Prevalence and psychological impact of Acne vulgaris among female secondary school students in Arar city, Saudi Arabia, in 2018

Teledermatology and Virtual Visits for Acne Management: A Review

Acne vulgaris is a common dermatological condition requiring individualized management. Teledermatology provides convenience and accessibility that is highly suitable for this dermatological condition. Herein, our review aimed to describe the current state of teledermatology in the context of acne management and to assess patient satisfaction, adherence to virtual care, and the experiences of health care providers in delivering remote dermatological services. A systematic search for articles was conducted in Medline, Embase, and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Title, abstract, full-text screening, and data abstraction were carried out in duplicate. One thousand one hundred three nonduplicate articles were screened based on title and abstract review. A total of 21 studies were included in the review. It was found that teledermatology is well-suited to the effective management of acne vulgaris. When compared to in-person care, teledermatology resulted in similar outcomes on several acne-grading scales. Additionally, patient satisfaction was comparable, with a large proportion of patients preferring virtual care to traditional in-person visits. However, compliance was found to be lower for virtual care. There are several secondary benefits to telemedicine, including time savings and greater accessibility to care for rural patients. Teledermatology is an evolving, promising medium for acne management for both clinicians and patients. Future research comparing the effectiveness of different teledermatology platforms, its limitations and pitfalls, and integration of patient and physician preferences to improve treatment outcomes is warranted.

Living With Acne Vulgaris in Young Adults: A Holistic Examination of Its Impact on Quality of Life Using the Dermatology Life Quality Index (DLQI)

BACKGROUND

Acne vulgaris is an inflammatory skin disease that shows chronic effects in adolescents and young adults. Its impact on quality of life (QoL) often extends beyond the physical symptoms, influencing social interactions and reducing self-confidence. Although these impacts are widely acknowledged, they are seldom given sufficient attention or assessed in depth with standardized measures like the Dermatology Life Quality Index (DLQI). This study aimed to evaluate the extent to which acne interferes with QoL in young adults using DLQI scores and its associations with demographic and clinical factors.

METHODS

This hospital-based, cross-sectional study was conducted between October 2023 and December 2023 at Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, India. The study population comprised 200 participants aged 16-28 diagnosed with acne. Data collected included demographic factors (age, sex), clinical features (acne grade, duration, site, scars, hyperpigmentation, and skin type), and DLQI scores. Acne severity was classified from grade I to IV, and the relationships between DLQI scores and clinical/demographic variables were analyzed using chi-squared tests, with statistical significance set at p<0.05. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States).

RESULTS

The mean age of participants was 19.6 years, with women comprising 68.5% of the study population. Acne grade II was the most common, and the average DLQI score was 11.14, indicating a noticeable impact on QoL. Nearly half of the participants (48%) reported a "very large" effect on QoL. Highly significant associations were found between duration of acne, post-acne hyperpigmentation, and grade of acne with DLQI scores (all p<0.001), showing that longer duration, hyperpigmentation, and higher grades of acne significantly worsened QoL. Significant associations were also observed for site of acne and acne scars (both p<0.05), with multiple acne sites and severe scarring linked to greater negative impacts on DLQI scores. Grade III-IV acne were especially tied to bigger hits on QoL. Additionally, site of acne and acne scars were highly associated with acne grade (p<0.001). Factors such as having acne for over two years, oily skin, acne across multiple sites (face, chest, and back), and post-acne hyperpigmentation contributed to higher DLQI scores.

CONCLUSION

Acne vulgaris has a marked impact on QoL in young adults, especially those with severe, persistent, and extensive cases. Focusing on both the physical and mental aspects of acne in treatment could make a difference. Further multi-center studies with larger samples are recommended to generalize these findings and help create targeted interventions.

Topical, light-based, and complementary interventions for acne: an overview of systematic reviews

BACKGROUND

Acne is a chronic inflammatory and immune-mediated disease of the pilosebaceous unit (the skin structure consisting of a hair follicle and its associated sebaceous gland). It is characterised by non-inflammatory lesions (open and closed comedones) and inflammatory lesions (papules, pustules, nodules, and cysts). Lesions may be present on the face, thorax, and back, with variable severity. Acne exhibits a global distribution and has a growing prevalence. Acne vulgaris is the most common form. Acne gives rise to complications such as scars and can seriously affect people's mental health, especially those with severe acne. Acne has a huge impact on the quality of life and self-esteem of those affected.

OBJECTIVES

To synthesise the existing evidence on the efficacy and safety of non-systemic pharmacological interventions and non-pharmacological interventions (physical therapy and complementary therapies) in the treatment of acne vulgaris and related skin complications.

METHODS

We searched the Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE, and Embase to 2 December 2021, and checked the reference lists of included reviews. At least two authors were responsible for screening, data extraction, and critical appraisal. We excluded reviews with high risk of bias as assessed with the ROBIS tool. We evaluated the overall certainty of the evidence according to GRADE (as carried out by the authors of the included reviews or ourselves). We provide comprehensive evidence from the review data, including summary of findings tables, summary of results tables, and evidence maps.

MAIN RESULTS

We retrieved and assessed a total of 733 records; however, only six reviews (five Cochrane reviews and one non-Cochrane review) with low risk of bias met the overview inclusion criteria. The six reviews involved 40,910 people with acne from 275 trials and 1316 people with acne scars from 37 trials. The age of the participants ranged from 10 to 59 years, with an average age range from 18 to 30 years. Four reviews included original trials involving only female participants and three reviews included original trials with only male participants. Main results for clinically important comparisons: Benzoyl peroxide versus placebo or no treatment: In two trials involving 1012 participants over 12 weeks, benzoyl peroxide may reduce the total (mean difference (MD) -16.14, 95% confidence interval (CI) -26.51 to -5.78), inflammatory (MD -6.12, 95% CI -11.02 to -1.22), and non-inflammatory lesion counts (MD -9.69, 95% CI -15.08 to -4.29) when compared to placebo (long-term treatment), but the evidence is very uncertain (very low-certainty evidence). Two trials including 1073 participants (time point: 10 and 12 weeks) suggested benzoyl peroxide may have little to no effect in improving participants' global self-assessment compared to placebo (long-term treatment), but the evidence is very uncertain (risk ratio (RR) 1.44, 95% CI 0.94 to 2.22; very low-certainty evidence). Very low-certainty evidence suggested that benzoyl peroxide may improve investigators' global assessment (RR 1.77, 95% CI 1.37 to 2.28; 6 trials, 4110 participants, long-term treatment (12 weeks)) compared to placebo. Thirteen trials including 4287 participants over 10 to 12 weeks suggested benzoyl peroxide may increase the risk of a less serious adverse event compared to placebo (long-term treatment), but the evidence is very uncertain (RR 1.46, 95% CI 1.01 to 2.11; very low-certainty evidence). Benzoyl peroxide versus topical retinoids: Benzoyl peroxide may increase the percentage change in total lesion count compared to adapalene (long-term treatment), but the evidence is very uncertain (MD 10.8, 95% CI 3.38 to 18.22; 1 trial, 205 participants, 12 weeks; very low-certainty evidence). When compared to adapalene, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): percentage change in inflammatory lesion counts (MD -7.7, 95% CI -16.46 to 1.06; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), percentage change in non-inflammatory lesion counts (MD -3.9, 95% CI -13.31 to 5.51; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.96, 95% CI 0.86 to 1.06; 4 trials, 1123 participants, 11 to 12 weeks; low-certainty evidence), investigators' global assessment (RR 1.16, 95% CI 0.98 to 1.37; 3 trials, 1965 participants, 12 weeks; low-certainty evidence), and incidence of a less serious adverse event (RR 0.77, 95% CI 0.48 to 1.25, 1573 participants, 5 trials, 11 to 12 weeks; very low-certainty evidence). Benzoyl peroxide versus topical antibiotics: When compared to clindamycin, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): total lesion counts (MD -3.50, 95% CI -7.54 to 0.54; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), inflammatory lesion counts (MD -1.20, 95% CI -2.99 to 0.59; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), non-inflammatory lesion counts (MD -2.4, 95% CI -5.3 to 0.5; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.95, 95% CI 0.68 to 1.34; 1 trial, 240 participants, 10 weeks; low-certainty evidence), investigator's global assessment (RR 1.10, 95% CI 0.83 to 1.45; 2 trials, 2277 participants, 12 weeks; very low-certainty evidence), and incidence of a less serious adverse event (RR 1.27, 95% CI 0.98 to 1.64; 5 trials, 2842 participants, 10 to 12 weeks; low-certainty evidence). For these clinically important comparisons, no review collected data for the following outcomes: frequency of participants experiencing at least one serious adverse event or quality of life. No review collected data for the following comparisons: topical antibiotics versus placebo or no treatment, topical retinoids versus placebo or no treatment, or topical retinoids versus topical antibiotics.

AUTHORS' CONCLUSIONS

This overview summarises the evidence for topical therapy, phototherapy, and complementary therapy for acne and acne scars. We found no high-certainty evidence for the effects of any therapy included. Randomised controlled trials and systematic reviews related to acne and acne scars had limitations (low methodological quality). We could not summarise the evidence for topical retinoids and topical antibiotics due to insufficient high-quality systematic reviews. Future research should consider pooled analysis of data on new emerging drugs for acne treatment (e.g. clascoterone) and focus more on acne complications.

Knowledge, Attitude, and Risk Perception in Oral Isotretinoin Use: A Cross-Sectional Study from Jordan

The most prevalent skin condition is acne vulgaris. Recent clinical practice guidelines recommend oral isotretinoin to treat moderate-to-severe acne. The aim of this study is to assess the knowledge, attitude, and risk perception of oral isotretinoin for acne treatment. This is a cross-sectional descriptive study conducted in the country of Jordan. The study sample includes people resident in Jordan aged ≥14 years who have been treated with oral isotretinoin for acne. The study involved 373 participants who previously used oral isotretinoin for skin disorders. Most were Jordanian (89.3%), aged 19-25 (37.3%), and from the central region (82.8%). Mostly, they used isotretinoin for severe or mild acne (25.2% and 24.1%, respectively), rosacea (4.1%), or to alleviate acne scars. Surprisingly, 58.1% did not consult their specialist for side effects, and 20% shared their treatment. The average proper use score was 9.98 out of 16. A link was found between higher risk knowledge scores and proper use scores. Side effects such as nausea, irregular heartbeat, and pancreatitis affected some users (11.5%, 10.5%, 7.0%, and 3.2%, respectively). Knowledge about isotretinoin's risks varied, with percentages recognizing teratogenicity (57.7%), liver damage (52.6%), and lipid profile effects (37.2%), while 25% believed that they had no side effects. The study revealed partial adherence to oral isotretinoin guidelines, with gaps in monitoring and consultation. A positive correlation emerged between risk knowledge and proper usage, emphasizing the need for comprehensive education and monitoring strategies in isotretinoin therapy for skin disorders.

The Efficacy of Metformin as a Therapeutic Agent in the Treatment of Acne Vulgaris: A Systematic Review

A large portion of the world's population is affected by acne vulgaris (AV), with many of these individuals being adolescents. The underlying mechanism of AV is hyperkeratinization and Cutibacterium acnes infection of the pilosebaceous follicle secondary to excessive stimulation of sebaceous glands by androgens. Metformin is a biguanide medication primarily used in efforts to lower patients' sugar levels in the management of type 2 diabetes. It has been proven to reduce levels of circulating androgens in patients with insulin resistance, indicating its potential for treating AV. A search strategy was developed and performed using the databases Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Controlled Register of Trials (CENTRAL), and Web of Science. The keywords "metformin" and "acne" were searched, along with related Medical Subject Headings (MeSH) and other subject headings. Studies that met the inclusion criteria were controlled trials, published after 2010, and in the English language. Participants with and without comorbidities such as polycystic ovary syndrome (PCOS) were considered. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined. A total of 15 studies were included in this systematic review. Across the 15 studies, there were 1,046 participants, with 13 studies looking exclusively at women with PCOS. Of the remaining two studies, one examined males with altered metabolic profiles, while the other included men and women with moderate AV. Notable risks of bias included studies that did not exclusively state the blindness of the study. Of the studies that were examined, 13 showed that metformin reduces AV, with seven studies showing statistical significance. Acne vulgaris is an inflammatory condition that has plagued patients for years due to the limited treatment options available. The hyperglycemic medication metformin, used in the management of type 2 diabetes, is being explored as a novel therapeutic that can possibly be repurposed for the treatment of AV. The use of metformin in AV is hypothesized to disrupt the proposed linkage between insulin resistance and AV proliferation. This proposed research could offer physicians a new option for the treatment of AV as well as render an alternative AV treatment for patients.

Impact of Acne Vulgaris and Vitiligo on Quality of Life and Self-Esteem in the Patient Population of Madinah, Saudi Arabia

BACKGROUND

Acne vulgaris and vitiligo are skin disorders that can have a negative impact on a person's self-esteem and quality of life (QoL). The purpose of this study is to look into the impact of acne and vitiligo on the self-esteem and QoL of the patient population in Madinah, Saudi Arabia.

METHODS

A cross-sectional survey of 171 Saudi adults (141 individuals with acne vulgaris (9.4%) and 30 with vitiligo (1.5%) between the ages of 16 and 35 was conducted in Madinah. A self-reported questionnaire with four domains was used: socio-demographic data, lifestyle and coexisting pathologic factors or diseases, Rosenberg's self-esteem scale, and the dermatology life quality index (DLQI).

RESULTS

Acne patients had a mean total score of 20.3 on the self-esteem scale, with 5% (n = 7) having low self-esteem, 48.2% (n = 68) having medium self-esteem, and 46.8% (n = 66) having high self-esteem. Females had higher self-esteem (75.29) than males (56.95). The mean DLQI score for acne patients was 5.4, with 30.5% (n = 47) unaffected, 29.1% (n = 45) mildly affected, 23.4% (n = 35) moderately affected, 5.6% (n = 10) severely affected, and 1.4% (n = 4) severely affected. Vitiligo patients had a mean self-esteem scale score of 13.7, with 63.3% (n = 19) having low self-esteem, 30% (n = 9) having medium self-esteem, and 6.7% (n = 2) having high self-esteem. The mean DLQI was 15.2, with 6.7% (n = 2) reporting that vitiligo had no effect on their lives, 10% (n = 3) reporting a moderate effect, 66.7% (n = 20) reporting a severe effect, and 16.7% (n = 5) reporting a very severe effect.

CONCLUSIONS

Our research confirms that acne vulgaris and vitiligo have a negative impact on self-esteem and quality of life. Along with medical treatment, effective treatment and psychological improvement of the patient should be prioritized.

Females May Have Less Severe Acne, but They Suffer More: A Prospective Cross-Sectional Study on Psychosocial Consequences in 104 Consecutive Polish Acne Patients

Acne is a common skin condition affecting both adolescents and adults, and it can profoundly impact patients' quality of life and mental well-being. This prospective cross-sectional study aims to explore the differences in psychosocial aspects between male and female acne patients in Poland. A total of 104 consecutive acne patients were included in this study. Clinical severity, patients' quality of life, stigmatization levels, and psychiatric disturbances were evaluated using the following instruments: Investigator Global Assessment (IGA), Dermatology Life Quality Index (DLQI), Cardiff Acne Disability Index (CADI), 6-Item Stigmatization Scale (6-ISS), and Hospital Anxiety and Depression Scale (HADS). This study found that female patients exhibited significantly less severe acne and experienced significantly decreased quality of life and increased levels of stigmatization. Furthermore, anxiety levels among female patients exceeded those observed in their male counterparts. Notably, no disparities in the severity of depression were observed between the two gender groups. Correlations were discerned among all psychosocial parameters in the entire study cohort and in the female subgroup, while such correlations were not uniformly observed among male participants. This study underscores the importance of considering psychosocial aspects and implementing routine measurements in the management of acne to improve patients' well-being.

Understanding the impact of acne vulgaris and associated psychological distress on self-esteem and quality of life via regression modeling with CADI, DLQI, and WHOQoL

Acne vulgaris (AV) is a psychosomatic disorder and can negatively affect individuals, especially in terms of psychological well-being, self-esteem, and quality of life (QoL). The current study aimed to investigate the association between AV and psychological health, as well as the influence of acne and psychological distress in predicting patients' self-esteem and QoL. This cross-sectional study included 150 patients clinically diagnosed with AV. The severity of acne was measured using GAGS, and following that, patients were instructed to complete the following forms: DASS-21, RSES, CADI, DLQI, and WHOQoL. Female AV patients had significantly higher depression (p = 0.003, t = 3.025) and anxiety (p < 0.001, t = 3.683). Pearson's correlation analysis indicated a strong, positive, and significant correlation between having acne and experiencing depression (r = 0.630), anxiety (r = 0.661), and stress (r = 0.758) (p < 0.001). Multiple regression analysis suggested acne and associated psychological distress had a significant and negative impact on the patient's self-esteem and quality of life. This study highlights the multifaceted consequences of AV and the need to manage its psychological distress. It emphasizes the need for holistic patient care that addresses acne's physical and emotional aspects, with the ultimate goal of enhancing well-being and QoL.

Effects of acne severity and acne-related quality of life on depressive symptoms among adolescents and young adults: a cross-sectional study in Bangladesh

INTRODUCTION

Depression is a common mental health disorder and one of the major causes of disability. This study aimed at investigating the relationship of acne severity and acne-related quality of life with depressive symptoms, and the mediating effect of acne-related quality of life in a relationship between acne severity and depressive symptoms.

METHODS

This is a cross-sectional study. Data were collected from acne patients attending a tertiary-level hospital, using a questionnaire that comprised three validated instruments - Investigator's Global Assessment (a single item) scale, Cardiff Acne Disability Index, and Beck Depression Inventory for measuring acne severity, acne-related quality of life, and depressive symptoms, respectively. Logistic regression and linear regression were used to examine the association between acne severity and depressive symptoms and a correlation between the acne-related quality of life and depressive symptoms, respectively. A mediation analysis was also performed to see the mediation effects of acne-related quality of life in a relationship between acne severity and depressive symptoms.

RESULTS

A total of 185 acne patients (155 females, 83.8%) with a mean age was 22.55 ± 8.67 years were included in the study. Adolescents and young adults with severe and moderate acne had 6.14-and 2.28 times higher odds of depression compared to their peers with mild acne, respectively. Patients with low levels of acne-related quality of life had a higher level of depressive symptoms (β = 0.42, p < 0.001). The total effect (direct + indirect) was also significant (β = 0.27, 95% CI: 1.29-4.09), implying the effect of acne severity on depression.

CONCLUSION

The present study suggests that acne severity and acne-related quality of life were associated with depressive symptoms among patients with acne vulgaris. The study also indicates that the relationship between acne severity and depressive symptoms might occur through a chain-mediating effect of acne disability in this population.

A Systematic Review of Chronic Diseases and Their Prevalence Among the Population of Northern Borders Province (NBP) in Saudi Arabia

Estimation of the prevalence of chronic conditions is pivotal to effective healthcare planning and management. Therefore, our objective was to systemically review previous literature about the prevalence of chronic diseases among residents of Northern Borders Province (NBP) in Saudi Arabia. The electronic search has been done using scientific databases (PubMed, Ebsco, SciFinder, and Web of Science) and search engines up to September 2021. The following main key terms: chronic disease OR chronic conditions AND prevalence AND Northern Borders Province OR Northern Borders AND Saudi Arabia were applied. Other related terms with a more specific search were done with names of the main cities in the province and the most common diseases in Saudi Arabia. Duplicates were removed electronically by Endnote and manually. Extracted data were tabulated in the literature matrix. The risk of bias and quality of included studies were assessed using the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) checklist. Out of 63 observational studies that were assessed for eligibility, 21 observational studies were included to synthesize the evidence. These studies were conducted on Arar (n=16), Turaif (n=2), and Rafha (n=1), while the remaining were national studies in which NBP was one of the included regions (n=2). The most frequently studied diseases were diabetes (4 records), psychological diseases (4 records), and obesity (3 records). The most prevalent disease was gastroesophageal reflux disease (GERD), with an estimated prevalence of 61% among adults in Arar city. In conclusion, although some research is conducted about chronic diseases somewhere in NBP, further studies are needed to study chronic diseases using a representative sample of the whole NBP population.

Role of topical spironolactone in the treatment of acne: A systematic review of clinical trials-Does this therapy open a path towards favorable outcomes?

Acne vulgaris is the eighth most common disease worldwide and presents with inflammatory and noninflammatory skin lesions along with other dermal abnormalities. Oral spironolactone is used for treating acne vulgaris due to its antiandrogenic properties and inhibition of sebogenesis. Recent evidence shows that spironolactone in topical form has similar efficacy to its oral form with comparatively fewer adverse events associated with its use. However, to establish an evidence-based understanding, this systematic review aims to investigate the efficacy and safety of topical spironolactone in the treatment of acne vulgaris. PubMed, ClinicalTrials.gov, Cochrane library, and Google Scholar were comprehensively searched from the date of inception till March 18, 2022 All the clinical trials experimenting with the role of topical spironolactone in the treatment of acne were included. Articles examining the effects of oral spironolactone or other topical agents were excluded. The Cochrane risk of bias assessment tool (RoB 2.0, version 2019) was used to assess the risk of bias in each study. The study findings have been reported in line with PRISMA 2020 guidelines. The literature search yielded 600 articles. Five clinical trials with 195 patients were included in this review. Out of the five trials, two showed a high risk of bias while three had overall some concerns. Patients treated with topical spironolactone showed a significant decrease in the number of papules (p = 0.004), closed comedones (p < 0.05), and lesions (p < 0.05). Compared to placebo, treatment with 5% spironolactone showed a significant decrease in total lesion count (p = 0.007). In addition, 2% spironolactone showed efficacy over clindamycin and reduced the number of comedones (p < 0.0001), papules (p < 0.0001), and pustules (p < 0.0001) while the acne severity index was also considerably lowered (p < 0.0001). Spironolactone was not found to affect significant skin hydration, sebum, elasticity, melanin, and redness (p > 0.05). Topical spironolactone yields better results than other first-line treatments for acne and displays fewer side effects. However, further large-scale clinical trials are required before spironolactone can be used as the preferred treatment in the clinical management of acne.

The management of acne vulgaris in young people in primary care: A retrospective cohort study

Background

Acne vulgaris (acne) is common among young persons (YPs). Clinical practice guidelines are available for acne management to minimize their physical and psychological impact. However, evidence of adherence to these guidelines is sparse in primary care practices. The study aimed to determine the demographic profile of YPs who sought primary care consultations for acne, their related prescriptions and referrals to specialists for further management.

Method

A retrospective study was conducted using data from a cluster of eight public primary care clinics in Singapore. Demographic, clinical, prescription, and referral data were extracted from the electronic health records of YPs aged 10-29 years with a documented diagnosis of acne (ICD-10 classification) from 1st July 2018 to 30th June 2020. The data were reviewed, audited for eligibility criteria, and de-identified before analysis.

Results

Complete data from 2,700 YPs with acne were analyzed. Male (56.1%) YPs and those of Chinese ethnicity (73.8%) had the most frequent attendances for acne. The mean and median age at presentation was 19.2 (standard deviation = 4.3) and 19 (interquartile range = 16-22) years, respectively. Only 69.7% of YPs received an acne-related medication; 33.5% received antibiotic monotherapy; 53.0% were prescribed oral doxycycline, 35.0% acne cream (combination of sulfur, salicylic acid, and resorcinol), and 28.4% benzoyl peroxide 5% gel; 54.3% of those treated with antibiotics were prescribed with a shorter duration than recommended; 51.3% were referred to a dermatologist on their first visit, and 15.8% had more than one visit.

Conclusion

Acne management for YPs can be enhanced with refresher training among primary care physicians for better adherence to its clinical practice guidelines.

Prevalence and quality of life of facial acne: a cross-sectional study in high school students in Poland

Introduction

Acne is a frequent chronic inflammatory disease, which affects most commonly adolescents. It might have a negative effect on patients' well-being.

Aim

To appraise the prevalence of facial acne among adolescents and to assess how acne of different clinical severity influences quality of life in this age group.

Material and method

This cross-sectional study was conducted on a representative sample of individuals aged 15-19 years in high schools in Poland. A total of 730 students were included in the final analysis. Standardized photographs according to the Investigator's Global Assessment (IGA) were used for self-assessment of both the presence and severity of facial acne. The Dermatology Life Quality Index (DLQI) was employed to evaluate subjects' quality of life (QoL) impairment.

Results

Facial acne was found in 547 (74.9%) respondents with no significant difference in acne prevalence among females (75.1%) and males (74.6%). The vast majority of acne individuals (90.9%) suffered from minimal and mild acne, moderate acne was reported by 7.3% and severe one by 1.8% of acne students. Acne had a small effect on QoL (DLQI mean score of 2.8 ±3.6 points); females had significantly more decreased QoL than males (3.17 ±3.74 and 1.76 ±2.69 points, respectively). QoL impairment positively correlated with the clinical severity of facial acne.

Conclusions

Facial acne is a common health problem in adolescents. Although it is not very severe in the majority of subjects it significantly decreases their QoL. Therefore, acne should be treated as a serious skin condition requiring a holistic approach to the patients.

Psychodermatologic pathology in adolescents: findings from the Colombian National Mental Health Survey

BACKGROUND

Associations between mental health and dermatology have generated a new branch of study called psychodermatology, which includes relevant conditions to the adolescent population. However, there is limited research focusing on this field and this specific population.

OBJECTIVE

To estimate the prevalence of dermatological pathologies in the Colombian adolescent population and their possible associations with mental health conditions.

METHODS

We performed a secondary analysis of the Colombian National Mental Health Survey results. A representative sample of the adolescent Colombian population answered questions regarding dermatological conditions and mental health disorders. We estimated the prevalence and evaluated associations using the chi squared independence test.

RESULTS

Of 1753 adolescents, 8.3% (CI95%=[6.8-10.1]) had dermatitis or skin allergies and 4.5% (CI95%=[3.3-6.1]) acne. For dermatitis, we found associations with age, education, and family dysfunction (p-Values=0.024; <0.001; 0.046 respectively). Acne was associated with age, sex, educational level, the number of social groups involved in, alcohol consumption, psychoactive substances use and previous violent experiences (respective p-Values=0.007; 0.004; 0.005; 0.036; 0.002; 0.003; 0.044). Regarding mental health, dermatological conditions were associated with depression, affective disorders, suicide attempt and suicide ideation.

CONCLUSION

Our results are the first to describe the prevalence of these disorders in Colombia. This is an exploratory study; nonetheless, it is of great value since it is the first to describe these associations in adolescents in a middle-income country, which should be considered during clinical examinations. Further longitudinal studies evaluating possible causal relationship between psychiatric and dermatological conditions are fundamental to establish causal links.

Psychological Impact of Acne Vulgaris Among Young Females in the Eastern Province, Saudi Arabia

Introduction Acne vulgaris is considered one of the most common dermatological issues that affect approximately 9.4% of the world's population, and the most affected group is adolescents. Acne can vary among adolescents and adults of different ethnicities and countries. Aim This study aimed to assess the psychological impact of acne vulgaris among female adults in the Eastern province of Saudi Arabia. Subjects and methods This is a cross-sectional study conducted among young females aged 15 to 25 years old. A self-administered validated questionnaire translated into Arabic was distributed among the female respondents with acne vulgaris using an online survey. The questionnaire includes basic demographic data and the Dermatology Life Quality Index (DLQI) questionnaire to assess the psychological impact of acne vulgaris. Results Four hundred seventy-six female participants aged 15-25 years took part. The majority were single (86.3%) and of Saudi nationality (92.4%). The prevalence of psychological impact affecting acne patients was 85.5% (ranging from low effect to severe effect). A significant relationship was observed between psychological impact according to marital status (p=0.034) and educational level (p=0.023). In a multivariate regression model, patients who had never been married and were more educated were the independent significant factors associated with increased rates of psychological impairment. Conclusion The quality of life of young females has been greatly affected by acne vulgaris. The severity of psychological impairment associated with acne vulgaris can be significantly predicted among educated and single females. Psychological counseling is necessary to decrease the burden caused by the dermatologic condition affecting young females in the region.

Psychological Impact of Acne Vulgaris on the Young Saudi Population

Background

Acne is a chronic inflammatory skin disease caused by bacterial colonization that damages the pilosebaceous gland on the face and other parts of the body. It is one of the most frequent dermatologic diseases in the young population. Acne vulgaris is a devastating disease, and it has a significant impact on a patient's quality of life, influencing their self-esteem as well as their psychosocial development. This study aimed to explore the psychological symptoms associated with patients with acne, its impact on their quality of life according to their personal characteristics, and to raise the importance of observing and managing psychological symptoms during acne treatment.

Methods

In this cross-sectional study, data were collected through a paper questionnaire. The questionnaire was composed of two parts, the first includes data about demographics and general health while the second has details about the Dermatology Life Quality Index (DQLI); the Arabic validated version was used for data collection. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY).

Results

According to the impact of acne on respondents' lives, 40.0% have no effect at all, 31.0% have small effects, 19.0% have moderate effects,9.0% have large effects, and 0.7% have extremely large effects.

Conclusions

Acne is a major problem that affects the quality of life of young patients. Its effect is significantly higher among less educated patients and those with a longer duration of disease.

The Effect of Depression on Treatment Adherence Among a Sample of Saudi Patients Diagnosed with Acne Vulgaris

Purpose

Acne vulgaris is an inflammatory disorder of the skin and is the most common dermatological disease, affecting all ages and races. Acne is known to be associated with depression. This study aimed to assess the impact of depression on patient adherence to acne vulgaris treatment using The Expectation Confirmation Theory (ECT).

Patients and Methods

This cross-sectional study was conducted with 204 patients with acne using four scales (depression, satisfaction, intention to adhere to acne medication, and control for confirmation). ECT scales were used to assess patient satisfaction and intention to adhere to medication. Demographic data were also collected, and descriptive and analytical statistical analyses were performed.

Results

A total of 204 questionnaires were completed. The mean age of the respondents was 25 ± 7.2. The majority were female; 167 (83.50%). Multiple linear regression analysis indicated a negative association between depression (β= −0.121, p = 0.033; 95% CI, −0.232 to −0.009) and satisfaction, when holding other variables constant, and the expected medication effect (confirmation) had a positive association with satisfaction (β= 0.334, p< 0.001; 95% CI, 0.202 to 0.466), keeping all other factors constant. Male sex was negatively associated with satisfaction (β= −2.388, p= 0.015; 95% CI −4.303 to −0.473), while keeping all other covariate sconstant. Residence in central provinces was a significant predictor of satisfaction (β= 2.562, p= 0.004; 95% CI, 0.832 to 4.292), when holding other factors constant. After conducting a simple linear regression, a positive significant association was found between adherence and satisfaction (β = 0.1713; 95% CI, 0.068 to 0.274).

Conclusion

Adherence is the cornerstone for a successful treatment plan and prevention of relapse or treatment failure, and satisfaction is an essential indicator for improving health policies and implementing social service provisions.

Acupuncture: A therapeutic approach against acne

Acne is a common but chronic skin disease that influence large population especially juvenile. Acne can continue, begin, or grow into severe form in adult age, affecting face, back, and chest. It may be a serious issue if not cared or treated timely. Even if acne got treated it leaves a persistent scar, which is difficult to alleviate. These acne lesions are long-lasting and result in significant impact on mental and physical health of an individual. There are four mechanisms that are involved in acne lesion formation. However, the accurate series of events of the interaction among the factors in acne pathogenesis is still unsettled. Pubescent acne is due to increase hormone levels, when in fact adult acne is due to fluctuation in hormone levels. There are various approaches for the treatment of acne, including oral medications, creams or gels, acupuncture. Traditional Chinese Medicine stated acne as a infection that is associated with the pathogenic influence of damp heat and heat on specific meridians. As an ancient and integral part of Chinese medicine acupuncture therapy is employed in the treatment of many diseases including acne. It functions by ameliorating the deep-rooted mechanisms playing crucial role in acne development. In this review, we have explained the acne causes, pathogenesis, and its available treatment options. Additionally, we also discussed the acupuncture therapy methods, devices, different techniques. and its mechanism of action in treating acne. Furthermore, clinical trials studies motivated us to highlight the scope of acupuncture in the growing system of medicine.

Assessment of Anxiety and Depression in Patients with Acne Vulgaris in Medina: A Case-Control Study

Purpose

Acne vulgaris is a common dermatological disease in adolescents that show high prevalence rates of anxiety and depression that may lead to consequences that affect quality of life. This study aimed to assess and compare anxiety and depression in patients with acne and a control group and to determine their correlation with other demographic data.

Patients and Methods

This was a case-control study conducted in 2019 for 3 months at the derma-tology department of Ohud Hospital and two other private clinics in the Medina region of Saudi Arabia. For this study, 296 consecutive patients in the age group of 12 to 60 years who were diagnosed as having acne vulgaris were enrolled and matched with a control group. Data were collected through a self-administered questionnaire, including sociodemographic data and Hospital Anxiety and Depression Scale scores.

Results

We found no significant differences between the two groups regarding sex, age group, nationality, and educational level, but found a significant difference in marital status (p < 0.001). Most (62.5%) of the acne cases were moderate in severity. The overall anxiety score in the acne group was 7.68 ± 4.90, with a significant difference with the control group (p = 0.031), whereas the anxiety level and depression score showed no significant difference (p = 0.082 and p = 0.656, respectively). Moreover, a strong correlation was found between anxiety and depression in the acne group (r = 0.732, p < 0.001).

Conclusion

A positive correlation was found between the anxiety and depression scores in the patients with acne, which was not related to age group or educational level. However, the anxiety scores of the patients with acne showed a significant relationship with sex.

Association between Satisfaction with Life and Personality Types A and D in Young Women with Acne Vulgaris

People with acne vulgaris report a lower level of satisfaction with life and are more frequently classified as having Type D personalities than those without acne. This research examined, for the first time, the moderating and mediating role of personality type in the relationship between acne severity and satisfaction with life. Among 300 female nursing and cosmetology students ranging in age from 19 to 24 years (M = 21.28, SD = 1.39), 150 individuals (50%) presented with symptoms of acne vulgaris (AV group), while the other 150 (50%) were categorized as controls without acne vulgaris (WAV sample). A cross-sectional study was conducted using three self-report questionnaires: The Satisfaction with Life Scale (SWLS), the Framingham Type A Scale (FTAS), and the Type D Scale (DS14). Acne vulgaris was clinically diagnosed using the Hellgren–Vincent Scale (HVS). The AV group scored significantly higher on the FTAS and DS14 and lower on the SWLS than the WAV sample. Life satisfaction correlated negatively with both the negative affectivity (NA) and social inhibition (SI) subscales of the DS14. The moderating role of the Type A behavioral pattern (TABP) and the mediating role of both NA and SI subscales of the DS14 were observed in the relationship between acne severity and satisfaction with life. The type of personality may explain the mechanism of the relationship between acne disease and subjective well-being. Therefore, psychological interventions and strategies focused on managing stress and mood may effectively improve satisfaction with life in people with acne.

Epidemiology of Acne Vulgaris and Its Association With Lifestyle Among Adolescents and Young Adults in Hail, Kingdom of Saudi Arabia: A Community-Based Study

Acne vulgaris is the commonest dermatological problem internationally and nationally. Its incidence is increasing every year in the Kingdom of Saudi Arabia (KSA). Though it is not a major health issue but it significantly affects the patient cosmetically, psychologically and socially. Previous studies have shown its association with lifestyle (age, diet, stress, sleep, smoking, exercise, obesity, etc.) and family history. By simple cost-effective lifestyle modification, its occurrence and late consequences could be minimized. Few hospital-based studies are done on this issue in Hail City, KSA. Hence present cross-sectional study was designed where data was collected by Google-Form from 484 residents of Hail City. Results have revealed that 65% of our respondents were suffering from mild to moderate Acne. Thirty percent of the respondents had BMI equal to more than 30. Majority of respondents (81%) had acne on whole face. Similarly, dairy products were also consumed by more than 50%. Majority of respondents (more than 50%) took chocolates, fast foods, oily foods and sea-foods. Nuts were taken quite often by 37% of respondents. Age between 21-25 years and oily skin have a highly significant association (p = 0.000) with development of acne. Other variables that show significant association with acne were being obese, stressful, irregular menstrual cycles and excessive intake of nuts. Hence there is a need to address this issue in order to design recommendations for the general public to minimize the incidence and consequences of acne vulgaris by simple lifestyle modifications.

Prevalence and Psychological Impact of Acne Vulgaris in Female Undergraduate Medical Students of Rawalpindi and Islamabad, Pakistan

Background:

Acne vulgaris is a common skin disease, affecting approximately 9.4% of the world’s population, with considerable effect on the quality of life. According to a previously conducted study, the prevalence rate of acne in Pakistan was found to be 5%. And to this date, no reliable data is available about the prevalence of acne in Rawalpindi and Islamabad, Pakistan.

Objectives

To determine the prevalence of acne vulgaris and its psycho-social impact on female undergraduate medical students of Rawalpindi and Islamabad.

Methods

A cross-sectional study was conducted during the month of August 2019 among female undergraduate medical students from three randomly selected medical colleges of Rawalpindi and Islamabad. The diagnosed cases of acne vulgaris were assessed by using the Dermatology Life Quality Index (DLQI). The collected data were then analyzed using SPSS version 20 (IBM Corp., Armonk, NY, US).

Results

The prevalence of acne vulgaris was found to be 14.47% in female undergraduate medical students of Rawalpindi and Islamabad. Sixty percent (n=99) were found to have itchy sores and stinging skin, 66.7% (n=110) were embarrassed by their acne-prone skin, and the social activity of 60% (n=99) of the participants was affected by their active acne. Of the students, 73.9% were not affected by their acne while studying or working. Around 61.2% (n=101) complained that their acne treatment was a problem and hiding it took time or made a mess.

Two percent showed a severe impact, with 14% having very large, 44% moderate, 30% low, and the remaining 10% with no effect of acne in their psychosocial functioning.

Conclusion

Acne vulgaris is a chronic skin disease that considerably affects the psychosocial functioning of female undergraduate medical students. A holistic approach in treating acne requires the participation of a dermatologist and mental health professional.

Erythema of Rosacea Affects Health-Related Quality of Life: Results of a Survey Conducted in Collaboration with the National Rosacea Society

Introduction

Persistent facial erythema associated with rosacea may negatively impact quality of life (QoL), self-esteem, and self-confidence. We evaluated burden and health-related QoL (HRQoL) impacts of centrofacial erythema of rosacea.

Methods

A cross-sectional, Web-based survey conducted in collaboration with the National Rosacea Society enrolled adults who self-reported having received a physician diagnosis of rosacea and self-evaluated their current erythema as mild to severe on the validated Subject Self-Assessment for Rosacea Facial Redness. Sociodemographic and clinical characteristics, rosacea symptoms, and their impacts on QoL [validated Impact Assessment for Rosacea Facial Redness (IA-RFR)] and HRQoL [validated Dermatology Life Quality Index (DLQI)] were recorded.

Results

A total of 708 eligible respondents completed the survey (white/Caucasian, 93.5%; female, 83.1%; mean age, 52.4 years). Respondents had mild (59.2%), moderate (33.2%), or severe (7.6%) erythema. The most bothersome symptoms were persistent facial erythema (69.2%) and blushing/flushing (60.9%). Mean IA-RFR scores showed negative impacts across all severities of erythema. The mean (standard deviation) total DLQI score was 5.2 (6.0) overall [mild erythema, 3.8 (4.9); moderate, 5.7 (5.4); severe, 13.4 (8.9); P < 0.0001].

Conclusion

Centrofacial erythema of rosacea represents a substantial HRQoL burden, especially for those with more severe erythema.

Funding

Allergan plc, Dublin, Ireland.

Assessment of Knowledge, Attitude, and Practices Regarding Self-medication for Acne Among Medical Students

Introduction

Acne is one of the most common skin conditions worldwide. Self-medication for acne is a fairly common practice among medical students. The objective of our study was to identify the prevalence of self-medication and to assess its knowledge, attitude, and practices among medical students.

Materials and methods

This descriptive cross-sectional study was conducted at Rawalpindi Medical University, Rawalpindi, Pakistan, from January 2019 to June 2019. Data were collected by using the convenient sampling technique. Students were asked to fill a semi-structured questionnaire. Students of all the medical years studying in our university were included in the study. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, US).

Results

Out of 349 students, 244 (69.9%) suffered from acne and self-medication was practiced by 123 (50.4%) acne sufferers. The practice of self-medication was significantly higher in students having acne lesions on the face (52.2%). The most common source of information was reported to be acquaintances (55.8%). Most of the students had knowledge of the dosage of drugs (46.3%) and precautions for their use (41.5%). Sixty-three percent of the students were of the opinion that self-medication is part of self-care. Most of the students read the expiration date on the drug label (88.6%).

Conclusion

Acne is a highly prevalent condition among medical students and the practice of self-medication among acne sufferers is high. The practice of self-medication and visits to dermatologists were both significantly more common in the students with lesions on the face. The knowledge of students regarding self-medication of acne was not adequate.