The effects of acne vulgaris on quality of life and changes in quality of life after treatment are not only explainable by objective severity of acne. Patients' and clinicians' judgements about acne severity are different.

Background: Adherence to treatment is a mayor issue in dermatology, and its relationship to quality of life has barely been studied. Objective: To evaluate the relationship between scores on the Skindex-29 skin disease assessment scale and adherence to treatment in patients with acne. Methods: An observational, prospective study of 1,628 patients carried out by 252 clinicians in Spain. Results: Adherence was related to better objective and subjective severity index scores and better Skindex-29 scale scores at the end of the study. Young, male and unemployed patients had the worst adherence scores. Baseline and final Skindex-29 scale scores were significantly worse in non-adherent females, while non-adherent males scored better. Reasons for non-adherence were side effects for older patients and forgetfulness for younger ones. Conclusion: Dermatologists should explain that adherence to treatment is linked to better outcomes and better quality of life. Young females with high Skindex-29 scale scores and males with low Skindex scores are especially prone to non-adherence.

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