Acne Vulgaris in China: What Patients Do (and Don’t) Know About Skin Care and Their Condition

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Acne Vulgaris in China: What Patients Do (and Don’t) Know About Skin Care and Their Condition

Acne vulgaris (AV)—the medical term for common acne—is one of the most widespread skin conditions globally, impacting up to 90% of adolescents and a growing number of adults. For many, it’s more than just pimples: acne can erode self-esteem, disrupt social interactions, and even affect work or school performance. But how do people with acne in China manage their skin, and what misconceptions do they hold about their condition? A 2021 study published in the Chinese Medical Journal sought answers by surveying over 1,000 acne patients across the country.

Who Was Studied?

The research, led by Ruo-Ran Cui (School of Clinical Medicine, Chongqing Medical University) and colleagues from institutions including Shanghai Skin Disease Hospital and L’Oréal China, analyzed data from 1,119 participants. Of these, 654 were outpatients from four hospitals (Shanghai Renji Hospital, Shanghai Ninth People’s Hospital, etc.), and 465 were university students (Chongqing Medical University, Xi’an Jiaotong University, etc.). All completed an anonymous electronic questionnaire in June 2020.

Most participants were women (71%), with an average age of 28.3 years. The acne severity was split into mild (33%), moderate (52%), and severe (15%), and 40% had lived with acne for 3 years or longer.

How Does Acne Affect Daily Life?

Acne took a toll on nearly every aspect of participants’ lives:

  • Appearance: 78% said acne harmed their looks.
  • Emotion: 70% reported negative impacts on their mood (e.g., anxiety, low self-esteem).
  • Social contact: 40% felt acne made them avoid social situations.
  • Work/study: 31% said acne interfered with their job or school performance.
  • Relationships: 27% linked acne to challenges in romantic relationships.

Treatment and Skin Care Habits

Despite the high prevalence of moderate-to-severe acne, only 64% of participants had seen a dermatologist for treatment. Of those who did, 59% used topical creams (e.g., benzoyl peroxide) and 37% took oral medications (e.g., antibiotics). A surprising 70% admitted to squeezing pimples with their hands—a risky habit that can push bacteria deeper into the skin, worsen inflammation, and cause scarring.

When it came to skin care, most patients relied on:

  • Cleansers: 76% used them to manage oil and dirt.
  • Moisturizers: 53% applied hydrating products (even with oily skin, moisture is key to balanced skin).
  • Sunscreen: Only 26% used it—despite UV exposure being a major cause of dark spots (hyperpigmentation) from acne.

More than half (59%) believed skin care products could improve their acne, and 72% trusted dermocosmetics (skin care with medical benefits, like oil-control or anti-inflammatory ingredients) to help.

Skin Type and Acne Severity

Skin type played a clear role in acne severity:

  • Oily skin: 37% of participants (linked to more severe breakouts).
  • Combination skin: 44% (dry in some areas, oily in others—also tied to worse acne).
  • Neutral/dry/sensitive: 18% total (less likely to have severe acne).

The study found a significant association between oily/combination skin and acne severity (P=0.04), supporting earlier research that links excess oil production to clogged pores and pimples.

What Do Patients Think Causes Acne?

Participants named these top triggers for their acne:

  1. Staying up late/poor sleep (80%)
  2. Incorrect skin care (54%)
  3. Mood (e.g., stress, anxiety) (48%)
  4. Diet (33%)
  5. UV light (10%)
  6. Air quality (7%)

A key misperception: 39% of patients believed acne would “disappear naturally” after adolescence. This is a myth—adult acne affects millions of people worldwide, often due to hormones, stress, or lifestyle factors.

What Worries Acne Patients Most?

When asked about long-term concerns, participants ranked:

  1. Recurrence: 67% feared their acne would come back after treatment.
  2. Large pores: 61% worried about permanent pore enlargement.
  3. Scarring/pigmentation: 56% dreaded dark spots or indented scars (atrophic scars) from acne.
  4. Oily skin: 40% wanted to reduce excess oil.

Mask Wear and Acne: A COVID Reality

The 2020 COVID-19 pandemic introduced a new challenge: mask-induced acne (or “maskne”). Masks trap heat, sweat, and oil against the skin, creating a perfect environment for bacteria to grow. Over 73% of participants believed long-term mask wear worsened their acne.

The study offered simple tips for mask-wearing acne patients:

  1. Wipe your face with a moisturizing wet towel to remove sweat and oil.
  2. Use oil-controlling cleansers and emollients (lightweight moisturizers) to balance skin.
  3. See a dermatologist if breakouts persist or worsen—topical or oral medications may help.

Where Do Patients Get Acne Advice?

Doctors were the most trusted source of information (69% of patients), but social media played a big role:

  • Friends: 38% got dermocosmetic recommendations from peers.
  • Social media: 27% used Little Red Book/Sina Weibo, 24% Zhihu, and 18% TikTok/Kuaishou.
  • Brand officials: 45% turned to beauty brands for advice.

This mix of professional and informal sources highlights an opportunity: Healthcare providers could use social media to share accurate acne tips—reaching patients where they already seek information.

Key Takeaways

The study reveals three critical insights about acne care in China:

  1. Misperceptions persist: Nearly 40% of patients think acne fades after adolescence, and few link it to environmental factors like air pollution.
  2. Risky habits are common: Squeezing pimples and skipping sunscreen are widespread—even though they worsen acne.
  3. Social media is a tool for education: While doctors are trusted, platforms like TikTok and Little Red Book are where many patients get advice. Healthcare providers could use these channels to share evidence-based tips.

For anyone with acne, the message is clear: Seek help from a dermatologist, avoid squeezing pimples, wear sunscreen daily, and be critical of informal advice online.

Original study: Cui RR, Li W, Shen Z, Zhang ZX, Chen AJ. Assessment of skin care behavior and cognition of patients with acne vulgaris in China. Chinese Medical Journal. 2021;134(5):614-615. doi:doi.org/10.1097/CM9.0000000000001397

References:

  1. Shen Y, Wang T, Zhou C, et al. Prevalence of acne vulgaris in Chinese adolescents and adults: a community-based study of 17,345 subjects in six cities. Acta Derm Venereol. 2012;92(1):40-44. doi:doi.org/10.2340/00015555-1164
  2. Wolkenstein P, Machovcová A, Szepietowski JC, et al. Acne prevalence and associations with lifestyle: a cross-sectional online survey of adolescents/young adults in 7 European countries. J Eur Acad Dermatol Venereol. 2018;32(2):298-306. doi:doi.org/10.1111/jdv.14475
  3. Alshammrie FF, Alshammari R, Alharbi RM, et al. Epidemiology of acne vulgaris and its association with lifestyle among adolescents and young adults in Hail, Kingdom of Saudi Arabia: a community-based study. Cureus. 2020;12(8):e9277. doi:doi.org/10.7759/cureus.9277
  4. Thiboutot DM, Dréno B, Abanmi A, et al. Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2018;78(1):S1-S23.e1. doi:doi.org/10.1016/j.jaad.2017.09.078
  5. Gheisari M, Araghi F, Moravvej H, et al. Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic. J Eur Acad Dermatol Venereol. 2020;34(7):e297-e298. doi:doi.org/10.1111/jdv.16492

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