The patient‐centered acne severity scale study

Acne is one of the most common skin conditions seen by dermatologists. As with many other cutaneous diseases, due to its visibility, acne often produces a large psychosocial impact on patients who suffer from the disease. Such psychosocial burdens are exacerbated by the variation in acne presentation that can lead to the usage of multiple different treatments before visible improvements are appreciated. Although many scales have been established to determine severity from the clinician standpoint, patient‐oriented scales are lacking. Clinicians use these severity tools to guide management and judge patient improvement from visit to visit. Creation of such a severity scale from a patient's perspective would allow patients to not only assess their perception of their acne independent of a physician but could also be used to determine patient satisfaction with treatment that would then help to more effectively guide management. Therefore the goal of this study is to create and validate a patient‐centered acne severity scale using a visual analogue scale format.     

Disease-specific quality of life is associated with anxiety and depression in patients with acne

OBJECTIVE: We aimed to evaluate the relationships between acne severity, anxiety, depression and disease-specific quality of life in patients with acne. METHOD: A total of 61 patients with acne vulgaris and 38 healthy volunteers were included in the study. Acne severity was assessed by the Global Acne Grading System. All patients were asked to complete the Acne Quality of Life Scale (AQOL), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HAD), and healthy controls to fill only the HAD. RESULTS: The mean HAD anxiety subscale (HAD-A) and HAD depression subscale (HAD-D) scores of the patients were significantly higher than those of the controls. The rates of subjects at risk for anxiety (26.2%) and for depression (29.5%) were significantly higher in the patient group than in the control group (0% and 7.9%, respectively). We found no correlations between acne severity and scores of AQOL, DLQI, HAD-A and HAD-D. AQOL and DLQI scores were positively correlated with HAD-A and HAD-D scores in the patient group. The patients at risk for anxiety had significantly higher scores on AQOL and DLQI compared to those who were not at risk. There were no statistically significant differences between the female and male patients with respect to AQOL, DLQI, HAD-A and HAD-D scores. CONCLUSION: (1) Irrespective of the degree of severity, patients with acne are at increased risk for anxiety and depression compared to the normal population. (2) Acne negatively affects quality of life, and the greater the impairment of quality of life due to acne, the greater the level of anxiety and depression. (3) A greater impairment of dermatologic quality of life seems to put the patient at an increased risk for anxiety disorder.     

The correlation between ABO blood types and acne vulgaris severity

Background

Acne vulgaris is a chronic inflammatory disease with multifactorial etiology. Studies on the pathogenesis of acne are still important. Recently, various studies have been conducted on the significance of genetics in the pathogenesis of acne. Blood group is transferred genetically and could affect the development, progress, and severity of certain diseases.

Aim

In the current study, the correlation between the severity of acne vulgaris and ABO blood groups was investigated.

Materials and Methods

A total of 380 patients (263 mild and 117 severe acne vulgaris patients) and 1000 healthy individuals were included in the study. Severity of acne vulgaris patients and healthy controls was determined based on the blood group and Rh factor data obtained retrospectively from the patient files in the hospital automation system.

Results

In the study, the rate of females was significantly higher in the acne vulgaris group (X²:154.908; p:0.000). The mean age of the patient was significantly lower when compared to the controls (t:37.127; p:0.0001). The mean age of the patients with severe acne was significantly lower when compared to those with mild acne. When compared to the control group, the incidence of severe acne was higher in those A blood type when compared to the patients with mild acne, while the incidence of mild acne was higher in other blood groups when compared to the control (X²:17.756; p:0.007). No significant difference was determined between the Rh blood groups of the patients with mild, severe acne and the control group (X²:0.812; p:0.666).

Conclusion

The results revealed a significant correlation between acne severity and ABO blood groups. Future studies that would be conducted with larger samples in different centers could confirm the current study findings.     

皮肤科门诊女性痤疮患者的心理状态及生活质量调查

 目的: 调查皮肤科门诊青春期及成人期女性痤疮患者心理状态与生活质量情况。方法：收集2020年1月至2021年1月就诊于香港大学深圳医院皮肤科门诊的689例女性痤疮患者,调查广泛性焦虑障碍量表（GAD-7）、健康问卷抑郁症状群量表（PHQ-9）及痤疮特异性生活质量（AQOL）的得分情况;并按照年龄分组,评估青春期组及成人组心理状态和生活质量的差异。结果：女性痤疮患者中46.30%的患者有抑郁情绪,47.60%的患者有焦虑情绪,AQOL平均得分为68.90±27.40。两组间焦虑、抑郁比例及AQOL评分比较,差异均无统计学意义（均P>0.05）。结论：痤疮对女性患者心理状态和生活质量产生明显的负面影响,青春期与成人期患者无明显区别。     

Quality of life in mild to moderate acne: relationship to clinical severity and factors influencing change with treatment

BACKGROUND: Because of its effects on quality of life, acne vulgaris is more than a merely physiological or cosmetic entity. OBJECTIVES: To describe the influence of mild to moderate acne on patients' quality of life, measured using Skindex-29, and to correlate changes in Skindex-29 scores with changes in objective and subjective indices in clinical severity after treatment with topical 4% erythromycin 0.2% zinc. Also, to evaluate efficacy and side-effects of the treatment. METHODS: Observational, prospective study of 1878 patients cared for by 252 clinicians in Spain. Data included epidemiological information and responses to Skindex-29, a subjective change and objective severity index. RESULTS: Baseline Skindex scale scores were worse in women, older patients, and those with more severe clinical disease. Skindex was sensitive to changes in objective severity but changes in Skindex scale scores were also related to other factors. Patients who reported their skin condition to be 'the same' or 'worse' at the end of the study had significantly worse baseline scores on the 'symptoms' and 'emotions' scales but 'functioning' scores were not worse than for those who reported their condition had improved. CONCLUSION: 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.     

痤疮患者外周血IL-6、TNF-α表达水平及其与痤疮严重程度的相关性研究

 

目的: 检测痤疮患者外周血中IL-6、TNF-α表达水平,并分析两者与痤疮严重程度的相关性。方法：收集我院皮肤科门诊诊治的寻常痤疮患者114例,其中轻度35例、中度43例、重度36例,另选择同时期健康体检者30例作为对照组。使用化学发光法检测治疗前及治疗后4周血清中IL-6、TNF-α的水平,并对结果进行比较分析。结果：轻、中、重度痤疮患者外周血中IL-6水平差异有统计学意义（P<0.01）,而TNF-α水平无明显差异（P=0.243）。轻度、中度、重度患者IL-6水平均高于对照组（P值均<0.05）,而不同严重程度患者组间IL-6水平差异无统计学意义（P值均>0.05）。痤疮严重程度与IL-6、TNF-α水平均无明显相关性（P值均>0.05）。 结论：IL-6参与了痤疮的炎症反应,但不能用于评估痤疮病情的严重程度。TNF-α与痤疮之间的关系仍需进一步深入研究。

     

DLQI scores in patients with keloids and hypertrophic scars: a prospective case control study

Background: Keloids and hypertrophic scars (HTS) can cause functional impairment and psychosocial burdens, both of which affects quality of life (QoL). Our aim was to compare Dermatology Life Quality Index (DLQI) scores in patients with keloids and HTS to those of psoriasis patients and normal controls. Patients and Methods: Forty‐eight consecutive patients with keloids and HTS and 48 with psoriasis vulgaris attending our dermatology outpatient clinic, as well as 48 sex‐ and age‐matched healthy controls completed the DLQI. Results: Total DLQI scores of patients with keloids and HTS (7.79 ± 5.10) and psoriasis (8.73 ± 5.63) were comparable and significantly higher than that of healthy controls (0.58 ± 0.77). No significant difference were found between patients with psoriasis and patients with keloids and HTS in terms of the total DLQI scores and the subscale scores (p > 0.05) except “treatment” (p < 0.05) sub‐scale scores which were higher in psoriasis. Conclusions: The QoL of patients with keloids and HTS is impaired as much as that of those with psoriasis. The DLQI questionnaire is a reliable and valid instrument for assessing the QoL in patients with keloids and HTS.     

Evaluation of the correlation between severity of acquired idiopathic generalized anhidrosis and quality of life scores

Symptoms of acquired idiopathic generalized anhidrosis (AIGA) include heat retention and/or heat stroke due to the effects of the disorder on the perspiration ability of the whole body under thermal environmental changes or exercise. Additionally, cholinergic urticaria can also occur in these patients. AIGA has a major impact on everyday life. However, the effects of AIGA severity on the quality of life (QOL) of the patients have not been sufficiently defined. The objective of this study was to evaluate the correlation between AIGA severity and QOL. Study subjects comprised 44 patients diagnosed with AIGA at three registered institutions. AIGA severity assessment was conducted and the Dermatology Life Quality Index (DLQI) questionnaire was administered. Correlations between AIGA severity and DLQI, as well as severity by DLQI subscale, were assessed. We found a positive correlation between total score of AIGA severity criteria and DLQI total scores (R = 0.720, P = 0.001). The impairment increased with the increase in AIGA severity (P < 0.01). In relation to the DLQI subscales, leisure (social and sporting activities) impairment was significantly higher for patients with severe AIGA than those with mild AIGA (P < 0.01). Comparing QOL for AIGA patients with that of patients with other dermatological disorders, it is possible that QOL impairment for AIGA patients is as severe as that for patients with atopic dermatitis. AIGA severity and DLQI are correlated and AIGA patients experience disruption of everyday life more broadly than conventionally perceived.     

Triple-combination clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel for moderate-to-severe acne in children and adolescents: Randomized phase 2 study

Background/Objectives

Topical clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel (IDP-126) is the first fixed-dose triple-combination formulation in development for acne. This post hoc analysis investigated efficacy and safety of IDP-126 in children and adolescents with moderate-to-severe acne.

Methods

In a randomized, double-blind phase 2 study (NCT03170388), participants ≥9 years of age with moderate-to-severe acne were eligible for randomization (1:1:1:1:1) to once-daily IDP-126, one of three dyad combination gels, or vehicle gel for 12 weeks. This post hoc analysis of pediatric participants (n = 394) included children and adolescents up to 17 years of age. Assessments included treatment success, inflammatory/noninflammatory lesion counts, Acne-Specific Quality of Life (Acne-QoL) questionnaire, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability.

Results

At Week 12, treatment success rates were significantly greater with IDP-126 (55.8%) than with vehicle (5.7%; p < .001) or any of the dyad combinations (range: 30.8%–33.9%; p < .01, all). Lesion reductions with IDP-126 were also significantly greater than with vehicle (inflammatory: 78.3% vs. 45.1%; noninflammatory: 70.0% vs. 37.6%; p < .001, both) and 9.2%–16.6% greater than with any of the dyad combinations. Increases (improvements) from baseline in Acne-QoL domain scores were generally greater with IDP-126 than in any other treatment group. The most common treatment-related TEAEs across treatment groups were application site pain and dryness. Most treatment-related TEAEs were of mild-to-moderate severity.

Conclusion

IDP-126 gel—a novel fixed-dose, triple-combination topical formulation for acne—demonstrated superior efficacy to vehicle and three dyad component gels and was well tolerated in children and adolescents with moderate-to-severe acne.     

Effects of oral antibiotic roxithromycin on quality of life in acne patients

Macrolides are effective for inflammatory acne, but there are not many studies on roxithromycin. In this study, patients with acne were surveyed for improvement of their quality of life after treatment with roxithromycin. Patients were orally given roxithromycin 300 mg daily for 2–4 weeks. At the time of pre- and post-treatment, the dermatologists graded the severity of acne symptoms, and the patients answered questionnaires. In 123 half faces of 76 patients, 80 half faces were improved, 42 half faces were not changed, and one half face was deteriorated. The score of symptom and feeling and leisure in DLQI-J and emotions and symptoms in Skindex-29-J were significantly decreased after roxithromycin treatment. Roxithromycin has a therapeutic effect on inflammatory acne and leads to improvement of quality of life in the patients.     

Medication adherence among acne patients: a review

Background Acne is a chronic disease often requiring the use of medications for extended periods of time. In general, adherence decreases over time in patients with chronic diseases, and adherence to topical medications is poor compared to adherence to oral medications, placing individuals using topical medications at increased risk for nonadherence and treatment failure. Poor adherence may also be a common cause of treatment failure in teens with acne. Purpose We reviewed the current literature on medication adherence in teenagers with acne to assess adherence levels and predictors of adherence. We hope to provide a foundation for further research into medication adherence in acne patients. Methods A Medline search was conducted using the key words “acne” and “adherence” or “compliance.” Studies reporting adherence were included in the analysis. Results A positive correlation was found between quality of life of patients with acne and medication adherence. Weaker predictors of adherence include increased age, female gender, and employment. The most commonly reported reason for nonadherence was inadequate time to use the treatment medication. Patients taking medications requiring less frequent dosing had better adherence, and medication adherence correlated with better health status among acne patients. A longer duration between office visits may be associated with decreased compliance. Limitations Few studies investigating the prevalence and causes of nonadherence in acne patients were identified. Conclusions Adherence to medications is difficult to measure and rates reported by patients often overestimate actual adherence. Patients cite lack of time as a common reason for nonadherence to topical medications.     

Validation of the Cardiff acne disability index and the impact of educational materials in a Romanian cultural adaptation context

Background

Acne has a high impact on patients being a chronic, common, and visible skin condition. Knowledge regarding treatment improves outcomes. The Cardiff Acne Disability Index (CADI) is commonly used in clinical practice for quality-of-life assessment. It has been validated in many languages, however, not in Romanian.

Aims

To validate the Romanian adaptation of the CADI and educational materials for acne patients.

Patients and Method

A 12-week prospective cross-sectional Web-based study, including 3rd- to 5th-year medical students attending our university was conducted. We obtained permission from the CADI copyright owner and performed the steps of the standardized translation process. The Romanian CADI adaptation was delivered online in a test–retest setup, during which participants were offered acne educational materials and completed a knowledge evaluation questionnaire.

Results

A total of 95 complete answers were analyzed. The Romanian CADI adaptation showed good internal consistency, with Cronbach's α = 0.807 in the first application and Cronbach's α = 0.839 in the second. High test–retest reliability was observed, with interclass correlation coefficient ICC = 0.987 and Spearman's rank correlation coefficient r_s = 0.970 for the overall CADI scores between the two administrations. The mean baseline score in the knowledge evaluation questionnaire was 15.52 points (±1.556), with a statistically significant improvement after exposure to the educational material (Z = −7.207, p < 0.001). This material was considered useful or very useful by 78(82.8%) participants.

Conclusion

Romanian acne patients can benefit from CADI, a reliable and disease-specific tool for quality-of-life evaluation, together with validated, guideline-aligned educational material in their language.     

寻常痤疮对患者心理的影响

目的：了解痤疮患者心理受影响的程度和一些相关因素。方法：对北京、上海、广州、西安、武汉5个城市共2331例门诊痤疮患者采用APSEA量表进行问卷式调查。结果：痤疮影响了部分患者的心理健康，表现为焦虑、易怒和不自信。甚至干扰了他们的生活、影响择业。参与影响痤疮患者生活质量的可能因素是痤疮的严重程度、患者的文化程度。结论：痤疮对于患者的心理具有一定程度的影响，应该引起皮肤科医生的重视，尤其是重度痤疮和文化程度低的患者。     

Quality of life and acne in Scottish adolescent schoolchildren: use of the Children''s Dermatology Life Quality Index© (CDLQI) and the Cardiff Acne Disability Index© (CADI)

BACKGROUND: Acne vulgaris is known to adversely affect all aspects of quality of life. However, although acne is thought to occur in the majority of adolescents, there are few data currently available on the impact of acne in this age group. OBJECTIVES: Measurement of the impairment of health-related quality of life (HRQoL) in teenage Scottish schoolchildren in a comparative study using two HRQoL questionnaires. A secondary objective was to collect data on the use and perceived efficacy of medical and over-the-counter (OTC) preparations. STUDY DESIGN: An anonymous cross-sectional survey of 200 adolescent (15-18 years) Dundee schoolchildren was conducted by means of two self-reported questionnaires: the Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI). Data on demographics and therapeutic modalities and their perceived efficacy were also collected. ANALYSIS: Statistical analysis was performed using the package Stata 7.0. RESULTS: Self-reported acne was present in 83% of teenagers (147/178), with similar sex distribution (54% male, 46% female). The overall mean CDLQI score (max. 30) was low 1.7 {6% impairment} (CI -1 to 0), range 0-19. Nine pupils scored between 5 and 9 {17-30% impairment} suggesting moderate HRQoL impairment and three scored > 10 {> 33% impairment} indicating severe impairment. The overall mean CADI score (max. 15) of 1.9 {13% impairment}, CI 0 to 1 (range 0-15) was also low, but 12 pupils scored between 5 and 9 {33-60% impairment}, one scoring 10 + {> 67% impairment} and one scoring the maximum, 15 {100% impairment}. There was no significant difference in mean scores between the sexes in either questionnaire (P = 0.5). There was good correlation between the results from the two questionnaires (Spearman's rho = 0.62). Three-quarters (75%) had used OTC products, of which only a third (33%) felt they helped 'a lot'. Fifteen per cent were receiving prescribed treatment from their doctors of which 66% found it helpful. CONCLUSIONS: Self-reported acne occurred in 83% (147/178) of the Scottish teenagers involved in this study, which confirms previous reports of a high prevalence of acne in teenagers. Cross-validation of the CLDQI and CADI demonstrated good correlation and both scales were easy to administer and identified 11% (16/147) of teenagers who perceive their lives to be significantly affected by their acne (8% moderately to severely, 3% severely). It is important to identify and treat such teenagers early to reduce the future socio-economic burden of their acne.