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Hazarika N, Yadav P, Bagri M, Chandrasekaran D, Bhatia R. Oral isotretinoin with desloratadine compared with oral isotretinoin alone in the treatment of moderate to severe acne: a randomized, assessor-blinded study. Int J Dermatol 2024; 63:929-935. [PMID: 38546101 DOI: 10.1111/ijd.17129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/23/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Our aim was to measure the effectiveness of oral isotretinoin with desloratadine compared with oral isotretinoin alone in treating moderate to severe acne at a tertiary care teaching hospital in North India. In this study, 90 patients with moderate to severe acne were enrolled to participate based on their fulfilling the inclusion criteria. METHODS A randomized, assessor-blinded, parallel-arm study was conducted. Randomization was done using computer-generated tables to allocate treatments in a 1:1 ratio. A low-dose oral isotretinoin at a dose of 0.3 mg/kg/day with tab desloratadine at 5 mg/day was applied to the study group and compared against the same patients going without the dosage when controls were conducted. Follow-up was at 4, 8, and 12 weeks. RESULTS The primary outcome was an improved global acne grading system (GAGS) score and decreased acne lesion count. SECONDARY OUTCOME patient satisfaction with treatment. The 90 participants were randomized and 15 participants dropped out of the study, leaving 75 participants for intention to treat analysis (n = 41, n = 30). At week 12, the GAGS score and acne lesion count between the study and control groups were comparable (P > 0.05). Pruritus reported was 9.76% in the study versus 33.33% in the control group (P = 0.018). Also, 53.66% of participants reported "excellent" treatment satisfaction in the study group versus 36.67% in the control group. CONCLUSIONS The addition of desloratadine to an isotretinoin regimen has a role in reducing disease and therapy-related pruritus in acne and leads to improved patient satisfaction.
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Affiliation(s)
- Neirita Hazarika
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Piyush Yadav
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manmohan Bagri
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya Chandrasekaran
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Riti Bhatia
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Muzaffar KH, Halilu HB, Dantata BA, Saati SM, Salah LA. Prevalence of Anxiety, Depression, and Body Dysmorphic Disorders Among Dermatology Outpatients With Acne Vulgaris at a Public Hospital in Saudi Arabia. Cureus 2024; 16:e64917. [PMID: 39156258 PMCID: PMC11330682 DOI: 10.7759/cureus.64917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Acne vulgaris is a chronic inflammatory skin condition that primarily affects the face, affecting a person's physical appearance. Anxiety, depression, and body dysmorphic disorder (BDD) are the three primary psychological conditions seen in dermatological patients. This study aimed to assess how prevalent anxiety, depression, and BDD in acne patients and the negative effect of acne on quality of life and self-esteem in dermatology patients. MATERIALS AND METHODS This cross-sectional study was done at the dermatology clinic in East Jeddah Hospital, Jeddah, Saudi Arabia. Data was collected using two pre-designed questionnaires. Part 1 contained demographic information and part 2 included four sets of questionnaires including the dermatology life quality index (DLQI), Rosenberg Self-Esteem Scale (RSES), Hospital Anxiety and Depression Scale (HADS), and Body Dysmorphic Disorder Questionnaire (BDDQ). Post-acne hyperpigmentation index (PAHPI), global scale for acne scar severity (SCAR-S), and LEEDS were used by the dermatologist to assess the patients' acne severity, post-acne scars, and pigmentation conditions. Data were analyzed using the IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). RESULTS The majority of the participants were females (76%), Saudi Arabians (95%), students (58%), single (82%), and attended university (66%). The mean acne duration was 5.75 ± 4.58 years and 44% of the participants used social media for more than five hours per day. The participants scored high on the RSES (27.54 ± 3.05), indicating normal self-esteem. The HADS-A score was 11.14 ± 2.74, whereas the HADS-D score was 11.46 ± 1.78, indicating anxiety and depression symptoms. Their mean SCAR-S score is 4.38 ± 2.89. DLQI scores (6.04 ± 6.05) indicate that acne had a moderate effect on patients' quality of life. The percentage of positive BDD patients is significantly higher than those with negative BDD (p = 0.022). Furthermore, a significant association between PAHPI total score and SCAR-S (r = 0.48, p ≤ 0.001) and HADS-D (r = 0.39, p = 0.005) total scores. CONCLUSION The study focuses on how acne vulgaris affects patients' quality of life. The findings suggest that acne-related quality of life is positively associated with anxiety and depressive symptoms. This study provides clinicians with practical advice for implementing a more thorough management strategy for acne vulgaris.
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Alfahl SO, Almehmadi LA, Alamri RS, Almalki DS, Alnakhli F. Impact of Acne Vulgaris and Vitiligo on Quality of Life and Self-Esteem in the Patient Population of Madinah, Saudi Arabia. Cureus 2024; 16:e52586. [PMID: 38371097 PMCID: PMC10874647 DOI: 10.7759/cureus.52586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Acne vulgaris and vitiligo are skin disorders that can have a negative impact on a person's self-esteem and quality of life (QoL). The purpose of this study is to look into the impact of acne and vitiligo on the self-esteem and QoL of the patient population in Madinah, Saudi Arabia. METHODS A cross-sectional survey of 171 Saudi adults (141 individuals with acne vulgaris (9.4%) and 30 with vitiligo (1.5%) between the ages of 16 and 35 was conducted in Madinah. A self-reported questionnaire with four domains was used: socio-demographic data, lifestyle and coexisting pathologic factors or diseases, Rosenberg's self-esteem scale, and the dermatology life quality index (DLQI). RESULTS Acne patients had a mean total score of 20.3 on the self-esteem scale, with 5% (n = 7) having low self-esteem, 48.2% (n = 68) having medium self-esteem, and 46.8% (n = 66) having high self-esteem. Females had higher self-esteem (75.29) than males (56.95). The mean DLQI score for acne patients was 5.4, with 30.5% (n = 47) unaffected, 29.1% (n = 45) mildly affected, 23.4% (n = 35) moderately affected, 5.6% (n = 10) severely affected, and 1.4% (n = 4) severely affected. Vitiligo patients had a mean self-esteem scale score of 13.7, with 63.3% (n = 19) having low self-esteem, 30% (n = 9) having medium self-esteem, and 6.7% (n = 2) having high self-esteem. The mean DLQI was 15.2, with 6.7% (n = 2) reporting that vitiligo had no effect on their lives, 10% (n = 3) reporting a moderate effect, 66.7% (n = 20) reporting a severe effect, and 16.7% (n = 5) reporting a very severe effect. CONCLUSIONS Our research confirms that acne vulgaris and vitiligo have a negative impact on self-esteem and quality of life. Along with medical treatment, effective treatment and psychological improvement of the patient should be prioritized.
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Affiliation(s)
- Samah O Alfahl
- Family Medicine, College of Medicine, Taibah University, Madinah, SAU
| | | | - Ranad S Alamri
- Medicine, College of Medicine, Taibah University, Madinah, SAU
| | - Dalia S Almalki
- Medicine, College of Medicine, Taibah University, Jeddah, SAU
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Prevalence and quality of life of facial acne: a cross-sectional study in high school students in Poland. Postepy Dermatol Alergol 2022; 39:1035-1039. [PMID: 36686019 PMCID: PMC9837594 DOI: 10.5114/ada.2021.112765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction Acne is a frequent chronic inflammatory disease, which affects most commonly adolescents. It might have a negative effect on patients' well-being. Aim To appraise the prevalence of facial acne among adolescents and to assess how acne of different clinical severity influences quality of life in this age group. Material and method This cross-sectional study was conducted on a representative sample of individuals aged 15-19 years in high schools in Poland. A total of 730 students were included in the final analysis. Standardized photographs according to the Investigator's Global Assessment (IGA) were used for self-assessment of both the presence and severity of facial acne. The Dermatology Life Quality Index (DLQI) was employed to evaluate subjects' quality of life (QoL) impairment. Results Facial acne was found in 547 (74.9%) respondents with no significant difference in acne prevalence among females (75.1%) and males (74.6%). The vast majority of acne individuals (90.9%) suffered from minimal and mild acne, moderate acne was reported by 7.3% and severe one by 1.8% of acne students. Acne had a small effect on QoL (DLQI mean score of 2.8 ±3.6 points); females had significantly more decreased QoL than males (3.17 ±3.74 and 1.76 ±2.69 points, respectively). QoL impairment positively correlated with the clinical severity of facial acne. Conclusions Facial acne is a common health problem in adolescents. Although it is not very severe in the majority of subjects it significantly decreases their QoL. Therefore, acne should be treated as a serious skin condition requiring a holistic approach to the patients.
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Mandavia R, Cariati M, Shahidi S, Spencer C, Somenek M, Lapa T. Combination radiofrequency microneedling and carbon dioxide laser for acne scarring: A systematic review and retrospective case series across two centers. J Cosmet Dermatol 2022; 21:5672-5679. [PMID: 35896510 DOI: 10.1111/jocd.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/06/2022] [Accepted: 07/20/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Combination radiofrequency (RF) microneedling with fractional ablative carbon dioxide (CO2 ) laser is a new approach for acne scar treatment. AIMS (1) to systematically review the literature on the safety and effectiveness of this treatment for acne scarring; (2) to assess safety and effectiveness in a 2-center case series. METHODS Systematic review: Articles that assessed the safety and effectiveness of combination RF microneedling and fractional CO2 laser for acne scarring were included and quality assessed using the Downs and Black checklist. CASE SERIES Patient records were reviewed from 2 clinics, one in London, UK, and the other in Washington D.C., United States, to identify patients who underwent a single treatment with RF microneedling and fractional CO2 laser for acne scarring. Outcome assessment was via the Scar Global Assessment (SGA) scale. RESULTS Systematic review: Three articles were included and reported improvements in acne scar severity. Adverse effects included erythema, edema, pain, vesicle formation, erosion, petechiae, desquamation, post-inflammatory hyperpigmentation (PIH), and acne flare. Quality scores ranged from 14 to 15 (maximum of 21). CASE SERIES Twenty-six patients were included. Mean SGA Score was 3.0 at baseline and 1.3 at follow-up. All patients had an improved SGA score. Adverse effects included erythema, pain, edema, skin crusting, PIH, and acne flare. All patients resumed normal activities within 7 days of treatment. CONCLUSION Combination RF microneedling and fractional CO2 laser appears a safe and effective treatment for patients with acne scarring. A single treatment can result in noticeable improvements in acne scar severity with a short recovery time.
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Affiliation(s)
- Rishi Mandavia
- Dr Tatiana Aesthetic Dermatology Clinic, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | | | | | | | - Michael Somenek
- Somenek + Pittman MD Advanced Plastic Surgery, Chicago, Illinois, USA
| | - Tatiana Lapa
- Dr Tatiana Aesthetic Dermatology Clinic, London, UK
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Chancheewa B, Asawanonda P, Noppakun N, Kumtornrut C. Myofibroblasts, B Cells, and Mast Cells in Different Types of Long-Standing Acne Scars. Skin Appendage Disord 2022; 8:469-475. [PMID: 36407643 PMCID: PMC9672862 DOI: 10.1159/000524566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/06/2022] [Indexed: 09/08/2023] Open
Abstract
Acne scars are classified into various types based on their appearances, ranging from hypertrophic to atrophic. Abnormal wound healing processes play an important role in the pathogenesis of scars; however, the exact mechanisms involved in various scar appearances have still not been elucidated. In this study, we used immunofluorescence and immunohistochemistry techniques to detect the presence of myofibroblasts, B cells, and mast cells in each type of acne scar persisting longer than 6 months. We found the highest density of myofibroblasts in hypertrophic acne scars, while in the other atrophic scars, we could not identify any myofibroblast-rich areas in our specimens. B-cell infiltration was mild and found in only 23% (4/17) of all acne scar specimens. Interestingly, mast cells were identified in all specimens, ranging from minimal to high density, and a high number of mast cells in acne scars were associated with obesity. In conclusion, myofibroblasts are abundant only in hypertrophic acne scars, and mast cells, but not B cells, might play an important role in the pathogenesis of long-standing acne scars.
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Affiliation(s)
- Bussabong Chancheewa
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nopadon Noppakun
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanat Kumtornrut
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Gandhi RN, Makhecha MB. A Split Face Study to Compare the Efficacy of Platelet Rich Plasma Versus Normal Saline Injections in Acne Scars and to Assess the Utility of Ultrabiomicroscopic Sonography in Evaluation of Treatment Response. J Cutan Aesthet Surg 2022; 15:375-380. [PMID: 37035589 PMCID: PMC10081466 DOI: 10.4103/jcas.jcas_80_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Background Multiple studies have proposed the effectiveness of Platelet rich plasma (PRP) in treatment of atrophic acne scars. But an unanswered question is - whether it is the presence of growth factors in PRP or the mechanical factors during the injection that are responsible for its effectiveness? Also, no study compares PRP as a monotherapy against inert solution like normal saline (NS), that too, in a split face pattern using a non-invasive objective evaluation method. Aims Primary - To compare the efficacy of intralesional PRP and NS injections, in the treatment of atrophic acne scars. Secondary - To assess the side effect profile of the PRP injections. Study Design Prospective Interventional Comparative Split Face study. Materials and Methods 30 out of 33 patients completed the study and 20 of them were subjected to Ultrabiomicroscopic (UBM) analysis. Each patient received intralesional injections of NS and PRP in a split face pattern at two weekly intervals for five sittings. Treatment response was assessed using Goodman And Baron qualitative grading system, photographic evaluation by two blinded dermatologist and UBM analysis (scar depth & length). Results All the three methods showed a statistically significant treatment response. However, there was no significant inter group difference and PRP and NS had similar efficacy in treating acne scars. Conclusion We conclude that subscision like mechanical effect of injecting solution is more important than the nature of the solution in treatment of atrophic acne scars and UBM sonography can be proposed as an objective assessment tool for such studies.
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Affiliation(s)
- Riddhi N Gandhi
- Department of Dermatology, HBTMC & Dr R N COOPER Hospital, Mumbai, India
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Rudzińska J, Głąbska D. Influence of Selected Food Product Groups Consumption Frequency on Acne-Related Quality of Life in a National Sample of Polish Female Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11670. [PMID: 36141942 PMCID: PMC9517132 DOI: 10.3390/ijerph191811670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Acne vulgaris affects over 80% of adolescents, mainly female ones, and may reduce their general quality of life, so its prevention and treatment are becoming necessary, while among the options for acne management, the potential influence of diet is indicated. The aim of the study was to assess the influence of selected food product groups consumption frequency on acne-related quality of life in a national sample of Polish female adolescents. The studied population of 1370 Polish female adolescents was gathered using random quota sampling of secondary schools representative of the whole country. The acne-related quality of life was assessed using the Acne Quality of Life (AQoL) Scale with the calculated Social Quality of Life (SOCQOL) Score, as well as the Acne Disability Questionnaire (ADQ) with the calculated Cardiff Acne Disability Index (CADI). The acne-related food product groups' consumption frequency was assessed using the Acne-specific Food Frequency Questionnaire (Acne-FFQ). There were no differences in food product consumption between subgroups stratified by the acne-related quality of life (p > 0.05), and there was no correlation between food product consumption and the results of the SOCQOL Score (p > 0.05). For the CADI, positive correlations were indicated for fast foods (p = 0.0450; R = 0.0688), salty snacks (p = 0.0342; R = 0.0727), and chocolate confectionary (p = 0.0147; R = 0.0837), while a negative correlation was indicated for dairy beverages other than milk (p = 0.0414; R = -0.0701). In the studied group of Polish female adolescents, fast foods, salty snacks, and chocolate confectionary were indicated as potential acne-promoting factors, while dairy beverages other than milk were indicated as a potential acne-protective factor.
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Shukla P, Verma P, Suvirya S, Pathania S, Kapoor D. Cutaneous dermatophytosis: A problem deeper than we perceive – A cross sectional prospective study on quality of life in 385 patients. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Yıldırım F, Mert B, Çağatay E, Aksoy B. Predictors of quality of life in adults and adolescents with acne: A cross-sectional study. Indian J Dermatol 2022; 67:239-246. [PMID: 36386112 PMCID: PMC9644776 DOI: 10.4103/ijd.ijd_781_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Acne is becoming more prevalent in adults, particularly women across the globe. Although previous studies have compared clinical and epidemiologic characteristics of adolescent and adult acne, an adequate understanding of the quality of life (QoL) of adult acne patients and associated comorbidities are still lacking. Objectives: We sought to compare the differences between adolescent and adult patient groups, regarding gender, socio-clinico-demographic factors, and comorbid associations, as well as their relatedness with life quality. Methods: This is a cross-sectional study with 1013 acne patients. Data on the severity, onset and location of acne, sex, family history of acne, smoking and alcohol habits, medication history, presence of seborrhea, and other comorbidities were collected. We employed the classification used by the American Academy of Dermatology for assessing acne severity. To assess the QoL in the patients, the Dermatology Life Quality Index (DLQI) score was used. Results: Of the 1013 patients included in this study; 380 (female: 333, male: 47) were adult, and 633 (female: 535 and male: 98) were adolescent cases. The median total DLQI scores of adult and adolescent groups were not significantly different. Our results showed that factors such as age, gender, duration, body mass index, family history, and psychiatric disorders exhibited no impact on QoL in both adolescents and adults. Age of onset was correlated with DLQI scores in the adult group. The main influencers of DLQI in the adult group were allergic disorders, hormonal imbalances, and previous treatment history. Besides, major influencers in adolescent patients were acne severity, acne location, hirsutism, hyperseborrhea, premenstrual exacerbation, menstrual irregularities, previous treatment history, and smoking. Conclusions: The findings of our current study have shown that DLQI has been influenced by different factors in adolescents and adults that should be kept in mind.
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Daye M, Cihan FG, Işık B, Hafızoğlu B. Evaluation of bowel habits in patients with acne vulgaris. Int J Clin Pract 2021; 75:e14903. [PMID: 34553475 DOI: 10.1111/ijcp.14903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 09/19/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the bowel habits of patients with acne vulgaris. METHOD In this case-control study, socio-demographical characteristics of the participants (age, gender, marital status, educational status, profession, economic status, smoking-alcohol habits, chronic diseases, previous operations, people they live with and diet) were questioned and the global acne grading scores of the patients were calculated. Bristol Stool Scale, Rome III IBS Criteria, International Physical Activity Questionnaire-Short Form, Hospital Anxiety Depression and KADF (dietary fibre information) scales were completed. RESULTS The patient group consisted of 102 participants and the control group consisted of 104 participants. The mean age was 20.9 ± 3.9 years old in the case group and 21.8 ± 5.0 years old in the control group. Patient and control groups were similar in terms of age and gender. Smoking rates were significantly higher in the patient group (P = .035). The amount of coffee consumed/day was significantly higher in the patient group (P = .040). According to the global acne grading scores, 55.9% (n = 57) had medium, 39.2% (n = 40) had mild, 3.9% (n = 4) had severe and 1% (n = 1) had very severe acne. Anxiety scores were found to be significantly higher in the patient group (P = .005). When the case and control groups were compared for IBS presence, no significant difference was found (P = .317). Also, IBS was not related to acne severity (P = .162). CONCLUSION Further large sample sized studies are needed on this subject, as there is strong evidence about brain-gut-skin axis existence.
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Affiliation(s)
- Munise Daye
- Department of Dermatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Fatma Gökşin Cihan
- Department of Family Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Begüm Işık
- Department of Dermatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Berna Hafızoğlu
- Department of Family Medicine, Necmettin Erbakan University, Konya, Turkey
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Mikhael NW, Mansour AI, Salah El Din EM, El Azab MH, Salem RM. Serum Neurotensin: An Objective Mirror to Acne-induced Quality of Life and Psychological Impairment. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E69-E73. [PMID: 35096258 PMCID: PMC8794489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Acne is a multifactorial disorder, and stress potentially plays a role in its pathogenesis. OBJECTIVES We aimed to assess the serum levels of neurotensin in patients with acne vulgaris (AV) and investigate the relationship of these levels to quality of life (QoL), depression, anxiety, and stress. METHODS The study included 60 patients with AV classified into mild (n=20), moderate (n=20), and severe (n=20) groups and 20 healthy, age-matched, sex-matched, and body mass index (BMI)-matched individuals in a control group. Patient QoL was assessed using the Dermatology Life Quality Index (DLQI). Each participant completed the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS-10). Serum levels of neurotensin were measured with enzyme-linked immunosorbent assay (ELISA). RESULTS Neurotensin levels and scores from the three questionnaires were significantly higher among the patients with AV than the control subjects. They were also significantly elevated in patients with post-acne scars and hyperpigmentation and in those with severe acne. CONCLUSION It is well known that acne greatly impacts QoL and might be associated with depression, anxiety, and stress. Further, serum neurotensin could be a promising marker to objectively evaluate the psychosocial impact of AV.
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Affiliation(s)
- Nancy W Mikhael
- Dr. Mikhael is a Professor of Dermatology and Andrology and Dr. Salem is an Assistant Professor of Dermatology and Andrology, Dermatology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Mansour is an Assistant Professor of Clinical and Chemical Pathology, Clinical and Chemical Pathology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Salah El Din is with the Faculty of Medicine at Benha University in Benha, Egypt
- Dr. El Azab is a Lecturer of Psychiatry and Neurology, Psychiatry and Neurology Department, Faculty of Medicine, at Benha University in Benha, Egypt
| | - Amira I Mansour
- Dr. Mikhael is a Professor of Dermatology and Andrology and Dr. Salem is an Assistant Professor of Dermatology and Andrology, Dermatology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Mansour is an Assistant Professor of Clinical and Chemical Pathology, Clinical and Chemical Pathology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Salah El Din is with the Faculty of Medicine at Benha University in Benha, Egypt
- Dr. El Azab is a Lecturer of Psychiatry and Neurology, Psychiatry and Neurology Department, Faculty of Medicine, at Benha University in Benha, Egypt
| | - Esraa M Salah El Din
- Dr. Mikhael is a Professor of Dermatology and Andrology and Dr. Salem is an Assistant Professor of Dermatology and Andrology, Dermatology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Mansour is an Assistant Professor of Clinical and Chemical Pathology, Clinical and Chemical Pathology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Salah El Din is with the Faculty of Medicine at Benha University in Benha, Egypt
- Dr. El Azab is a Lecturer of Psychiatry and Neurology, Psychiatry and Neurology Department, Faculty of Medicine, at Benha University in Benha, Egypt
| | - Mohammed Hammad El Azab
- Dr. Mikhael is a Professor of Dermatology and Andrology and Dr. Salem is an Assistant Professor of Dermatology and Andrology, Dermatology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Mansour is an Assistant Professor of Clinical and Chemical Pathology, Clinical and Chemical Pathology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Salah El Din is with the Faculty of Medicine at Benha University in Benha, Egypt
- Dr. El Azab is a Lecturer of Psychiatry and Neurology, Psychiatry and Neurology Department, Faculty of Medicine, at Benha University in Benha, Egypt
| | - Rehab M Salem
- Dr. Mikhael is a Professor of Dermatology and Andrology and Dr. Salem is an Assistant Professor of Dermatology and Andrology, Dermatology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Mansour is an Assistant Professor of Clinical and Chemical Pathology, Clinical and Chemical Pathology Department, Faculty of Medicine, at Benha University in Benha, Egypt
- Dr. Salah El Din is with the Faculty of Medicine at Benha University in Benha, Egypt
- Dr. El Azab is a Lecturer of Psychiatry and Neurology, Psychiatry and Neurology Department, Faculty of Medicine, at Benha University in Benha, Egypt
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Singh IP, Poonia K, Bajaj K. Quality of life in young adults with acne: Results of a cross-sectional study. J Cosmet Dermatol 2021; 20:4017-4023. [PMID: 34674372 DOI: 10.1111/jocd.14540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of acne on quality of life (QoL) may vary between patients from different age groups. There are limited data in the literature on QoL of young adults with acne and acne scars. OBJECTIVES To assess the QoL of young adults (age 18 to 25) with acne by using dermatology life quality index (DLQI) and Cardiff acne disability index (CADI), to assess the scores of individual items on DLQI and CADI, and to compare the two scales. METHODS In this cross-sectional questionnaire study of 1392 subjects with acne, each subject completed two questionnaires: DLQI and CADI. Mean values of DLQI and CADI, and those of individual items on DLQI and CADI were calculated; t-test was used for testing mean values and Spearman's rho coefficient for correlation between two questionnaires. RESULTS Mean DLQI (4.50) and CADI (3.60) scores were low. However, scores were significantly higher in females and in those with acne scars. "Feelings of embarrassment" and "interference with social activities" scored significantly higher for females across both questionnaires. There was no correlation between severity (as well as duration) of acne and HRQoL scores. Spearman's rho coefficient of correlation between DLQI and CADI was 0.71. CONCLUSIONS Acne impaired the QoL of young adults, acne scars more so. Females felt worse about their appearance with greater embarrassment and impaired social activities. QoL scores seem to depend on patients' perceptions, which may depend on factors other than objective severity of acne. We found good correlation between the two scales.
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Affiliation(s)
- Inder Pal Singh
- Department of Dermatology, Adesh Medical College Hospital, Kurukshetra, India
| | - Kavita Poonia
- Department of Dermatology, Adesh Medical College Hospital, Kurukshetra, India
| | - Kanika Bajaj
- Department of Dermatology, Adesh Medical College Hospital, Kurukshetra, India
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14
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Barbieri JS, Fulton R, Neergaard R, Nelson MN, Barg FK, Margolis DJ. Patient Perspectives on the Lived Experience of Acne and Its Treatment Among Adult Women With Acne: A Qualitative Study. JAMA Dermatol 2021; 157:1040-1046. [PMID: 34319378 DOI: 10.1001/jamadermatol.2021.2185] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction Acne often persists into adulthood in women. However, few studies have specifically explored the lived experience of acne in adult populations. Objective To examine the lived experience of acne and its treatment among a cohort of adult women. Design, Setting, and Participants A qualitative analysis was conducted from free listing and open-ended, semistructured interviews of patients at a large academic health care system (University of Pennsylvania Health System) and a private practice (Dermatologists of Southwest Ohio). Fifty women 18 to 40 years of age with moderate to severe acne participated in interviews conducted between August 30, 2019, and December 31, 2020. Main Outcomes and Measures Free-listing data from interviews were used to calculate the Smith S, a measure of saliency for each list item. Semistructured interviews were examined to detect themes about patient perspectives regarding their acne and its treatment. Results Fifty participants (mean [SD] age, 28 [5.38] years; 24 [48%] White) described acne-related concerns about their appearance that affected their social, professional, and personal lives, with many altering their behavior because of their acne. Depression, anxiety, and social isolation were commonly reported. Participants described successful treatment as having completely clear skin over time or a manageable number of blemishes. Many participants described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne. Conclusions and Relevance The results of this qualitative study suggest that women with acne have strong concerns about appearance and experience mental and emotional health consequences and disruption of their personal and professional lives. In addition, many patients describe challenges finding effective treatments and accessing care. Future trials to understand the optimal treatment approaches for women with acne are needed to improve outcomes in this population.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rachel Fulton
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Rebecca Neergaard
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Maria N Nelson
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances K Barg
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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15
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Alshammrie FF, Alshammari R, Alharbi RM, Khan FH, Alshammari SK. Epidemiology of Acne Vulgaris and Its Association With Lifestyle Among Adolescents and Young Adults in Hail, Kingdom of Saudi Arabia: A Community-Based Study. Cureus 2020; 12:e9277. [PMID: 32821620 PMCID: PMC7431307 DOI: 10.7759/cureus.9277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acne vulgaris is the commonest dermatological problem internationally and nationally. Its incidence is increasing every year in the Kingdom of Saudi Arabia (KSA). Though it is not a major health issue but it significantly affects the patient cosmetically, psychologically and socially. Previous studies have shown its association with lifestyle (age, diet, stress, sleep, smoking, exercise, obesity, etc.) and family history. By simple cost-effective lifestyle modification, its occurrence and late consequences could be minimized. Few hospital-based studies are done on this issue in Hail City, KSA. Hence present cross-sectional study was designed where data was collected by Google-Form from 484 residents of Hail City. Results have revealed that 65% of our respondents were suffering from mild to moderate Acne. Thirty percent of the respondents had BMI equal to more than 30. Majority of respondents (81%) had acne on whole face. Similarly, dairy products were also consumed by more than 50%. Majority of respondents (more than 50%) took chocolates, fast foods, oily foods and sea-foods. Nuts were taken quite often by 37% of respondents. Age between 21-25 years and oily skin have a highly significant association (p = 0.000) with development of acne. Other variables that show significant association with acne were being obese, stressful, irregular menstrual cycles and excessive intake of nuts. Hence there is a need to address this issue in order to design recommendations for the general public to minimize the incidence and consequences of acne vulgaris by simple lifestyle modifications.
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Affiliation(s)
| | - Rasha Alshammari
- Medicine and Surgery, College of Medicine, University of Hail, Hail, SAU
| | - Renad M Alharbi
- Medicine and Surgery, College of Medicine, University of Hail, Hail, SAU
| | - Farida Habib Khan
- Community Medicine, College of Medicine, University of Hail, Hail, SAU
| | - Saud K Alshammari
- Medicine and Surgery, College of Medicine, University of Hail, Hail, SAU
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16
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Rocha Barone C, Catucci Boza J, Challub Pires G, Perusato Pereira P, Ferreira Cestari T. The influence of sleep quality on the development of periocular hyperchromia: a case‐control study. J Cosmet Dermatol 2020; 19:1760-1767. [DOI: 10.1111/jocd.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Carolina Rocha Barone
- Department of Dermatology Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Juliana Catucci Boza
- Department of Dermatology Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Gabriel Challub Pires
- Department of Dermatology Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Paula Perusato Pereira
- Department of Dermatology Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Tania Ferreira Cestari
- Department of Dermatology Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
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17
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Rastogi MK, Mohan R, Gahalaut P, Mishra N, Thapa M. Effect of Topical Steroid-Dependent Facial Dermatitis on Quality of Life: A Hospital-Based Cross-Sectional Study Using DLQI. Indian J Dermatol 2020; 64:465-470. [PMID: 31896845 PMCID: PMC6862370 DOI: 10.4103/ijd.ijd_176_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The rampant, disturbing, and dismal unrestricted use of topical corticosteroids on face results in steroid-induced dermatitis termed topical steroid-dependent face (TSDF). It is an embarrassing and irritating condition for a patient. There is paucity of data from India regarding the effect of TSDF on the quality of life (QoL) of such patients. Aims The aim of this study was to study the effect of TSDF on the QoL of patients with the help of a validated, easy-to-use, and reproducible dermatology life quality index (DLQI). Methods A cross-sectional study was done among the outpatients seeking treatment for TSDF at a tertiary care hospital of a medical college. Patients were administered Hindi questionnaire version of DLQI. Controls were apparently healthy age- and sex-matched individuals. Results DLQI scores revealed that TSDF had some effect on QoL in 98.11% of study patients. Study group had a mean DLQI score of 11.49. Statistically significant higher DLQI scores were recorded among females, patients aged <20 years and those who had no formal education/illiterate. Conclusions TSDF affects QoL in majority of patients and it has a very large effect on the QoL in more than one-third of the patients.
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Affiliation(s)
- Madhur K Rastogi
- Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Rikta Mohan
- Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Pratik Gahalaut
- Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Nitin Mishra
- Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Manisha Thapa
- Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
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18
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Afsar FS, Seremet S, Demirlendi Duran H, Karaca S, Mumcu Sonmez N. Sexual quality of life in female patients with acne. PSYCHOL HEALTH MED 2019; 25:171-178. [PMID: 31635480 DOI: 10.1080/13548506.2019.1679845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Acne is a common skin disease which can have a negative psychosocial impact on quality of life. Sexual health is an important part of overall health and little is known about the effects of acne on individual sexuality. We aimed to assess the sexual quality of life and general quality of life in female patients with acne and compare to those without acne. Sixty female participants with acne and age-matched 40 female controls were enrolled in the study and asked to complete the Sexual Quality of Life-Female Questionnaire and the Short Form-36 Health Survey. Acne severity was evaluated objectively by the Global Acne Grading System and subjectively by the Visual Analogue Scale. Participants reported a significantly worse sexual quality of life and had significantly decreased scores on the quality of life scales of Bodily Pain, General Perception of Health and the Physical Component Summary when compared to controls. Neither the sexual quality of life nor the quality of life was correlated with objective and subjective acne severity and duration of acne. Acne can negatively affect sexual quality of life in female patients as well as differentdimensions of quality of life. The sexual quality of life should be considered while evaluating acne in women irrespective of its severity.
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Affiliation(s)
- F Sule Afsar
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir, Turkey
| | - Sila Seremet
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir, Turkey
| | - Hatice Demirlendi Duran
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir, Turkey.,Department of Dermatology, Buca Women's and Children's Hospital, Izmir, Turkey
| | - Semsettin Karaca
- School of Medicine, Department of Dermatology, Katip Celebi University, Izmir, Turkey.,Private Practice
| | - Nihal Mumcu Sonmez
- Department of Psychiatry, Tepecik Research and Training Hospital, Izmir, Turkey
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19
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Barone CR, Boza JC, Machado PG, Cestari TF. Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia. J Cosmet Dermatol 2018; 18:230-235. [DOI: 10.1111/jocd.12549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
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20
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Porwal S, Chahar YS, Singh PK. A Comparative Study of Combined Dermaroller and Platelet-Rich Plasma Versus Dermaroller Alone in Acne Scars and Assessment of Quality of Life Before and After Treatment. Indian J Dermatol 2018; 63:403-408. [PMID: 30210162 PMCID: PMC6124227 DOI: 10.4103/ijd.ijd_118_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Scarring due to acne is a frequently encountered problem in dermatological outpatient department. Microneedling has been a well-accepted modality for the treatment of atrophic acne scars. Platelet-rich plasma (PRP) is a newer option to investigate. Aims: The aims of this study were (1) to compare the efficacy of combined dermaroller and PRP therapy with dermaroller alone in facial acne scars and (2) to assess the psychosocial impact due to acne scars and its treatment. Methods: A total of 55 patients were included in the study and randomly divided into two groups, Group A: 28 and Group B: 27. Proper counseling was done, and detailed clinical findings were recorded. Patients in Group A were treated with dermaroller alone while Group B patients underwent treatment with a combination of dermaroller and intradermal PRP injections. A total of three sitting were done at monthly interval. Final response was assessed at 1 month after the last sitting. Criteria of evaluation included Goodman and Baron's quantitative scale, visual analog score, and dermatology life quality index scores. Side effects were noted. Results were analyzed using Chi-square test and t-test. Results: Significant percentage improvement was noted in both the groups. However, Group B treated with both modalities had better results when compared with that in the Group A. Conclusion: A combination approach using dermaroller and PRP was a safe and better option than using dermaroller alone in atrophic acne scars for clinical improvement as well as for improvement in dermatology life quality index score.
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Affiliation(s)
- Shefali Porwal
- Department of Dermatology, Venereology and Leprosy, S N Medical College, Agra, Uttar Pradesh, India
| | - Yatendra Singh Chahar
- Department of Dermatology, Venereology and Leprosy, S N Medical College, Agra, Uttar Pradesh, India
| | - Pramod Kumar Singh
- Department of Dermatology, Venereology and Leprosy, S N Medical College, Agra, Uttar Pradesh, India
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21
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Chernyshov PV, Zouboulis CC, Tomas-Aragones L, Jemec GB, Manolache L, Tzellos T, Sampogna F, Evers AWM, Dessinioti C, Marron SE, Bettoli V, van Cranenburgh OD, Svensson A, Liakou AI, Poot F, Szepietowski JC, Salek MS, Finlay AY. Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2017; 32:194-208. [PMID: 28898474 DOI: 10.1111/jdv.14585] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/05/2017] [Indexed: 12/13/2022]
Abstract
Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health-related QoL assessment in acne and because of the high impact of acne on patients' lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodore Fontane, Dessau, Germany
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Troms, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Rome, Italy
| | - A W M Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - C Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, Athens, Greece
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - O D van Cranenburgh
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.,Dutch Skin Foundation, Nieuwegein, The Netherlands
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - A I Liakou
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, "Attikon" General University Hospital, Athens, Greece
| | - F Poot
- Department of Dermatology, ULB-Erasme Hospital, Brussels, Belgium
| | - J C Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - M S Salek
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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