Community‐based epidemiological study of psychosocial effects of acne in Japanese adolescents

In this community‐based cross‐sectional study, 1443 Japanese adolescents aged 13–19 years participated from two schools in Kagawa Prefecture. Students completed a self‐administered questionnaire to assess the prevalence of acne, knowledge about acne, self‐management of acne and emotional well‐being. A five‐item version of the Mental Health Inventory (MHI) subscale of the Short Form 36 was used to assess psychological health and depression status. Among respondents, 859 (59.5%) said they had acne (51.6% of the boys and 64.8% of the girls). A majority (56.8%) of those who said they had acne also reported a family history of acne. Of the 555 female respondents with acne, 39.1% reported experiencing acne flares in temporal proximity to menstruation. Less than half (38.8%) of respondents with acne had sought or were seeking treatment. The three most common factors believed to trigger or exacerbate acne were stress, lack of sleep and sweat. The mean MHI score of 847 students with acne was significantly lower than 475 students without acne. The mean MHI score of female students with acne was significantly lower than male students with acne. Students with acne were also significantly more depressed than those without acne and female students were significantly more depressed than male students. Acne is a common problem for Japanese teenagers and causes personal and social difficulties. Our results suggest the necessity of educational programs in school or public to ensure that adolescents are aware of acne and to encourage young people to improve their mental health through better acne treatment.     

Self‐Reported Acne Severity,Treatment, and Belief Patterns across Multiple Racial and Ethnic Groups in Adolescent Students

Abstract: Acne vulgaris is a common condition among adolescents regardless of age, gender, and race. We compare the frequency, severity, help‐seeking behavior, treatment, and beliefs about acne among students based on race, ethnicity, gender, and age. Anonymous surveys were administered to 1,214 students aged 10–19 years of varied gender, race, and ethnicity in public middle and high schools in New Jersey. Results showed the frequency and severity of acne were high (76% and 65%, respectively) and more prevalent in white compared to non‐white respondents (RR = 1.13, 95% CI = 1.04–1.24 and RR = 1.22, 95% CI = 1.09–1.37, respectively), and also in older compared to younger ages (RR = 1.24, 95% CI = 1.17–1.32 and RR = 1.43, 95% CI = 1.32–1.55, respectively). The majority of respondents (83%) reported never having seen a physician for their acne; however, those reporting acne of some severity were more likely to have seen a physician compared with those who did not report acne (21% vs. 8%, p < 0.001). Blacks who reported mild or moderate severity of acne were more likely to have seen a health professional compared to white respondents with same the acne severity (RR = 3.63, 95% CI = 2.06–6.37 and RR = 3.06, 95% CI = 2.02–4.65, respectively). Conversely, Hispanic respondents with mild or moderate acne were less likely to have seen a health professional compared to whites with the same acne severity (RR = 0.56, 95% CI = 0.35–0.89 and RR = 0.47, 95% CI = 0.26–0.86, respectively). Beliefs about external factors affecting acne also varied by race and ethnicity. In conclusion, the severity, frequency, and beliefs about acne all play a role in help‐seeking behaviors, which vary to a significant extent by race and ethnicity.     

Self‐Reported Help‐Seeking Behaviors and Treatment Choices of Adolescents Regarding Acne

Abstract: Acne vulgaris is a common condition affecting adolescents that they often choose to treat on their own rather than seek out and follow medical advice. Using data from an anonymous survey administered to 1,214 students in public middle and high schools in New Jersey, we compared the self‐reported acne frequency, severity, and beliefs of students based on their help‐seeking behaviors, treatment choices, and treatment adherence. Chi‐square analyses were performed for data comparison. A large proportion of students in this sample (57%) treated their own acne, and a much smaller proportion (17%) have sought medical care. Students who saw a health professional reported acne of higher frequency and severity than those who did not (p = 0.01). Severity also appeared to affect treatment adherence, with students who adhered to recommended treatments reporting more frequent (p < 0.001) and more severe (p = 0.02) acne than those who chose to self‐treat. Beliefs and knowledge varied most significantly according to treatment adherence. In conclusion, most adolescent students treat their own acne. Self‐assessment of acne severity plays a significant role in the tendency to seek out and adhere to medical treatment. Beliefs and knowledge may also affect adherence, suggesting a role for physicians to influence adherence rates through patient education. Because the majority of students are getting information from nonphysician sources, there may be a need to evaluate the resources they are using to make sure they are receiving appropriate, helpful information.     

Sensitivity and specificity of self‐reported acne in 18‐year‐old adolescent males

Background Self‐reporting is widely used in medical research. The objective of the present study was to evaluate the specificity and sensitivity of self‐reported lesions of acne (scars and active lesions) obtained by an interview with the examination carried out by a dermatologist. Methods A questionnaire was applied to male adolescents who registered for obligatory military service. After that, skin examination was carried out. Results Of the 2,191 adolescents examined, 474 (21.60%) showed acne scars, and 625 (28.51%) admitted to having scars. The sensitivity of self‐reported scars was 50.84%, and the specificity was 77.65%. The prevalence of active acne obtained by the dermatological examination was 85.76% and from self‐reported acne was 76.12%, with a sensitivity of 80.95% and a specificity of 52.88%. Neither schooling nor social class made any difference to sensitivity or specificity. Conclusions Our findings showed that sensitivity and specificity of self‐reported acne was very low, pointing out that, in a sample of adolescents, self‐reporting of acne shows itself as an inadequate instrument for epidemiological studies.     

Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey

Background Acne vulgaris is a common disease among adolescents and known to have adverse effects on psychological status. Methods A cross‐sectional study was conducted on 600 participants by means of a questionnaire designed for this study in high school students. In addition, an objective evaluation of acne in participants was undertaken. The questionnaire consisted of questions about acne, General Health Questionnaire (GHQ) and Rosenberg Self‐Esteem Scale (RSES). Results Five hundred and sixty‐three questionnaires out of 600 were answered and 550 adolescents who gave permission for examination were evaluated. The study population consisted of 303 girls and 260 boys between the ages 13 and 19, and the mean age was 15.24 ± 1.05 years. Acne prevalence was 63.6% with 29.2% non‐inflammatory and 34.4% inflammatory acne. It was more prevalent and severe in boys than in girls. Not the objective but the subjective severity of acne and opinion that one could benefit from acne treatment was found to be related to anxiety, depression and self‐esteem. Factors implicated among causes of acne were food, bad skin hygiene and hormones in decreasing frequency. Forty‐eight per cent of adolescents expect a maximum duration of 4 weeks for treatment. Conclusion Despite the high prevalence of acne, there is still much deficiency of knowledge and wrong beliefs about acne. This indicates that there is an urgent need for education about etiopathogenesis, potential complications and importance of effective treatment for acne. Effective treatment may make significant contributions for the mental health of adolescent and as well as adult populations.     

Perceptions about oral isotretinoin treatment

There are some studies on the knowledge, beliefs, and perceptions of patients about acne vulgaris, however, there is no sufficient data on patients' beliefs about oral isotretinoin treatment (OIT). The aim of this study was to assess the knowledge, beliefs, and perceptions of the patients with acne vulgaris about the therapy of OIT and its side effects. A total of 214 patients with acne vulgaris in our outpatient clinic were included. Patients who were planned to treat with OIT were asked whether they had information about the treatment and its side effects. It was noted whether the patients accepted treatment after being informed both verbally and written about the OIT details. The study consisted of 133 female and 81 male aged 12–57 years. Most of the patients (78%) stated that they had heard of OIT. The most common source of the information on isotretinoin therapy was friends (57.6%). The dryness was the best‐known side effect. While 86.4% of patients (n: 185) accepted OIT, the group (14.4%) stated that “I have knowledge about side effects.” And refused to use the treatment. Most of the patients agreed to the treatment after explanation of dermatologist. Patients may be educated and informed via reliable medical sources to prevent bias and improve compliance to the treatment.     

Acne vulgaris in Nigerian adolescents – prevalence, severity, beliefs, perceptions, and practices

Background  Community-based studies of acne vulgaris conducted in many parts of the world show that it is very common in adolescents but little is known from Africa.
Methods  In a cross-sectional study, 539 randomly selected students aged 11–19 years in a secondary school in Kaduna, Nigeria were administered a questionnaire to assess self-report of acne, its severity and impact; beliefs and perceptions of causes, and treatments used. 418 students were later examined to detect and grade acne severity.
Results  274 (50.8%) were male while 265 (49.2%) were female. Mean age for respondents was 16 years. 320 students (59.4%) self-reported acne. Of 418 students examined, 379 had acne giving a prevalence of 90.7%. There was no significant gender difference in prevalence at all ages of adolescence. Prevalence of acne increased with age (76.7% at age 10–13 years; 88.2% at age 14–16 years; 97.1% at age 17–19 years). 353 of 379 (93.1%) had mild acne while 26 of 379 (6.9%) had moderate acne. The severity of acne was similar in boys and girls. 47.7% of students reported feeling "very sad/unhappy" about their acne although in more than 70% of those who self-reported, this did not interfere with relationship with family, friends or school work. Diet was the commonest factor believed to cause acne. Cleansing agents were the most commonly used treatments.
Conclusions  Acne vulgaris is very common in Nigerian adolescents, although it is mild acne in most.     

Adolescents’ self perceived acne-related beliefs: from myth to science

BackgroundAcne vulgaris is recognized as the third most prevalent skin disease worldwide, with highest prevalence among adolescents. Beliefs and perceptions of adolescents about acne are incoherent in the literature.ObjectivesTo assess the most frequently reported acne-related beliefs in adolescents in order to focus on misconceptions and develop proper recommendations.MethodsA cross-sectional community-based study on representative sample of 2516 schoolchildren was conducted in six randomly selected secondary schools in Belgrade, Serbia. Only schoolchildren with present or past acne history participated. Factors believed to aggravate or ameliorate acne were recorded and analyzed, and the comparisons between girls and boys were evaluated using Pearson's chi-squared test.ResultsA total of 1452 schoolchildren with acne participated, aged 14–18 years, among them 801 (55.2%) girls and 651 (44.8%) boys. Boys significantly more frequently believed that sweating, exercise, and dairy foods aggravate acne, whereas girls significantly more frequently blamed emotional stress, sweets, fatty foods, sun, and lack of sleep. The top four amelioration factors were as follows: comedone extraction, healthy diet, sun exposure, and increased water consumption. Acne regression was more frequently perceived to be linked with cigarettes in boys, but with sun exposure and weight loss in girls.Study limitationsThe narrow age span of adolescents (14–18 years) and exclusion of acne-free adolescents are limitations due to study design.ConclusionThis survey is part of the first epidemiological study on a representative sample in the Western Balkan region. The significance of the most frequent acne-related beliefs is discussed and myths about acne are highlighted.     

A nationwide study of acne treatment patterns in Korea: analysis of patient preconceived notions and dermatologist suggestion for treatment

Patients often have preconceived notions about acne treatments before visiting dermatologists. The aim of this study was to explore the association between patients' beliefs regarding acne and physicians' suggestion for treatment modality in dermatology clinics. A cross-sectional, nationwide multicentre study was conducted. A total of 1,370 patients completed questionnaires about beliefs about acne treatment before seeking medical care, and 101 dermatologists assessed their acne severity and proposed treatment methods. We found that patients had preconceptions in understanding disease characteristics, assessing subjective acne severity and preferring specific treatment modalities. Dermatologists' determination of topical agents as first-line treatment was affected by disease severity and patients' preferences. They were also more likely to prescribe isotretinoin even in moderate acne compared to oral antibiotics and topical agents. Selections of physical treatments and light-based therapies were affected by patients' preferences, subjective self-evaluation and dermatologists' assessments. Thus, we suggest that acne treatment strategies should incorporate both patients' subjective perceptions and objective clinical practices into a management paradigm.     

Acne: prevalence and relationship with dietary habits in Eskisehir,Turkey

Background Acne vulgaris is a common disease affecting adolescents. There is not comprehensive data on acne prevalence in the Central Anatolia Region in particular. Etiology of acne is not clarified yet. Acne might be related to environmental factors. There is increasing evidence supporting acne and diet relationship. Objectives The aim of the study was to determine the acne prevalence in adolescents in the city of Eskisehir, located in the Central Anatolia, Turkey in addition to evaluate factors affecting acne and its relationship with dietary habits. Methods A cross‐sectional study was conducted on 2300 participants aged 13–18 years. The participants were asked to complete a questionnaire form consisting information about acne and a questionnaire form consisting information about dietary habits (The Adolescent Food Habits Checklist). In addition an objective evaluation of acne was determined. Results The mean age of students with acne was 15.10 ± 1.53. The current acne prevalence was 60.7%. Although 21% of the participants had severe acne (grade 3–4) and 25% developed sequelaes, only 11.5% of all participants consulted a doctor. The participants without acne had healthier dietary habits than participants with acne (P < 0.05). Frequent fat intake (OR = 1.39, 95% CI: 1.06–1.82), frequent sugar intake (OR = 1.30, 95% CI: 1.05–1.60), frequent eating sausages, burgers (OR = 1.24, 95% CI: 1.03–1.48), frequent eating pastries, cakes (OR = 1.20, 95% CI: 1.01–1.43) were associated with increased risk for acne. Conclusions Acne prevalence is high among adolescents in Eskisehir but the rate of consulting doctor is low. Increasing public awareness is critical for convincing adolescents to seek medical help earlier. Acne was related with dietary habits. Fat, sugar and fast food consumption is found to be positively correlated with acne prevalence.     

Most common patterns of acne in male adolescents: a population‐based study

Background Acne vulgaris is a common skin disease affecting more than 85% of adolescents and often continuing into adulthood. Population‐based studies to assess the patterns and severity of acne have not been achieved. Objectives The aim of this study was to assess the most common patterns of facial and trunk acne in young (18‐year‐old) men in a representative sample of male adolescents in a city in southern Brazil and to investigate the severity of inflammatory and non‐inflammatory lesions in these individuals. Methods In Brazil, military service is compulsory for all males. Every adolescent male must report to his military service headquarters to submit to a medical screening examination. The study included 2201 adolescents, each of whom underwent a skin examination conducted by a dermatologist to identify and quantify all non‐inflammatory (comedones) and inflammatory (papules, pustules, and nodules) lesions. Results Non‐inflammatory lesions (comedones) were observed on 1487 individuals, and inflammatory lesions (papules and pustules) were noted on 1497 individuals. The most common patterns of facial acne were the full‐face, bilateral malar and frontal mentonian distributions. Conclusions This is the first population‐based study to evaluate patterns of acne. Facial involvement was very prevalent, and the frontal region was found to dominate patterns of distribution of acne vulgaris. Comedonian acne of the face was much more intense and affected the entire face. In inflammatory facial acne, the majority of the study subjects exhibited up to five lesions in the region under study.     

Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study

BACKGROUND: Acne vulgaris is a distressing condition that affects the majority of adolescents, but its impact on mental health in this age group is poorly understood. OBJECTIVES: To determine the prevalence of acne, knowledge about acne and rates of help-seeking behaviour in English teenagers. It was hypothesized that presence of acne would be associated with higher rates of emotional and behavioural difficulties. METHODS: Three hundred and seventeen pupils (80% response rate) aged 14-16 years participated from a comprehensive school in Nottingham. An age-appropriate, validated measure of emotional well-being, the Strengths and Difficulties Questionnaire (SDQ), and an Acne Management Questionnaire were used to assess participants' psychological health, level of acne knowledge and help-seeking behaviour. Acne severity was by graded by visual facial examination using an adaptation of the Leeds Acne Grading Technique. RESULTS: There was a prevalence of acne in 50% of the study sample, with 11% of participants having moderate to severe acne (> 20 inflammatory lesions). Participants with definite acne (12+ lesions) (P < 0.01) and girls (P < 0.05) had higher levels of emotional and behavioural difficulties. Participants with acne were nearly twice as likely as those without acne to score in the abnormal/borderline range of the SDQ (32% vs. 20%; odds ratio 1.86, 95% confidence interval 1.03-3.34). Knowledge about the causes of acne was low (mean 45%), and was unrelated to acne status. Fewer than a third of participants with definite acne had sought help from a doctor. CONCLUSIONS: Acne is a common disorder in English adolescents and appears to have a considerable impact on emotional health in this age group. Low levels of acne knowledge and poor acne management are concerns that could be amenable to a school-based education programme.     

Large‐scale worldwide observational study of adherence with acne therapy

Acne is a common chronic disease that typically requires prolonged treatment. Several small studies conducted over the past few years suggest that adherence to acne medications is often poor. In addition, data regarding the factors that positively or negatively impact adherence in patients with acne are sparse. This study utilized a simple, validated questionnaire (ECOB, Elaboration d’un outil d’evaluation de l’observance des traitements medicamenteux) to assess the risk of poor adherence in a large worldwide cohort of acne patients (n = 3339) from three major geographic regions [the Americas (n = 952), Europe (n = 1196), and Asia (n = 1191). In addition, information about patient and treatment characteristics was collected to identify factors that correlated with adherence. Overall, there was a poor adherence rate of 50% in this study; this varied by region, with significantly worse adherence in Europe versus Asia and America (poor adherence rates of 58%, 48%, and 43%, respectively, P < 0.0001). To provide insight into factors that affect medication‐taking behavior in acne, adherence was analyzed by the type of treatment (a combination of topical and systemic, topical only, oral isotretinoin). Among patients taking a combination of both systemic and topical therapy, 60% (n = 944) of patients had poor adherence to at least one treatment as defined in the study protocol. In this group, there was a higher proportion of patients who had poor adherence to systemic treatment versus topical treatment (54% vs. 44%, respectively). Among patients treated with topical therapy only, poor adherence occurred in 40% (n = 356) of cases. A total of 46% (n = 325) of patients using oral isotretinoin therapy had poor adherence. Multivariate analysis showed that poor adherence was independently correlated with young age (most strongly with <15 years but also in the age group from 15 to 25 years), the occurrence of side effects, lack of improvement as evaluated by dermatologist, previous systemic therapy, lack of knowledge about acne treatment, consultation with a primary care physician, and lack of patient satisfaction with treatment. Factors that had a positive effect on adherence were more severe acne, use of cosmetics (moisturizers, cleansers), use of either topical therapy alone or isotretinoin, good clinical improvement as evaluated by the dermatologist, patient satisfaction with therapy, and knowledge of acne treatment.     

Knowledge levels and concerns about oral isotretinoin treatment in the parents of adolescent acne patients

Oral isotretinoin is frequently used in the treatment of young acne patients. However, knowledge levels and attitudes about this treatment have not been studied in the parents previously. We aimed to investigate the knowledge levels and concerns about oral isotretinoin in the parents of adolescent acne patients. We conducted a cross‐sectional study on 136 parents of adolescent patients with moderate to very severe acne vulgaris who answered the questionnaire about oral isotretinoin treatment. Demographic data and acne characteristics were recorded. The parents' knowledge levels and concerns about the treatment process were asked by the questionnaire. Since 32 parents have never heard oral isotretinoin before, they were excluded from the study. Of the remaining 104 parents, 80.8% were female and 19.2% were male. Of the parents, 62.5% had some concerns about oral isotretinoin treatment and 34.6% had no idea whether the drug is suitable for the use of <18 years. 52.9% stated that they think the drug will damage the liver. The most known and worrying side effects were dry lips and vision problems, respectively. The knowledge levels about oral isotretinoin treatment and its side effects were low in the parents of adolescent acne patients, leading to prejudice to the drug.     

Psychodermatology in Balkans: Knowledge,awareness, and practice patterns of dermatologists in Albania

The aim of this study is to find out the practice patterns, awareness, and knowledge about psychodermatology in Albanian dermatologists. A survey questionnaire was sent to Albanian dermatologists by mail and distributed during a regional dermatology conference. The dermatologists were requested to provide information on demographic variables, level of training, referral patterns, degree of comfort in managing psychocutaneous disorders, awareness of community resources, and interest in continuing medical educational activities. A total of 75 surveys were mailed in and 41 were returned for analysis. Only 13.2% of dermatologists reported clear understanding of psychodermatology and 41.5% reported being somewhat comfortable in diagnosing and treating psychocutaneous disorders, however requiring further help. Psoriasis, prurigo, and acne were the most common diagnoses associated with psychiatric involvement. The most common diagnoses referred by dermatologists to psychiatrists were psoriasis, prurigo, acne, and trichotillomania. Almost all 98% of dermatologists were not aware of any community resources. About 70% of dermatologists expressed interest in attending continuing medical educational activities. Albanian dermatologist have significant gap in the knowledge, training, awareness, and in treating psychocutaneous disease.     

Frequency and characteristics of acne‐related post‐inflammatory hyperpigmentation

In patients with darker skin types (Fitzpatrick phototypes III–VI), acne is often accompanied by post‐inflammatory hyperpigmentation (PIH). Further, acne‐related pigmentation can pose a greater concern for the patient than the acne lesions. There has been little formal study of this acne‐related PIH. Recently, the Asian Acne Board – an international group of dermatologists with interest in acne research – made a preliminary evaluation of the frequency and characteristics of PIH in seven Asian countries. A total of 324 sequential acne subjects were evaluated for the presence of PIH. The majority (80.2%) of subjects had mild to moderate acne and there were more females than males (63.0% vs 37.0%). In this population of patients consulting a dermatologist for acne, 58.2% (188/324) had PIH. The results also showed that pigmentation problems are often long lasting: at least 1 year for more than half of subjects and 5 years or longer in 22.3%. In accordance with our clinical experience, patients reported that PIH is quite bothersome, often as bothersome or more so than the acne itself and sometimes more problematic. Excoriation was commonly reported by patients, and may represent a modifiable risk factor that could potentially be improved by patient education.     

Therapeutic considerations and clinical characteristics of a sample of adolescent patients with acne vulgaris in Tirana,Albania: A cross‐sectional study

Acne vulgaris is a common adolescent disorder but the data related to acne vulgaris is insufficient in Albania. The aim of this study was to assess the epidemiologic features of acne vulgaris and to identify lifestyle and constitutional factors in formulating a proper management protocol. A cross‐sectional study conducted on a representative sample of 2036 adolescents from 10 high schools located in Tirana. A self‐administered questionnaire was administered to collect the data. The binary logistic regression was applied to assess the factors linked to the presence of acne vulgaris in adolescents. The mean age in the study population was 16.2 ± 0.9 years. The self‐reported prevalence of acne was 50.3% (52.1% in females and 47.9% in males). Lifetime prevalence was 68.5%. The factors significantly associated with an increased likelihood over time were: frequent consumption of sweets, frequent endurance of stress, poor quality of sleep, positive family history of acne, oily and combination skin, menstrual disorders. Acne vulgaris is common among adolescents in our country. The identification of various modifiable factors related to acne generates opportunities to tailor and focus prevention efforts and better management and treatment planning in relevant high‐risk groups.     

Community-based study of acne vulgaris in adolescents in Singapore

BACKGROUND: There are few studies on the prevalence of acne vulgaris among Asian teenagers. OBJECTIVES: To determine the epidemiology of acne in teenagers in Singapore. METHODS: A community-based cross-sectional study in 1045 adolescents aged 13-19 years. RESULTS: Of these respondents, 88% identified themselves as having acne. Eight hundred and six of these respondents were examined by a dermatologist, and 51.4% were classified as having mild acne, 40% moderate acne and 8.6% severe acne. Isolation of Propionibacterium acnes was attempted in 262 subjects. Cultures were positive in 174 subjects, giving an isolation rate of 66.4%. Antibiotic-resistant strains of P. acnes were detected in 26 isolates (14.9%). Eleven of these 26 subjects (42%) had previously been treated or were presently on antibiotic treatment for acne, but the other 58% of students who had antibiotic-resistant strains of P. acnes did not give a history of prior antibiotic therapy. Teenagers expressed psychological distress over acne, and believed that hormonal factors, diet and hygiene were important factors in causing acne. CONCLUSIONS: There is a need for accessible, accurate education on acne and its appropriate treatment.