Acne vulgaris is a common skin disorder, affecting 40 to 50
million people in the United States.1 Approximately 85% of the
adolescent population will develop acne to some degree, and 40%
to 54% of individuals older than 25 are affected as well. The
incidence is generally universal among ethnicities and between
genders, except in the case of adult acne; approximately 3% of
males are affected versus 12% of females.2 Although acne is a
self-limiting disorder that may appear to be mostly cosmetic in
nature, it may place an emotional and psychological burden on
the affected individual that is more than skin deep. The
physical change on the surface of the skin and, at times, the
accompanying scarring may lead to a reduction in quality of life
comparable to that of people with epilepsy, asthma, diabetes, or
arthritis.3 The psychologic impact, which can include social
withdrawal, lack of confidence, anxiety, and depression, has
been associated with higher rates of unemployment. In the U.S.,
the direct cost of acne is