Perceived vs. Clinical Acne Severity: Impact on QoL and Treatment Adherence in Male Military Personnel: A Cross-Sectional Study

Background: Acne vulgaris imposes a significant psychosocial burden, which may be intensified when patients’ perceived severity diverges from objective clinical grading. Such discordance may be amplified in high-stress populations like military personnel, yet evidence in this cohort remains limited. This study quantified this discordance in male military personnel and evaluated whether subjective or objective severity better predicts quality of life (QoL) impairment and treatment adherence. Methods: We conducted a cross-sectional, questionnaire-based study at a major military medical center in China from March to July 2025. A total of 300 active-duty male military personnel with acne vulgaris were enrolled. Acne severity was objectively assessed by dermatologists using the Global Acne Grading System (GAGS) and subjectively by patients using a 10-cm visual analog scale (VAS). QoL was measured using the Dermatology Life Quality Index (DLQI). Associations between severity scores, DLQI, sociodemographics, and treatment patterns were analyzed using Spearman’s rank correlation, Mann–Whitney U -test, Kruskal–Wallis H -test, and Chi-square test as appropriate. Results: Significant discordance existed between clinician and patient severity assessments (P< 0.001). Clinicians classified severity as mild (39.0%), moderate (52.7%), and severe (8.3%), whereas self-ratings were 12.7% mild, 53.0% moderate, and 34.3% severe; 52.3% of patients overestimated their severity. Self-rated severity correlated more strongly with DLQI impairment than GAGS scores (r=0.314 vs. 0.206, both P< 0.001). GAGS scores were primarily associated with impairments in physical symptoms, clothing, and social activities, while self-rated severity correlated significantly with all 10 DLQI domains. Higher DLQI scores were associated with marriage, acne scars, military service of 2– 5 years, and persistent symptoms (all P< 0.05). A treatment paradox emerged: patients with objectively severe acne sought more interventions but had shorter treatment duration (64% discontinued within ≤ 1 month, P=0.040), whereas those with subjectively severe acne maintained longer courses (69.9% continued > 3 months, P=0.011). Conclusion: In military populations, self-perceived acne severity more strongly predicts QoL impairment than objective grading and drives differential treatment engagement. Integrating dual-dimensional assessments and psychological support into military dermatology protocols is essential to optimize acne management. Keywords: acne vulgaris, military personnel, patient-reported outcomes, quality of life, severity of illness index, treatment adherence