Prevalence and risk factors of inflammatory acne vulgaris in rural and urban Ghanaian schoolchildren

Epidemiological Risk Factors Associated with Acne Vulgaris Presentation, Severity, and Scarring in a Singapore Chinese Population: A Cross-Sectional Study

BACKGROUND

Acne vulgaris is classified based on the severity of skin lesions and post-healing scar types of these lesions. Numerous epidemiology studies have investigated the risk factors associated with acne presentation and severity, but studies for acne scarring are lacking.

OBJECTIVE

To investigate the prevalence of acne, severity, and scarring grades and their associated risk factors among Singapore Chinese.

METHODS

A total of 3,888 subjects (2,090 cases/1,798 controls; median age = 21 ± 4.589; range 17-71) completed an investigator-administered questionnaire as part of a cross-sectional study, which included sociodemographics, familial medical history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 991) and scarring (n = 988) grades by a trained personnel.

RESULTS

The majority of the acne cases had mild acne/grade 1 scarring, while less than 1% had severe acne/grade 4 scarring. Parental acne was significantly associated with acne presentation and moderate/severe acne, while sibling acne was significantly associated with grade 3/4 scarring. Gender and age affected acne severity and scarring but not acne presentation, while tertiary maternal education level and the possession of ≥3 siblings were particularly associated with acne scarring. Underweight BMI was protective against acne presentation, while atopic diseases (asthma, allergic rhinitis, eczema) were its predisposing factors. Of the evaluated lifestyle factors, computer/TV usage had significant association with acne presentation, while alcohol consumption was significantly associated with acne severity. Frequent milk consumption was associated with a protective effect for moderate-severe acne, while frequent butter consumption had a detrimental effect on acne scarring extent.

CONCLUSION

Positive familial history is a strong predisposing factor in determining acne presentation, severity, and scarring. Demographic factors (gender, age) and sedentary lifestyle (increased computer/TV usage) influence acne presentation, while dietary habits (milk and butter consumption) influence acne severity and scarring. The predisposing factors revealed in this study could help us to gain insights into acne pathophysiology and hence develop interventions especially targeting modifiable risk factors.

Modifiable and non-modifiable epidemiological risk factors for acne, acne severity and acne scarring among Malaysian Chinese: a cross-sectional study

Background

Acne vulgaris, a highly prevalent multifactorial inflammatory skin disease, can be categorised into different severity and scarring grades based on the type, number, and severity of lesions. While many epidemiology studies have investigated the risk factors for acne presentation, fewer studies have specifically studied the risk factors for acne severity and scarring. Therefore, this study investigated the prevalence of acne, acne severity and scarring grades, and their associated non-modifiable and modifiable epidemiological risk factors among Malaysian Chinese.

Methods

A total of 1840 subjects (1117 cases/723 controls) completed an investigator-administered questionnaire as part of a cross-sectional study, which include socio-demographics, familial history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 1051) and scarring (n = 1052) grades by a trained personnel.

Results

Majority of the acne cases (up to 69%) had mild acne or Grade 1/2 scarring, while 21.6% had moderate/severe acne and 5.5% had Grade 3/4 scarring. Males had significantly higher risk of presenting with higher grades of acne scarring. Those who had acne, regardless of severity and scarring grades, had strong positive familial history (either in parents and/or sibling). Frequent consumption (most or all days) of foods that are commonly consumed during breakfast (butter, probiotic drinks, cereals and milk) decreased the risk for acne presentation and higher acne scarring, while periodic consumption (once/twice per week) of nuts and burgers/fast food decreased the risk for higher acne severity. Alcohol drinking was significantly associated with increased risk for acne presentation, while paternal, parental and household smoking were associated with reduced risk of more severe acne.

Conclusions

In conclusion, positive familial history is a strong predisposing factor in influencing acne presentation, severity and scarring. Frequent consumption of foods that are commonly consumed during breakfast is protective against acne presentation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10681-4.

Systematic review of the epidemiology of acne vulgaris

A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong association was observed between several risk factors – family history, age, BMI and skin type – and acne presentation or severity in multiple studies. The pooled odds ratio of 2.36 (95% CI 1.97–2.83) for overweight/obese BMI with reference to normal/underweight BMI and the pooled odds ratio of 2.91 (95% CI 2.58–3.28) for family history in parents with reference to no family history in parents demonstrate this strong association. In addition, a pooled odds ratio of 1.07 (95% CI 0.42–2.71) was obtained for sex (males with reference to females). However, the association between other factors, such as dietary factors and smoking, and acne presentation or severity was less clear, with inconsistent results between studies. Thus, further research is required to understand how these factors may influence the development and severity of acne. This study summarizes the potential factors that may affect the risk of acne presentation or severe acne and can help researchers and clinicians to understand the epidemiology of acne and severe acne. Furthermore, the findings can direct future acne research, with the hope of gaining insight into the pathophysiology of acne so as to develop effective acne treatments.

Optimizing the use of topical retinoids in Asian acne patients

Acne vulgaris is a common disease among people in Asia. International guidelines and treatment recommendations emphasize the central role of topical retinoids in the management of acne. However, topical retinoids remain underutilized in clinical practise, which may be in part due to fear of retinoid‐associated dermatitis/lack of experience, particularly in Asian patients. There is a perception that Asian skin has a greater tendency toward sensitivity compared with Caucasian skin. In our clinical experience, topical retinoid therapy can be used with excellent effect to treat Asians with acne. This article discusses available published work regarding the use of topical retinoids in Asian populations, and presents tips for utilizing these important agents in daily practise. Optimizing use of topical retinoids may improve adherence and, in turn, therapeutic outcomes and patient satisfaction.

The prevalence of acne in Mainland China: a systematic review and meta-analysis

INTRODUCTION

Acne, a very common skin disease, can result in psychological distress and sustain impairment in quality of life. Data on the prevalence of acne and the differences in gender, region and age are limited. The aim of this review is to estimate the prevalence of acne in Mainland China comprehensively and to quantify its association with gender, region and age.

METHODS

We searched electronic databases with predetermined search terms to identify relevant studies published between 1 January 1996 and 30 September 2016. We pointed out repeated results using Note Express software and evaluated the studies for inclusion. Two independent reviewers extracted the data, followed with statistical analyses using Comprehensive Meta-Analysis software version 2.0. A random effects model was adopted to calculate the overall pooled prevalence and to merge categories, including gender (males and females), region (Northern China and Southern China) and age (primary and secondary students: 7-17 years old; undergraduates: 18-23 years old; overall: no limits of age) for subgroup analyses. Logistic meta-regression analysis was used to clarify the associations between acne and the predictors age, gender and region using OR and their associated 95% CI.

RESULTS

25 relevant studies were included in this meta-analysis. The overall pooled prevalence rates of acne were 39.2% (95% CI 0.310 to 0.479). The prevalence rates in different age groups were 10.2% overall (95% CI 0.059 to 0.171), 50.2% for primary and secondary students (95% CI 0.451 to 0.554), and 44.5% for undergraduates (95% CI 0.358 to 0.534); by gender, the prevalence rates were 35.7% for females (95% CI 0.275 to 0.448) and 39.7% for males (95% CI 0.317 to 0.482); and by region, the prevalence rates were 34.2% for Northern China (95% CI 0.242 to 0.458) and 46.3% for Southern China (95% CI 0.374 to 0.555). The associations between acne and the predictors age, gender and region were statistically significant.

CONCLUSIONS

In Mainland China, primary and secondary students exhibited higher prevalence rates than undergraduate students; males had higher prevalence rates of acne than females; and the prevalence rates of acne in Southern China was higher than Northern China.

Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic

Introduction

Ghana is currently developing its provision of dermatology services. Epidemiologic studies of the skin diseases seen by Ghanaian dermatologists are needed to guide these efforts. We aimed to describe the skin conditions seen by and management practices of Ghanaian dermatologists in a specialized clinic.

Methods

We conducted a chart review of new patients presenting to the Korle Bu Teaching Hospital dermatology clinic during 2014.

Results

Among the 529 patients studied, 700 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis (24.6%); atopic dermatitis (8.4%), acne vulgaris (5.3%) and scabies (5.1%) were the most common specific diagnoses. Among infants, children, and adolescents, the most common diagnosis was atopic dermatitis (31.7%, 30.0%, and 14.9%, respectively). Acne vulgaris (12.0%) was the most common skin condition diagnosed in young adults. Irritant contact dermatitis (6.9%) was most common among adults. Lichen planus (9.9%) was the most commonly diagnosed skin condition in the senior population. Diagnoses made by dermatologists differed from the referral diagnosis documented by primary care providers for 65.8% of patients. The most frequently recommended treatments were antihistamines (47.8%) and topical steroids (38.4%). Only 18 diagnostic biopsies were performed.

Conclusion

Our study summarizes the skin diseases seen and management practices of Ghanaian dermatologists in a specialized clinic at a large public teaching hospital. The results of this study can help to guide future dermatology education and development efforts in Ghana.

The blemishes of modern society? Acne prevalence in the Dogon of Mali

BACKGROUND AND OBJECTIVES

Non-communicable diseases may reflect an evolutionary mismatch between our human ancestry and modern environments. To explore the mismatch hypothesis for Acne vulgaris, we studied the prevalence and severity of acne in Dogon adolescents in Mali, West Africa.

METHODOLOGY

We graded the prevalence and severity of acne in 1182 Dogon adolescents aged 11-18 years from nine villages using facial photos taken as part of a prospective cohort study. Eighty-nine (89%) of the individuals in the cohort migrated to the city during adolescence, enabling us to assess the effect of urban migration. Using multivariable logistic regression, we estimated the effect of predictor variables on the presence of acne.

RESULTS

The prevalence of acne in the cohort was 28%, with 90% of cases being mild or very mild. Thus, the prevalence and severity of acne was much lower than for adolescents in high-income countries. Controlling for age, puberty, and body mass index (BMI), the odds of boys developing acne was 85% lower in the city than in the villages (P = 0.002).

CONCLUSION AND IMPLICATIONS

Acne is similar to the 'diseases of civilization' in being promoted by the pro-inflammatory properties of modern diets. The low prevalence and severity of acne in the Dogon supports the mismatch hypothesis and suggests that acne should join the list of diseases of modern lifestyles. However, we also observed an unexpected decrease in acne in urban boys. Future research is needed for a deeper mechanistic understanding of the interplay between diet, inflammation, immune function and other environmental exposures that differ between urban and rural environments.

Epidemiology and risk factors of childhood acne in Korea: a cross-sectional community based study

BACKGROUND

The epidemiology of acne vulgaris appears to be evolving, with an increasingly earlier onset seen in childhood. Relevant studies have been rarely performed in Asia.

AIM

We sought to estimate the prevalence and clinical characteristics of acne among schoolchildren, and its association with treatment-seeking behaviour, body mass index (BMI), nutritional habits and other lifestyle elements.

METHODS

A cross-sectional study was conducted with elementary schoolchildren aged 7-12 years. Children were interviewed by self-administered questionnaires, and were subsequently evaluated by dermatologists.

RESULTS

Of 693 children enrolled, 36.2% were diagnosed with acne, and the prevalence increased with age. Additionally, clinical characteristics including severity, duration of disease and lesion distribution were significantly different between the lower (aged 7-9 years) and the higher (aged 10-12 years) grades. Subjective features including recognition about acne and treatment-seeking behaviours were also different between the two groups. Overweight or obesity (BMI ≥ 25 kg/m(2) at 18 years of age; OR = 2.7) and consumption of chocolates/sweets (OR = 1.6) were significant risk factors for acne.

CONCLUSIONS

In the current study, the prevalence of acne among elementary schoolchildren was high, but only a few children had received treatment. Physicians should be attentive to childhood acne, and educate patients and their parents about the need to treat it.

Smoking and dietary factors associated with moderate-to-severe acne in French adolescents and young adults: results of a survey using a representative sample

BACKGROUND

Dietary factors and smoking play a role in acne.

METHODS

CSA Santé conducted a survey in France in 2012. Each individual answered a questionnaire to report acne, with associated epidemiological variables. Data on subjects between 15 and 24 years of age were extracted. The characteristics of subjects reporting acne were compared to subjects reporting no acne, using univariate and multivariate analysis.

RESULTS

The daily consumption of chocolate and sweets was independently and highly associated with acne, with an odds ratio of 2.38 (95% CI: 1.31-4.31). Smoking more than 10 cigarettes a day was highly associated with no acne, with an odds ratio of 0.44 (95% CI: 0.30-0.66). The regular use of cannabis was associated with acne, with an odds ratio of 2.88 (95% CI: 1.55-5.37).

CONCLUSION

Chocolate, sweets and cannabis smoking are associated with acne. We found tobacco to be protective. We failed to investigate the respective roles of sugar, lipids and milk.

Skin diseases among schoolchildren in Ghana, Gabon, and Rwanda

OBJECTIVES

Skin diseases, especially skin infections, among schoolchildren in Africa can be a major health problem. The objective of this study was to determine the prevalences of skin diseases among children in rural and urban schools in three different African countries and to study the influence of socioeconomic level.

METHODS

Cross-sectional, population-based studies were performed in Ghana, Gabon, and Rwanda. Point prevalences of skin diseases were estimated on the basis of physical examination by at least one dermatologist.

RESULTS

A total of 4839 schoolchildren were seen. The overall prevalence of schoolchildren with any skin disease was high and amounted to 34.6% and 42.0% in two Ghanaian studies, 45.8% in Gabon, and 26.7% in Rwanda. In children with skin diseases, skin infections represented the greatest proportion of disease, accounting for 14.7% and 17.6% of skin disease in the Ghanaian studies, and 27.7% and 22.7% in Gabon and Rwanda, respectively. Diseases with the highest prevalence were tinea capitis and bacterial skin infections, especially in rural areas and in schools serving children living at lower socioeconomic levels.

CONCLUSIONS

The prevalences of skin diseases among African schoolchildren were high. Skin infections such as tinea capitis and pyoderma predominated.

Acne vulgaris

Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.

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.