available correlating scar morphology with body image concerns and scar-specific quality-of-life impairment in the Indian population. Objectives The objectives of this study are to examine the morphological profile of facial acne scars, evaluate the body image concerns and quality of life among patients with acne scars, and determine the correlation of facial acne scarring with body image concerns and quality-of-life impairment. Materials and methods This cross-sectional observational study was conducted in the Department of Dermatology, Venereology and Leprosy, Adichunchanagiri Hospital and Research Centre, Karnataka, over a period of 18 months. It included 150 patients of either gender, aged 18-40 years, with facial acne scars. Morphological assessment was performed under standardized illumination. Scar severity was graded using the Goodman and Baron qualitative grading system and the Self-assessment of Clinical Acne-Related Scars (SCARS) questionnaire. The Body Image Concern Inventory (BICI) and Facial Acne Scar Quality of Life (FASQoL) questionnaires were used for fulfilling the respective objective. Statistical analysis was performed using Epi Info software. Correlations were assessed using Spearman's rank correlation coefficient. A p-value of < 0.05 was considered statistically significant. Results The majority of participants (63.3%; n=95) were aged 21-25 years, and 69.3% (n=104) were female. Icepick scars were the most common morphological type at 78.7% (n=118), followed by boxcar scars at 61.3% (n=92). Clinician-based grading revealed that 72.6% (n=109) of participants had moderate to severe acne scarring. Based on a SCARS assessment, 36.0% (n=54) had mild, 30.0% (n=45) had moderate, and 15.3% (n=23) had severe/very severe scarring. Mean BICI scores increased significantly across SCARS severity categories (p<0.001). The mean FASQoL score was 6.79 ± 7.11, with higher scores observed in severe scarring (p<0.001). Moderate positive correlations were observed between SCARS and BICI (rₛ=0.419, p<0.001), SCARS and FASQoL (rₛ=0.500, p<0.001), Goodman-Baron grade and FASQoL (rₛ=0.448, p<0.001), and Goodman-Baron grade and BICI (rₛ=0.367, p<0.001). Conclusion Body image concern is evident across domains of dissatisfaction with appearance, preoccupation with perceived flaws, and mirror-checking behaviors. Scar-specific quality-of-life impairment manifests as emotional distress, social self-consciousness, and reduced interpersonal confidence. Patient-perceived severity demonstrates a particularly strong relationship with psychosocial burden, underscoring the importance of integrating clinician-based grading with validated patient-reported outcome measures for comprehensive assessment and patient-centered management.