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Basfar AS, Jawhari AM, Alotaibi MN, Alzahrani ES, Aseeri IA, Atalla AA. Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia. J Family Community Med 2023; 30:131-136. [PMID: 37303837 PMCID: PMC10252637 DOI: 10.4103/jfcm.jfcm_396_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/09/2023] [Accepted: 03/18/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students. MATERIALS AND METHODS A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables. RESULTS The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS. CONCLUSION The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.
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Affiliation(s)
- Abdullah S. Basfar
- Department of Family Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Amjad M. Jawhari
- Department of Family Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Mansour N. Alotaibi
- Department of Family Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Essam S. Alzahrani
- Department of Family Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Ibrahim A. Aseeri
- Department of Family Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Ayman A. Atalla
- Department of Family Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
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Piquero-Casals J, Morgado-Carrasco D, Rozas-Muñoz E, Mir-Bonafé JF, Trullàs C, Jourdan E, Piquero-Martin J, Zouboulis CC, Krutmann J. Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes. J Cosmet Dermatol 2023; 22:1919-1928. [PMID: 36946555 DOI: 10.1111/jocd.15726] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes. AIMS To describe the impact of the exposome on acne and how photoprotection can improve outcomes. METHODS A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light." RESULTS Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties. CONCLUSIONS The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.
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Affiliation(s)
- J Piquero-Casals
- Department of Dermatology, Clínica Dermatológica Multidisciplinar Dermik, Barcelona, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - E Rozas-Muñoz
- Department of Dermatology, Hospital San Pablo, Coquimbo, Chile
| | - J F Mir-Bonafé
- Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - C Trullàs
- Innovation and Development, ISDIN, Barcelona, Spain
| | - E Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - J Piquero-Martin
- Department of Dermatology, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - J Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Bagatin E, Thouvenin MD, Bacquey A, Baradat S, Lauze C, Mengeaud V, Soares JLM, Andrade LDSM, Miot HA, Rocha MA. The usefulness of a dermocosmetic containing Myrtus communis extract and azelaic acid for maintenance phase of adult female acne: Results from a randomized exploratory investigator-blinded comparative study. J Eur Acad Dermatol Venereol 2023; 37 Suppl 2:26-30. [PMID: 36729399 DOI: 10.1111/jdv.18795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acne is a very common condition. Currently, there are relatively few studies available to help guidance-based decisions for its long-term management, especially studies with cosmetic care products. We have developed a skin care product dedicated to adult female acne. OBJECTIVES Evaluate the efficacy and tolerance of the test product containing Myrtus communis extract and azelaic acid compared with a light moisturizing cream (LCM) in adult females in the acne maintenance phase. METHODS A clinical study was conducted as a Brazilian, multicentre, randomized, investigator-blinded trial in adult females with clear or almost clear facial acne after anti-acne treatment. The test group (26 subjects) applied the test product and the comparative product group (27 subjects) applied LCM. Both groups applied the products twice daily on the whole face. Subjects were evaluated every 4 weeks over 16 weeks. Efficacy was evaluated according to acne relapse; Investigator's Global Assessment (IGA); acne lesions counting; AcneQoL questionnaire; Subject Global change Assessment (SGA) of acne severity; and the number of Post-Inflammatory Hyperpigmentation (PIH) and Post-Inflammatory Erythema (PIE) lesions. Tolerance was assessed according to a 5-point scale. RESULTS Over 16 weeks, the number of acne relapse was more than double in the comparator compared to the test product group (eight subjects vs. three subjects respectively). There was no statistical difference in the evolution of the mean IGA from baseline between the two groups; however, 85% of subjects were assessed as clear or almost clear in the test product group and 67% in the comparative group. CONCLUSIONS This study demonstrated the effectiveness topical application of the test product compared to LCM on acne severity in the maintenance phase of adult female acne. Efficacy results after 16 weeks suggested a trend to limit acne relapses and a benefit of the test product in maintaining long-term remission.
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Affiliation(s)
| | | | - Adeline Bacquey
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Sophie Baradat
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Christophe Lauze
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Valerie Mengeaud
- Medical Department, Ducray Dermatological Laboratories, Les Cauquillous, Lavaur, France
| | | | | | - Helio A Miot
- Botucatu Medical School, Universidade do Estado de Sao Paulo/UNESP (Sao Paulo State University), Botucatu, Brazil
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Elbuluk N, Grimes P, Chien A, Hamzavi I, Alexis A, Taylor S, Gonzalez N, Weiss J, Desai SR, Kang S. The Pathogenesis and Management of Acne-Induced Post-inflammatory Hyperpigmentation. Am J Clin Dermatol 2021; 22:829-836. [PMID: 34468934 DOI: 10.1007/s40257-021-00633-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 12/11/2022]
Abstract
Acne vulgaris is a common inflammatory disease. Among patients with darker skin phototypes (Fitzpatrick III-VI), the inflammatory processes of acne stimulate excess melanogenesis and abnormal melanin deposition, leading to pigmentary sequelae known as post-inflammatory hyperpigmentation and post-inflammatory erythema in all skin tones, although post-inflammatory hyperpigmentation is more common in darker skin and post-inflammatory erythema in lighter skin. These pigmentary alterations can be long lasting and are often more distressing to patients than the active acne lesions. This article discusses what is known about acne-related pigmentation, much of which is extrapolated from general study of nonspecific pigment deposition. Because dyspigmentation poses both a significant clinical concern to patients and a therapeutic challenge to clinicians, we formed a working group consisting of pigmentary experts with the aim of increasing awareness and education of acne-related pigmentary sequelae.
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Affiliation(s)
- Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower Street, Suite 100, Los Angeles, CA, 90017, USA.
| | - Pearl Grimes
- Department of Dermatology, David Geffen School of Medicine, University of California - Los Angeles, CA, Los Angeles, USA
| | - Anna Chien
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Susan Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jonathan Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Dermatology Partners and Gwinnett Clinical Research Center, Snellville, GA, USA
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Innovative Dermatology, Plano, TX, USA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Aslan Kayiran M, Karadag AS, Jafferany M. Psychodermatology of acne: Dermatologist's guide to inner side of acne and management approach. Dermatol Ther 2020; 33:e14150. [DOI: 10.1111/dth.14150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Melek Aslan Kayiran
- Department of Dermatology and Venereology Istanbul Medeniyet University, School of Medicine, Goztepe Training and Research Hospital Istanbul Turkey
| | - Ayse Serap Karadag
- Department of Dermatology and Venereology Istanbul Medeniyet University, School of Medicine, Goztepe Training and Research Hospital Istanbul Turkey
| | - Mohammad Jafferany
- Department of Psychodermatology Central Michigan University Saginaw Michigan USA
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Samuels DV, Rosenthal R, Lin R, Chaudhari S, Natsuaki MN. Acne vulgaris and risk of depression and anxiety: A meta-analytic review. J Am Acad Dermatol 2020; 83:532-541. [PMID: 32088269 DOI: 10.1016/j.jaad.2020.02.040] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted. OBJECTIVE We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety. METHODS A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region. RESULTS Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region. LIMITATIONS Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature. CONCLUSIONS Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.
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Affiliation(s)
- Danielle V Samuels
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts.
| | - Robert Rosenthal
- Department of Psychology, University of California, Riverside, California
| | - Rick Lin
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, Texas; Bay Area Corpus Christi Medical Center, South Texas Dermatology Residency Program, McAllen, Texas
| | - Soham Chaudhari
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, Texas; Bay Area Corpus Christi Medical Center, South Texas Dermatology Residency Program, McAllen, Texas
| | - Misaki N Natsuaki
- Department of Psychology, University of California, Riverside, California
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Abanmi A, Al-Enezi M, Al Hammadi A, Galadari I, Kibbi AG, Zimmo S. Survey of acne-related post-inflammatory hyperpigmentation in the Middle East. J DERMATOL TREAT 2018; 30:578-581. [PMID: 30426810 DOI: 10.1080/09546634.2018.1542807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: Acne vulgaris is a common inflammatory skin disease in the Middle East, similar to other regions of the world. In the Middle East, there are a relatively large proportion of patients with darker pigmentation (Fitzgerald skin types III-VI) who are prone to developing post-inflammatory hyperpigmentation (PIH) as a sequela of acne. Data are sparse on the frequency and characteristics of PIH throughout the world. What information is available indicates that pigmentation problems can be very bothersome for patients and are often quite long-lasting. Thus, it is important for clinicians to be aware of the scope of the problem of acne-associated PIH as well as potential treatment options. Methods: Prospective non-interventional study of acne patients consulting dermatologists (n = 262) in the Middle East. Results: PIH was present in 87.2% of subjects. The majority of subjects (52.6%) reported that PIH had been present for one year or longer. Of note, 69.0% of subjects reported excoriating their acne lesions, suggesting that this may be a key modifiable risk factor for clinicians to stress during patient education efforts. Conclusions: PIH was bothersome for patients, with half of subjects indicating that PIH was more bothersome than acne. In addition to our study results, we present here a brief overview of PIH and its treatment.
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Affiliation(s)
- A Abanmi
- a Department of Dermatology, Dr Sulaiman Alhabib Hospital , Riyadh , Kingdom of Saudi Arabia
| | - M Al-Enezi
- b Department of Dermatology, Amiri Hospital , Kuwait City, Kuwait
| | - A Al Hammadi
- c Departmentof Dermatology, Health Authority , Dubai , United Arab Emirates
| | - I Galadari
- d Department of Dermatology, Faculty of Medicine, United Arab Emirates University , Dubai , United Arab Emirates
| | - A-G Kibbi
- e Department of Dermatology, American University of Beirut Medical Center , Beirut , Lebanon
| | - S Zimmo
- f Department of Dermatology, King Abdulaziz University , Kingdom of Saudi Arabia
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Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2017; 78:S1-S23.e1. [PMID: 29127053 DOI: 10.1016/j.jaad.2017.09.078] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.
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