Table 2. Emergent Categories and Codes Frequencies.
| Categories and codes | Representative quotation or researcher description | No. (%) | ||
|---|---|---|---|---|
| No. of occurrences FTA (n = 28)a | No. of occurrences AS (n = 28)a | Overall (n = 56)a | ||
| Psychological effect categoryb | ||||
| Effect on self-esteem | You mess with my self-esteem, and it bothers me a lot. (FTA study, Brazil) | 11 (39) | 4 (14) | 15 (27) |
| Self-conscious | I can’t go out in public without makeup, I’m afraid of people pointing it out making me feel self-conscious. (FTA study, USA) | 11 (39) | 8 (29) | 19 (34) |
| Unaware of acne outcomes | I tried to get rid of you by squeezing you and I did not know it could stain me. (FTA study, Brazil) | 4 (14) | 1 (4) | 5 (9) |
| Losing control | I didn’t choose to have you, you still came. (FTA, Canada) | 4 (14) | 0 | 4 (7) |
| Lingering burden (even if cured) | At first, I thought that you would disappear quickly and leave no traces, unfortunately this was not the case. Now I look at what remains, and I am overwhelmed at the sight. (AS, Germany) | 4 (14) | 6 (21) | 10 (18) |
| Image of self | When you look in the mirror you look terrible. (AS, Germany) | 2 (7) | 5 (18) | 7 (13) |
| Feelings and emotions categoryb | ||||
| Shame/embarrassment | I’m very ashamed because of you, very much! (FTA, Brazil) | 11 (39) | 3 (11) | 14 (25) |
| Feel ugly | But why do I feel so ugly? (FTA, Canada) | 8 (29) | 7 (25) | 15 (27) |
| Powerlessness | I cry sometimes because you come and go as you want. At the completely wrong times, as well. (FTA, USA) | 7 (25) | 2 (7) | 9 (16) |
| Unfairness | Why me? I don’t think I’ve done anything to deserve you being in my life, at all. (FTA, USA) | 5 (18) | 5 (18) | 10 (18) |
| Frustration | Something that has troubled me for years is how come there is no treatment effective enough? And why me? (AS, France) | 2 (7) | 5 (18) | 7 (13) |
| Difficult/hard | Your presence made some periods of my life really difficult, you collected all my frustrations, regrets. (AS, Italy) | 1 (3.5) | 6 (21) | 7 (13) |
| Bothersome | I find it exhausting and very annoying that I can never get rid of you. (AS, Germany) | 1 (3.5) | 5 (18) | 6 (11) |
| Sadness | You make me sad when I look at you. (AS, Brazil) | 0 | 4 (14) | 4 (7) |
| Hate | I hate you! (FTA, Canada) | 1 (4) | 3 (11) | 4 (7) |
| Physical effects categoryb | ||||
| Visible marks | Your marks on my face mean that I think about you every day. (AS, France) | 9 (32) | 8 (29) | 17 (30) |
| Cause of acne/acne scars | Some of those who suffer from acne blame hormones, eating habits, sweets, salami, greasy soaps, mum and dad who suffered from acne as adolescents too! (FTA, Italy) | 5 (18) | 3 (11) | 8 (14) |
| Irritation/redness | It turns out that you cause me discomfort, cause me irritation. (FTA, Brazil) | 5 (18) | 1 (4) | 6 (11) |
| Flare | I find it exhausting and very annoying that you break out at the worst of times. (FTA, Germany) | 4 (14) | 1 (4) | 5 (9) |
| Soreness/pain | I had lots of acne and it was sore and very ugly. (FTA, Brazil) | 4 (14) | 0 | 4 (7) |
| Skin unpleasant aspect | Ever since I went through puberty, I have always had problems with pimples and greasy, blemished skin. (AS, Germany) | 3 (11) | 3 (11) | 6 (11) |
| Extension (truncal) | When you appear on my back, I don’t get that mad. I can deal with/cover that up. Appearing on my face is a whole different story. (FTA, USA) | 3 (11) | 0 | 3 (5) |
| Reminiscence of acne | The acne went away and left me with you [scars]. (AS, Brazil) | 0 | 3 (11) | 2 (5) |
| Treatment burden categoryb | ||||
| Treatment burden (texture, odor, quantity, or other) | I wash my face 4 times a day and still look dirty. I look unclean. I look unpretty. I’ve tried birth control, different soaps. (FTA, Canada) | 6 (21) | 0 | 6 (11) |
| Financial burden | I’ve tried everything from proactive in my teen years to oil cleansing. The amount of money I’ve spent on you is crazy. (FTA, USA) | 5 (18) | 3 (11) | 8 (14) |
| Treatment lack of efficacy | How is it possible that nowadays there are efficient treatments for cancer and other serious diseases while acne that for ages has been troubling teenagers and adults can’t be successfully cured? (FTA, Italy) | 4 (14) | 4 (14) | 8 (14) |
| Lifestyle adaptation | I cannot take pictures without making changes [to my appearance] to try hide you. (FTA, Brazil) | 3 (11) | 0 | 3 (5) |
| Treatment efficacy | I am in treatment now, with a dermatologist who understood me, and I am getting success, the results are extremely visible, and I think you are, after all, leaving me. (FTA, Brazil) | 3 (11) | 2 (7) | 5 (9) |
| Attitudes and coping strategies categoryb | ||||
| Hide/cover-up | Since I can’t erase you, I decided to cover you with the beard. (AS, Italy) | 12 (43) | 11 (39) | 23 (41) |
| Hope | I hope to get rid of you as soon as possible. (FTA, Brazil) | 12 (43) | 7 (25) | 19 (34) |
| Fight | I’m fighting against you, but this is expensive. (FTA Brazil) | 6 (21) | 2 (7) | 8 (14) |
| Health care professional (HCP) follow-up | I have enough of taking burdock pills and putting cream, past adolescence I hope I will not have [acne] anymore, I have an appointment with a dermatologist in July. (FTA, France) | 4 (14) | 1 (3.5) | 5 (9) |
| Isolation | I find myself avoiding big crowds because I am self-conscious about what people might think, when they see my skin. (FTA, USA) | 4 (14) | 3 (11) | 7 (13) |
| Acceptance | Even though your presence is seen it is not felt. You remind me of a period of my life where a lot of change was happening. Because you are on my face, I see you every day, but I don’t feel less beautiful (AS, Canada) | 4 (14) | 13 (47) | 17 (30) |
| Constraints (diet, clothing, leisure) | I have to do blood tests to see if the treatment I am doing is not bad for my health, I cannot eat what I want. (FTA, Brazil) | 4 (14) | 1 (4) | 5 (9) |
| Trying to be positive | I don’t feel much about this unchosen companionship. Sometimes I ask “why me” but other than that I’m okay and feel great and confident in the skin I’m in. (AS, Canada) | 3 (11) | 6 (21) | 9 (16) |
| Socialization categoryb | ||||
| Other people’s opinion | Sometimes I find myself in situations when you become the subject of the conversation and the reason I am criticized. (FTA, Italy) | 11 (39) | 9 (32) | 20 (36) |
| Friendship | To the friends that I had, I always tried to hide you. (FTA, Brazil) | 3 (11) | 0 | 3 (5) |
| Love relationship | My boyfriend left, and I got really bad, I remember a lot of this time, because when I look in the mirror and see you, I know that you have marked my life forever. (AS, Brazil) | 0 | 3 (11) | 3 (5) |
| Work and school situation | I’ve faced social stigma at school and in the workplace. (AS, Canada) | 3 (11) | 3 (11) | 6 (11) |
| Participant’s position categoryb | ||||
| The plea/the order to leave | Don’t come back...ever!! seriously. (FTA, USA) | 16 (57) | 2 (7) | 18 (32) |
| Helplessness | But why do I feel so ugly? Why do I feel so ashamed? (FTA, Canada) | 7 (25) | 1 (3.5) | 8 (14) |
| Wish it never happened | I really would have loved to never have met you. Your marks on my face mean that I think about you every day. (AS, France) | 0 | 8 (29) | 8 (14) |
| Wish it disappears | I wish you were not there! I wish I had clean and uncomplicated skin. I hope that you will eventually disappear. (AS, Germany) | 0 | 8 (29) | 8 (14) |
| Magic spell | I truly wish there was a magic spell to make you disappear. (AS, Canada) | 0 | 3 (11) | 3 (5) |
| Personified condition’s position categoryb | ||||
| The stronger external force | I didn’t choose to have you, you still came however, and I still don’t want you. (FTA, Canada) | 11 (39) | 2 (7) | 13 (23) |
| The intruder | Acne, you are so comfortable living on my skin, I wish I could be comfortable living in it too. (FTA, Canada) | 6 (21) | 4 (14) | 10 (18) |
| The unwanted companion | My hope is that, someday soon, you will leave and never return for you are not welcome on my body. (FTA, Canada) | 4 (14) | 6 (21) | 10 (18) |
| The accountable one | Because you were in my body, I had no friends. (FTA, Brazil) | 5 (18) | 2 (7) | 7 (13) |
| The self-acceptance | It took me a while to accept these marks as part of my body, but I’ve gotten much better at accepting them. (AS, Canada) | 0 | 6 (21) | 6 (11) |
Abbreviations: AS, acne scars; FTA, facial and truncal acne.
a
Of the 60 participants of the qualitative FTA and AS study arms, 4 did not complete the personification exercise.
b
Categories are not mutually exclusive; therefore, the total percentage exceeds 100%.