Table 3. Main Themes and Representative Quotes.

Theme	Representative quotes
Concerns about appearance	“I would say it makes me self-conscious about myself and the way I look. It’s impacted me in a professional sense where I feel like I’m not taken as seriously [or] professionally in my career because I have acne. It makes me seem younger, in a sense, even though I’m not.”
Mental and emotional health	“I want to say in my 20s there were a couple times that I didn’t go out if I saw that my acne was just super bad. Because I was bummed, I wasn’t going out or participating in a social event. Emotionally, I was upset or angry or just wanted it to all go away. Always thinking it would go away just in one day, and then hating that my body was not doing what I thought it should do because I thought my actions would help me, help my acne. There were about two or three years when it was at its peak that it became emotionally and mentally draining. Sometimes I would go all day—I just wouldn’t even look in the mirror.”
Everyday life impact	“It prevents me from doing the things that I love to do. It prevents me from leaving my house. It prevents me from getting my mail without makeup on. It pretty much prevents me from doing anything without makeup on, so it 100% affects my entire life.”
Successful treatment	“I’d say the biggest [goal] is having clear skin, so just not seeing acne. A kind of intermediary step is having some acne but not feeling like it’s particularly noticeable. I’m not picking at it, or it’s not particularly visible. Yeah, there’s a sort of intermediary stage of feeling like I have it, but I’m not bothered by it, or I’m not noticing it, and I’d say those are the two ways of defining success, either it’s just not there, or it’s there, and I don’t notice it as much.”
Interactions with health care system	“It felt like [the treatments I was being offered] were just way too extreme for a problem that was external and not really materially impacting my day-to-day, even if I wasn’t happy about it. That changed a couple years ago with my current doctor who is at [University], who said, ‘Well, that’s your choice. We can absolutely try some topical things. I have some ideas how we can better work or better choose different ones for you, but frankly, I don’t think you’re going to get the results you want with them, and here’s why.’ I appreciated that respect and that layout of information and decisions, and of course, tried the new topicals and saw a little bit of difference, and she was right. After a couple months, we had given it the test period, I was like, ‘Okay, I’m willing to try some oral medication,’ and thank goodness I did because it’s what I needed, and it made a big difference, so now I feel great about it.” “For me, it’s been like hearing the same thing from each dermatologist. Oh, people with your skin color scar easily or [develop] hyperpigmentation, or we don’t really know the right products to use. It’s like you go to the dermatologist, and they don’t really know how to help you. It’s just like, geez, do you not specialize in all types of skin? Do I have to go to the dermatologist that only specializes in my skin tone?”