Self-reported acne severity, treatment, and belief patterns across multiple racial and ethnic groups in adolescent students

Identification of differentially methylated genes for severe acne by genome-wide DNA methylation and gene expression analysis

Severe acne is a chronic inflammatory skin condition that is affected by both genetic and environmental factors. DNA methylation is associated with a variety of inflammatory skin diseases, but its role in severe acne is unclear. In this study, we conducted a two-stage epigenome correlation study using 88 blood samples to identify disease-related differential methylation sites. We found close associations between the DNA methylation at 23 differentially methylated sites (DMSs) and severe acne, including PDGFD, ARHGEF10, etc. Further analysis revealed that differentially methylated genes (PARP8 and MAPKAPK2) were also expressed differently between severe acne and health control groups. These findings lead us to speculation that epigenetic mechanisms may play an important role in the pathogenesis of severe acne.

The Social and Psychological Impact of Acne Treatment: A Cross-Sectional Study of Blood Donors

BACKGROUND

Acne in adolescence and adulthood is believed to have a long-term impact on socioeconomic status (SES) and health-related quality-of-life (HRQoL) in adults.

OBJECTIVE

To estimate the cross-sectional prevalence of medically treated (MedTreAc) and untreated acne (UnTreAc) and to characterize its long-term impact in adults.

METHODS

A nationwide cross-sectional study on 17 428 blood donors aged 18-35 was performed. Associations among acne and HRQoL, depressive symptoms, total income, and SES were investigated via linear/logistic/multinomial logistic regression analyses adjusted for relevant covariables. HRQoL was measured by the Short Form-12, and depressive symptoms by the Major Depression Inventory. The data were self-reported.

RESULTS

Of the participants, 3591 (20.6%) and 1354 (7.8%) identified as the MedTreAc and UnTreAc phenotype, respectively. Neither phenotype was associated with a long-term impact on total income, but the MedTreAc group was associated with being an apprentice/student (OR = 1.26; 95% CI: 1.12, 1.42; P = 1.3×10^-4) or high skill-level employee (OR = 1.22, 95% CI: 1.07; 1.39, P = .0023), while self-employment was more common for those with UnTreAc (OR = 1.53; 95% CI: 1.12, 2.06, P = .0061). Additionally, the UnTreAc group was associated with a lower mental HRQoL (SF-12 mental component summary score -1.05, 95% CI: -1.56, -0.54; P = 1.4×10^-9) and increased odds ratio of depressive symptoms (OR = 1.44; 95% CI: 1.00, 2.02, P = .046).

CONCLUSION

In this population of blood donors, the cumulative prevalence of MedTreAc and UnTreAc were 20.6% and 7.8%, respectively. Untreated acne had a long-term impact on psychosocial well-being in adulthood. It was associated with lower mental HRQoL and higher occurrence of depressive symptoms. Acne was not associated with a lower salary or SES.

A systematic scoping review of racial, ethnic, and socioeconomic health disparities in pediatric dermatology

BACKGROUND/OBJECTIVES

Health disparities encompass a wide range of personal, societal, environmental, and system-based factors that contribute to inequitable health and health outcomes in vulnerable patient populations. The goal of this work was to scientifically summarize the existing published North American research on disparity as it pertains to pediatric dermatology.

METHODS

A systematic review was performed according to PRISMA guidelines. A medical librarian performed electronic searches from multiple electronic databases from their dates of inception to March 2021. Title and abstracts were reviewed by authors, identifying articles for full review. Data on article characteristics and identified disparities were then extracted and collected in a spreadsheet.

RESULTS

Fifty-one articles met final inclusion criteria, of which 25 highlighted disparities due to race/ethnicity, 13 highlighted disparities due to socioeconomic (SES), and 13 highlighted disparities due to both race/ethnicity and SES. The most frequent study designs were cross-sectional or survey, followed by retrospective cohort. Only two were prospective cohort studies. Disparities reported included reduced access to care and medications, increased school absenteeism, reduced knowledge about skin care including sun protection, increased hospitalizations and emergency department visits, and severe and persistent disease in the setting of minority race and poverty, among other indicators.

CONCLUSIONS

There are few, scattered research studies addressing disparity in pediatric dermatology. Greater focus will be needed in the future to improve knowledge of sources of disparity and its detrimental effects on the health of children, to rectify the notable disparity under-reporting of disparity research.

Barriers to healthcare access in pediatric dermatology: A systematic review

Barriers to healthcare access are healthcare inequities that have been widely studied across different medical specialties. No studies have previously evaluated the state of barriers to healthcare access research in pediatric dermatology. A systematic review was conducted to examine the types of barriers identified within pediatric dermatology literature. Relevant information was extracted and categorized into the themes of systemic, sociocultural, or individual barriers. The systemic barriers we found include finances, wait times, and geography. The sociocultural barriers included culture beliefs and communication. Patient beliefs and health knowledge were found as individual barriers. The small number and limited scope of studies we identified suggest that barriers to healthcare access in pediatric dermatology remain an understudied topic. Additional research is needed to further characterize these barriers to dermatologic care, as well as the impact of any interventions designed to overcome them.

Prevalence and Cutaneous Comorbidity of Acne Vulgaris in the Working Population

Purpose

Although acne vulgaris (AV) is a common disease and can persist into adulthood, there are few large-scale epidemiological studies on the prevalence of acne vulgaris in adults. The aim of our study was to characterise the epidemiology and comorbidity of acne vulgaris in working adults in Germany.

Patients and Methods

Within the framework of a cross-sectional study, a total of 161,269 employees underwent dermatological whole-body examinations in more than 500 German companies between 2001 and 2016. Point prevalence rates for acne vulgaris and further skin diseases and their 95% confidence intervals were calculated and differences between participants with and without acne vulgaris were tested with chi-squared tests.

Results

Mean age was 43.2 years ± 10.9, 55.5% were male. In total, n = 5311 people (3.3%) with acne vulgaris were identified. Prevalence decreased by age. Controlling for age and gender, acne was significantly associated with folliculitis (OR = 1.91; CI: 1.76–2.07), contact dermatitis (OR = 1.74; CI: 1.08–2.81), rosacea (OR = 1.74; CI: 1.40–2.15), pyoderma (OR = 1.58; 1.22–2.06), seborrheic dermatitis (OR = 1.47; CI: 1.27–1.71), hand eczema (OR = 1.34; CI: 1.00–1.76), verruca vulgaris plantaris (OR = 1.29; CI: 1.09–1.51), tinea pedis (OR = 1.27; CI: 1.10–1.47), spider veins (OR = 1.26; CI: 1.16–1.38) and telangiectasia (OR = 1.15; CI: 1.02–1.30).

Conclusion

These data underline the importance of acne vulgaris in the adult population. Further studies to better understand the pathophysiology of AV and its comorbidity in different phases of adulthood would be desirable to develop appropriate guidelines and therapy concepts.

Exploring patient journeys through acne healthcare: a patient perspective

BACKGROUND

Despite the large availability of caregivers, there are no standardized care pathways for patients with acne. This increases the risk of ineffective care and unnecessary medicalizing. To better understand how to provide effective, efficient, and patient-satisfying care, it is necessary to gain insights into the patient journey through acne healthcare services.

OBJECTIVE

To explore the patient journeys, assessed by a series of consecutive steps through acne healthcare.

METHODS

A cross-sectional survey was conducted among Dutch individuals with acne.

RESULTS

A total of 371 respondents completed the questionnaire. Data revealed 58 different pathways through acne healthcare services. Patient with severe acne had a stronger tendency to seek professional care than those with mild acne (p< .05). The highest proportion of clinically relevant improvement was found in patients treated by dermatologists, compared to respondents treated by beauticians, p = .023 and dermal therapists, p = .018.

CONCLUSIONS

Mapping the patient journeys contributed to a better understanding of the gap between professional guidelines and the experiences of patients. Identifying these areas of care implies that there is potential to bring acne care services more in line with the patients' needs. Further research is recommended; for example by comparing the clinical treatment outcomes of multiple sequences of caregivers.

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.

Association of Race/Ethnicity and Sex With Differences in Health Care Use and Treatment for Acne

Importance

Our understanding of potential racial/ethnic, sex, and other differences in health care use and treatment for acne is limited.

Objective

To identify potential disparities in acne care by evaluating factors associated with health care use and specific treatments for acne.

Design, Setting, and Participants

This retrospective cohort study used the Optum deidentified electronic health record data set to identify patients treated for acne from January 1, 2007, to June 30, 2017. Patients had at least 1 International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code for acne and at least 1 year of continuous enrollment after the first diagnosis of acne. Data analysis was performed from September 1, 2019, to November 20, 2019.

Main Outcomes and Measures

Multivariable regression was used to quantify associations between basic patient demographic and socioeconomic characteristics and the outcomes of health care use and treatment for acne during 1 year of follow-up.

Results

A total of 29 928 patients (median [interquartile range] age, 20.2 [15.4-34.9] years; 19 127 [63.9%] female; 20 310 [67.9%] white) met the inclusion criteria for the study. Compared with non-Hispanic white patients, non-Hispanic black patients were more likely to be seen by a dermatologist (odds ratio [OR], 1.20; 95% CI, 1.09-1.31) but received fewer prescriptions for acne medications (incidence rate ratio, 0.89; 95% CI, 0.84-0.95). Of the acne treatment options, non-Hispanic black patients were more likely to receive prescriptions for topical retinoids (OR, 1.25; 95% CI, 1.14-1.38) and topical antibiotics (OR, 1.35; 95% CI, 1.21-1.52) and less likely to receive prescriptions for oral antibiotics (OR, 0.80; 95% CI, 0.72-0.87), spironolactone (OR, 0.68; 95% CI, 0.49-0.94), and isotretinoin (OR, 0.39; 95% CI, 0.23-0.65) than non-Hispanic white patients. Male patients were more likely to be prescribed isotretinoin than female patients (OR, 2.44; 95% CI, 2.01-2.95). Compared with patients with commercial insurance, those with Medicaid were less likely to see a dermatologist (OR, 0.46; 95% CI, 0.41-0.52) or to be prescribed topical retinoids (OR, 0.82; 95% CI, 0.73-0.92), oral antibiotics (OR, 0.87; 95% CI, 0.79-0.97), spironolactone (OR, 0.50; 95% CI, 0.31-0.80), and isotretinoin (OR, 0.43; 95% CI, 0.25-0.75).

Conclusions and Relevance

The findings identify racial/ethnic, sex, and insurance-based differences in health care use and prescribing patterns for acne that are independent of other sociodemographic factors and suggest potential disparities in acne care. In particular, the study found underuse of systemic therapies among racial/ethnic minorities and isotretinoin among female patients with acne. Further study is needed to confirm and understand the reasons for these differences.

What Italians think about acne: results of a survey on 2327 acne patients and their mothers

BACKGROUND

The psychological impact of acne is comparable to that experienced by patients with severe diseases; however, most of the people does not consider acne as a true disease. We evaluated beliefs, sources of information and knowledge about acne in Italian adolescents and their mothers.

METHODS

This survey was carried out in 2327 acne patients and their mothers (4654 subjects) by means of a self-administered questionnaire. The questionnaire was based on ten questions: seven questions for the patients and three questions for their mothers.

RESULTS

All the 2327 patients and their mothers completed the survey. Approximately 75% of patients declared that acne has a negative influence on their self-esteem and relationships; furthermore, 87% of patients stated that acne limits their social life. Finally, 65% of patients declared that they are under treatment, but only in 20% of cases the treatment was prescribed by a dermatologist. The mothers considered pollution, wrong diet and hyperseborrhea as the most important etiological factors. They considered the treatment suggested by a cosmetologist and contraceptive pill as the best one; only 8% of mothers reported that they regularly took their children to the dermatologist.

CONCLUSIONS

In order to improve the treatment and the quality of life in acne patients, there is a need to improve awareness about this disease and its causes and to highlight the role and importance of dermatologists.

Oral isotretinoin for acne

BACKGROUND

Acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit associated with socialisation and mental health problems, may affect more than 80% of teenagers. Isotretinoin is the only drug that targets all primary causal factors of acne; however, it may cause adverse effects.

OBJECTIVES

To assess efficacy and safety of oral isotretinoin for acne vulgaris.

SEARCH METHODS

We searched the following databases up to July 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and LILACS. We updated this search in March 2018, but these results have not yet been incorporated in the review. We also searched five trial registries, checked the reference lists of retrieved studies for further references to relevant trials, and handsearched dermatology conference proceedings. A separate search for adverse effects of oral isotretinoin was undertaken in MEDLINE and Embase up to September 2013.

SELECTION CRITERIA

Randomised clinical trials (RCTs) of oral isotretinoin in participants with clinically diagnosed acne compared against placebo, any other systemic or topical active therapy, and itself in different formulation, doses, regimens, or course duration.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 31 RCTs, involving 3836 participants (12 to 55 years) with mild to severe acne. There were twice as many male participants as females.Most studies were undertaken in Asia, Europe, and North America. Outcomes were generally measured between eight to 32 weeks (mean 19.7 weeks) of therapy.Assessed comparisons included oral isotretinoin versus placebo or other treatments such as antibiotics. In addition, different doses, regimens, or formulations of oral isotretinoin were assessed, as well as oral isotretinoin with the addition of topical agents.Pharmaceutical companies funded 12 included trials. All, except three studies, had high risk of bias in at least one domain.Oral isotretinoin compared with oral antibiotics plus topical agentsThese studies included participants with moderate or severe acne and assessed outcomes immediately after 20 to 24 weeks of treatment (short-term). Three studies (400 participants) showed isotretinoin makes no difference in terms of decreasing trial investigator-assessed inflammatory lesion count (RR 1.01 95% CI 0.96 to 1.06), with only one serious adverse effect found, which was Stevens-Johnson syndrome in the isotretinoin group (RR 3.00, 95% CI 0.12 to 72.98). However, we are uncertain about these results as they were based on very low-quality evidence.Isotretinoin may slightly improve (by 15%) acne severity, assessed by physician's global evaluation (RR 1.15, 95% CI 1.00 to 1.32; 351 participants; 2 studies), but resulted in more less serious adverse effects (67% higher risk) (RR 1.67, 95% CI 1.42 to 1.98; 351 participants; 2 studies), such as dry lips/skin, cheilitis, vomiting, nausea (both outcomes, low-quality evidence).Different doses/therapeutic regimens of oral isotretinoinFor our primary efficacy outcome, we found three RCTs, but heterogeneity precluded meta-analysis. One study (154 participants) reported 79%, 80% and 84% decrease in total inflammatory lesion count after 20 weeks of 0.05, 0.1, or 0.2 mg/kg/d of oral isotretinoin for severe acne (low-quality evidence). Another trial (150 participants, severe acne) compared 0.1, 0.5, and 1 mg/kg/d oral isotretinoin for 20 weeks and, respectively, 58%, 80% and 90% of participants achieved 95% decrease in total inflammatory lesion count. One RCT, of participants with moderate acne, compared isotretinoin for 24 weeks at (a) continuous low dose (0.25 to 0.4 mg/kg/day), (b) continuous conventional dose (0.5 to 0.7 mg/kg/day), and (c) intermittent regimen (0.5 to 0.7 mg/kg/day, for one week in a month). Continuous low dose (MD 3.72 lesions; 95% CI 2.13 to 5.31; 40 participants; one study) and conventional dose (MD 3.87 lesions; 95% CI 2.31 to 5.43; 40 participants; one study) had a greater decrease in inflammatory lesion counts compared to intermittent treatment (all outcomes, low-quality evidence).Fourteen RCTs (906 participants, severe and moderate acne) reported that no serious adverse events were observed when comparing different doses/therapeutic regimens of oral isotretinoin during treatment (from 12 to 32 weeks) or follow-up after end of treatment (up to 48 weeks). Thirteen RCTs (858 participants) analysed frequency of less serious adverse effects, which included skin dryness, hair loss, and itching, but heterogeneity regarding the assessment of the outcome precluded data pooling; hence, there is uncertainty about the results (low- to very-low quality evidence, where assessed).Improvement in acne severity, assessed by physician's global evaluation, was not measured for this comparison.None of the included RCTs reported birth defects.

AUTHORS' CONCLUSIONS

Evidence was low-quality for most assessed outcomes.We are unsure if isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician-assessed acne severity. Only one serious adverse event was reported in the isotretinoin group, which means we are uncertain of the risk of serious adverse effects; however, isotretinoin may result in more minor adverse effects.Heterogeneity in the studies comparing different regimens, doses, or formulations of oral isotretinoin meant we were unable to undertake meta-analysis. Daily treatment may be more effective than treatment for one week each month. None of the studies in this comparison reported serious adverse effects, or measured improvement in acne severity assessed by physician's global evaluation. We are uncertain if there is a difference in number of minor adverse effects, such as skin dryness, between doses/regimens.Evidence quality was lessened due to imprecision and attrition bias. Further studies should ensure clearly reported long- and short-term standardised assessment of improvement in total inflammatory lesion counts, participant-reported outcomes, and full safety accounts. Oral isotretinoin for acne that has not responded to oral antibiotics plus topical agents needs further assessment, as well as different dose/regimens of oral isotretinoin in acne of all severities.

The Importance of Patient Registries in Skin of Color

Patient registries serve as powerful and cost-effective research tools that can help improve our understanding of disease pathogenesis and treatment. Although patient registries for various dermatologic diseases currently exist, few address diseases affecting primarily skin of color. Establishing patient registries for diseases that affect skin of color is one potential solution to overcoming some of the limitations researchers face when studying these disorders. Here, we present two patient registries in dermatology that may serve as examples of how patient registries can contribute to advancing our understanding of dermatologic diseases. We also address some of the potential benefits and limitations of patient registries.

Help-seeking behaviours, opportunistic treatment and psychological implications of adolescent acne: cross-sectional studies in schools and hospital outpatient departments in the UK

BACKGROUND

Acne vulgaris (acne) is a common adolescent skin condition. It is associated with negative psychological impacts and sufferers do not easily seek help, hence is undertreated.

OBJECTIVES

We investigated the self-reported prevalence, severity and psychological sequelae of acne, together with assessing help-seeking behaviour and its barriers, in separate school and hospital samples. We explored opportunistic treatment by paediatricians.

METHODS

Self-reported survey with participants drawn from: (1) 120 adolescents aged 13-18 in a London tertiary paediatric outpatient department and (2) 482 adolescents from two London schools, aged 11-18. Adolescents confidentially and anonymously completed a questionnaire (paper or online) and those with acne completed the Cardiff Acne Disability Index (CADI) questionnaire.

OUTCOME MEASURES

To explore if acne is being addressed opportunistically in outpatient appointments and the behaviours associated with seeking help and psychological implications of acne.

RESULTS

Acne prevalence was reported as 58.3% in the clinic and 42.3% in schools, with 34.3% and 20.6% of participants having moderate acne (MA) or severe acne (SA), respectively. The correlation between acne severity and CADI was significant (regression coefficient=4.86, p<0.005 (MA) and 9.08, p<0.005 (SA) in the hospital; 1.92, p<0.001 (MA) and 7.41, p<0.005 (SA) in schools). Severity of acne was associated with increased likelihood of seeing a doctor in both samples (OR=8.95, 2.79-28.70 (MA) in the clinic and 1.31, 1.30-2.90 (MA) and 3.89, 0.66-22.98 (SA) in the community). Barriers to help seeking included embarrassment and believing doctors were unapproachable. Doctors addressed acne opportunistically in 2.9% of the sample, although 16.7% of those with MA and SA wished their doctor had raised it.

CONCLUSION

Acne is common and has negative psychological implications, correlating with severity. Young people often forego seeking help and hospital clinicians rarely address acne opportunistically. Further work is needed to investigate how to reduce barriers to help seeking for acne.

Prioritizing treatment outcomes: How people with acne vulgaris decide if their treatment is working

OBJECTIVE

To collect information about how people with acne make day-to-day decisions concerning the effectiveness of their treatment.

METHODS

Between May and August 2013, an optional question was embedded in the James Lind Alliance Acne Priority Setting Partnership's online survey to collect treatment uncertainties. The question asked people with acne to "Tell us in your own words how you decide if your treatment has been effective."

RESULTS

A total of 742 respondents specified at least one outcome or means of assessing change (outcome measure). Fewer spots were the most commonly cited outcome, identified by 272 respondents (36.7%). Other frequently mentioned outcomes were in descending order: less redness (19.4%), reduction in spot size (12.1%), and less pain/discomfort (11.4%). Signs were much more commonly used than symptoms and surrogate outcomes such as changes in aspects of life quality were infrequently mentioned. Visual inspection of the skin was the most widely adopted outcome measure (16.3%).

CONCLUSIONS

Although the most frequently used methods map well onto the outcome measures adopted in the majority of acne trials, namely physician-assessed changes in lesion counts and global acne severity, people with acne often take into account several factors that cannot be assessed by a third party at a single point in time. The minimal use of changes in psychosocial wellbeing and mood may reflect that these are regarded as secondary consequences of improvements in appearance. The robustness of these findings now requires independent evaluation. If confirmed, they could form the basis of a new patient-reported outcome measure.

Efficacy of a twice-daily, 3-step, over-the-counter skincare regimen for the treatment of acne vulgaris

Background

Acne vulgaris (acne) is the most common skin disorder producing physical and emotional scars that can persist for years. An estimated 83% of acne sufferers self-treat, but there is lack of studies documenting the effectiveness of over-the-counter (OTC) acne treatment products.

Objective

This study was conducted to determine the effectiveness of an OTC, 3-step, anti-acne skincare regimen in treating acne and improving the appearance of red/inflamed facial skin.

Methods

This 6-week, open-label clinical study included both genders aged between 12 and 35 years with mild-to-moderate acne. All subjects were required to have an acne score of 1–3 (Cook’s acne grading scale: 0=clear to 7=very severe) and a moderate redness score of ≥2 (0=none and 4=severe). Subjects completed a 3-step facial treatment regimen every morning and evening using an OTC cleanser, toner, and acne treatment. Evaluations for effectiveness and safety were done at baseline and weeks 2, 4, and 6 using digital photographs (Visia-CR^® digital imaging system) of the face and analyzed using Image-Pro^® software for the grading of acne, red/inflamed skin, and the number and type of lesions.

Results

Thirty subjects (12 males and 18 females) were enrolled (mean age of 19 years; range 12–34 years). This skincare regimen resulted in statistically significant improvements in acne grading scores after 2 weeks of use, with mean scores continuing to improve after 4 and 6 weeks of use (P<0.001). Statistically significant improvements from baseline in red/inflamed skin, open and closed comedones, and papules were detected at all time points and for nodules at week 6, compared to their respective baselines (P<0.05).

Conclusion

This clinical study demonstrated the effectiveness of an OTC 3-step, anti-acne skincare regimen in significantly improving acne and the overall appearance of skin in the majority of subjects who had mild-to-moderate acne.

General quality of life of patients with acne vulgaris before and after performing selected cosmetological treatments

BACKGROUND

Achieving a satisfying quality of life for a patient by applying individually matched therapy is, simultaneously, a great challenge and a priority for contemporary medicine. Patients with visible dermatological ailments are particularly susceptible to reduction in the general quality of life. Among the dermatological diseases, acne causes considerable reduction in the quality of life and changes in self-perception that lead to the worsening of a patient's mental condition, including depression and suicidal thoughts. As a result, difficulties in contact with loved ones, as well as social and professional problems are observed, which show that acne is not a somatic problem alone. To a large extent, it becomes a part of psychodermatology, becoming an important topic of public health in social medicine practice. Pharmacological treatment of acne is a challenge for a dermatologist and often requires the necessity of cooperating with a cosmetologist. Cosmetological treatments are aimed at improving the condition of the skin and reduction or subsiding of acne skin changes.

AIM

The aim of this study was to assess the influence of selected cosmetological treatments on the general quality of life of patients with acne.

MATERIALS AND METHODS

The study group consisted of 101 women aged 19-29 years ([Formula: see text] years, SD =2.3 years). All subjects were diagnosed with acne vulgaris of the face. In the study group, the acne changes occurred over the course of 3-15 years ([Formula: see text] years, SD =2.7 years). Selected cosmetological treatments (intensive pulsing light, alpha-hydroxy acids, cavitation peeling, needle-free mesotherapy, diamond microdermabrasion and sonophoresis) were performed in series in the number depending on the particular patient's chosen treatment, after excluding contraindications. General quality of life of the patients was estimated using the Skindex-29 and Dermatology Life Quality Index (DLQI) questionnaires, before and after the cosmetological treatment.

RESULTS

Statistical analysis of the data obtained from the Skindex-29 questionnaire in areas (emotions, symptoms and physical functioning) and DLQI questionnaire in areas (daily activities, leisure, work and school, personal relations and treatment) showed great improvement in the general quality of life after applying a series of cosmetological treatments. The results are statistically relevant at P<0.0001.

CONCLUSION

The cosmetological treatment significantly improved the general quality of life of patients with acne vulgaris and their skin condition, which was evaluated by the Hellgren-Vincent scale. It was proven that therapy performed in cosmetological clinics may become an integral part of or complete dermatological treatment.

Acne Knowledge of Hispanic Parents of Teenagers with Mild to Moderate Acne

We performed a cross-sectional study of Hispanic and non-Hispanic parents of children with acne using a survey designed to determine their level of awareness of acne and its treatment; 82% of Hispanic parents and 40% of non-Hispanic parents agreed that a health care provider should treat mild acne (p < 0.001). Hispanic parents of adolescents with acne agreed more frequently than non-Hispanic parents that children with mild and moderate acne should be taken to a health care provider for treatment, but they tended not to visit health care providers. Future studies should aim to determine the reasons for this discrepancy, after which culturally sensitive educational programs can be developed to address this disparity.

Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership

OBJECTIVES

The Acne Priority Setting Partnership (PSP) was set up to identify and rank treatment uncertainties by bringing together people with acne, and professionals providing care within and beyond the National Health Service (NHS).

SETTING

The UK with international participation.

PARTICIPANTS

Teenagers and adults with acne, parents, partners, nurses, clinicians, pharmacists, private practitioners.

METHODS

Treatment uncertainties were collected via separate online harvesting surveys, embedded within the PSP website, for patients and professionals. A wide variety of approaches were used to promote the surveys to stakeholder groups with a particular emphasis on teenagers and young adults. Survey submissions were collated using keywords and verified as uncertainties by appraising existing evidence. The 30 most popular themes were ranked via weighted scores from an online vote. At a priority setting workshop, patients and professionals discussed the 18 highest-scoring questions from the vote, and reached consensus on the top 10.

RESULTS

In the harvesting survey, 2310 people, including 652 professionals and 1456 patients (58% aged 24 y or younger), made submissions containing at least one research question. After checking for relevance and rephrasing, a total of 6255 questions were collated into themes. Valid votes ranking the 30 most common themes were obtained from 2807 participants. The top 10 uncertainties prioritised at the workshop were largely focused on management strategies, optimum use of common prescription medications and the role of non-drug based interventions. More female than male patients took part in the harvesting surveys and vote. A wider range of uncertainties were provided by patients compared to professionals.

CONCLUSIONS

Engaging teenagers and young adults in priority setting is achievable using a variety of promotional methods. The top 10 uncertainties reveal an extensive knowledge gap about widely used interventions and the relative merits of drug versus non-drug based treatments in acne management.

Teenage acne and cancer risk in US women: A prospective cohort study

BACKGROUND

Acne reflects hormone imbalance and is a key component of several systemic diseases. We hypothesized that diagnosis of acne as a teenager might predict subsequent risk of hormone-related cancers.

METHODS

We followed 99,128 female nurses in the Nurses' Health Study II cohort for 20 years (1989-2009) and used Cox proportional hazards models to estimate the hazard ratios (HRs) of 8 specific cancers (breast, thyroid, colorectal, ovarian, cervical, and endometrial cancers, melanoma, and non-Hodgkin lymphoma) for women with a history of severe teenage acne.

RESULTS

After thoroughly adjusting for the previously known risk factors for each cancer, we found that among women with a history of severe teenage acne, the relative risk increased, with a multivariable-adjusted HR of 1.44 (95% confidence interval [CI], 1.03-2.01) for melanoma. We replicated this association in an independent melanoma case-control study of 930 cases and 1026 controls (multivariable-adjusted odds ratio, 1.27; 95% CI, 1.03-1.56). We also found that in both studies the individuals with teenage acne were more likely to have moles (52.7% vs 50.1%, P < .001 in the cohort study; and 55.2% vs 45.1%, P = .004 in the case-control study).

CONCLUSIONS

Our findings suggest that a history of teenage acne might be a novel risk factor for melanoma independent from the known factors, which supports a need for continued investigation of these relationships.

Acne-Related Quality of Life Among Female Adults of Different Races/Ethnicities

Background

Acne impairs quality of life, but its effect on different races/ethnicities is unclear. This study evaluated racial/ethnic differences in acne-related quality of life and psychological symptoms among female adults.

Methods

A Web-based survey was conducted with U.S. female adults (25–45 years old) with facial acne (≥25 visible lesions). Outcomes included sociodemographics, clinical characteristics, acne-related quality of life (Acne-Specific Quality of Life Questionnaire), psychological symptoms (Patient Health Questionnaire), and work/school productivity. Racial/ethnic differences were evaluated using descriptive statistics and analysis of variance/chi-square analyses.

Results

Three-hundred twelve subjects (Black = 30.8%, Hispanic = 17.6%, Asian/other = 17.3%, White = 34.3%) completed the survey (mean age = 35.3 ± 5.9 years). Acne negatively impacted quality of life for all subjects. Black subjects reported significantly less negative impact on self-perception versus Asian/other (Black = 12.6 ± 9.9, Asian/other = 8.4 ± 8.6; p = .05). Social functioning was less negatively impacted in White and Black subjects versus Asian/other (White = 12.7 ± 7.5, Asian/other = 8.4 ± 7.8, p < .05; Black = 12.1 ± 9.2, Asian/other = 8.4 ± 7.8, p = .06). Over one third (total sample = 40.7%, Black = 31.3%, Hispanic = 36.4%, Asian/other = 50.0%, White = 46.7%) reported moderate/severe anxiety/depression symptoms. Acne also impacted ability to concentrate on work/school.

Conclusion

Racial/ethnic differences were observed in acne-related quality of life and psychological symptoms in female adults; acne negatively impacted self-perceptions and social/emotional functioning.

Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action

Over-the-counter acne treatments containing tea tree oil from the plant Melaleuca alternifolia are widely available, and evidence indicates that they are a common choice amongst those self-treating their acne. The aims of this review were to collate and evaluate the clinical evidence on the use of tea tree oil products for treating acne, to review safety and tolerability and to discuss the underlying modes of therapeutic action.

Severe teenage acne and risk of endometriosis

STUDY QUESTION

Is there a relationship between severe teenage acne and endometriosis?

SUMMARY ANSWER

Endometriosis is positively associated with severe teenage acne.

WHAT IS KNOWN ALREADY

No studies have specifically explored a possible association between severe acne in adolescence and risk of endometriosis.

STUDY DESIGN, SIZE, DURATION

This prospective cohort study used data collected from 88 623 female nurses from September 1989 to June 2009 as part of the Nurses' Health Study II (NHS II) cohort.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Regression models were used to calculate hazard ratios (HRs) and confidence intervals (CIs) for endometriosis among women with and without severe teenage acne. Multivariate models were adjusted for established risk factors of endometriosis.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 4 382 laparoscopically confirmed endometriosis cases were documented during 1 132 272 woman-years of follow-up. Compared with women without a history of severe teenage acne, women who had severe teenage acne had a 20% increased risk of endometriosis (HR = 1.20, 95% CI: 1.08-1.32). The association was not affected by adjusting for use of tetracycline or isotretinoin.

LIMITATIONS AND REASONS FOR CAUTION

The HR is likely to be underestimated since we only included endometriosis cases confirmed by laparoscopy. Although geographically diverse, the NHS II cohort is primarily Caucasian, which may limit generalization to more ethnically diverse populations.

WIDER IMPLICATIONS OF THE STUDY

The results of this study suggest that severe teenage acne is associated with an increased risk of endometriosis. As a visible and non-invasive clinical indicator, severe teenage acne may be useful for early detection of endometriosis. We bring this counter-intuitive association to the attention of clinicians for the benefit of the patient and an early diagnosis of endometriosis.

STUDY FUNDING/COMPETING INTEREST

This study was funded by research grant CA176726 from the National Institute of Health. M.K. is supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078). The funding agencies had no role in the design of the study, in the analysis and interpretation of the data, in the writing of the report or in the decision to submit the paper for publication.

Self-reported acne is not associated with prostate cancer

OBJECTIVE

Some studies have suggested an inverse association between acne vulgaris and the acne-related bacterium Propionibacterium acnes and prostate cancer (PCa). Self-reported acne might be an easily obtainable marker to identify men at relatively low risk of PCa and might be incorporated into PCa risk calculators. This study aimed to evaluate the association between self-reported acne and PCa in a large case-referent study.

METHODS AND MATERIALS

The case group comprised 942 patients with PCa recruited from a population-based cancer registry in 2003 to 2006, 647 of whom met the criteria for aggressive PCa. The referents (n = 2,062) were a random sample of the male general population. All subjects completed a questionnaire on risk factors for cancer, including questions about acne. Odds ratios (ORs) and 95% confidence interval (CI) were calculated using multivariable logistic regression for PCa and aggressive PCa as separate end points, while adjusting for age and family history of PCa.

RESULTS

A history of acne was reported by 320 cases (33.9%) and 739 referents (35.8%). Self-reported acne was significantly associated neither with PCa (adjusted OR = 0.95, 95% CI: 0.80-1.12) nor with aggressive PCa (adjusted OR = 0.97, 95% CI: 0.80-1.18).

CONCLUSION

Self-reported acne is not suitable as a marker to identify men at low risk of aggressive PCa.

A Consensus on Acne Management Focused on Specific Patient Features

Background:

Most treatment guidelines for acne are based on clinical severity. Our objective was to expand that approach to one that also comprised individualized patient features: a case-based approach.

Methods:

An expert panel of Canadian dermatologists was established to develop demographic and clinical features considered to be particularly important in acne treatment selection. A nominal group consensus process was used for inclusion of features and corresponding appropriate treatments.

Results:

Consensus was achieved on the following statements: follicular epithelial dysfunction contributes to acne pathogenesis; inflammation from underlying disease(s) or prior treatment may impact further patient management; management focusing on specific patient features and on addressing psychosocial factors, including impact on quality of life, may improve treatment adherence and outcomes; and case-based scenarios are a practical approach to illustrate the effect of these factors. To address the latter, eight case profiles were developed.

Conclusions:

Management of acne should be based on multifactorial considerations beyond clinically determined acne severity and should include patient-reported impact, gender, skin sensitivity (including preexisting dermatoses), and phototype.

A genome-wide association study of severe teenage acne in European Americans

Despite the family aggregation of severe teenage acne, the genetic basis of this common skin condition remains unclear. We conducted a genome-wide association study (GWAS) on severe teenage acne in 928 European Americans. The SNP rs4133274 on chromosome 8q24 (72 kb upstream of MYC) revealed the most significant association with severe teenage acne (p value = 1.7 × 10(-6)). The variant allele of this SNP (G allele) was associated with an increased risk of severe teenage acne with odds ratio of 4.01 (95 % confidence interval = 2.37-6.82). Upon further replication, our findings suggest new genetic basis of acne and may explain the association between acne and cancer risk observed in the epidemiological studies.

Self-reported help-seeking behaviors and treatment choices of adolescents regarding acne

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.

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.