Adolescents' self perceived acne-related beliefs: from myth to science

Abstract Background: Acne vulgaris is recognized as the third most prevalent skin disease worldwide, with highest prevalence among adolescents. Beliefs and perceptions of adolescents about acne are incoherent in the literature. Objectives: To assess the most frequently reported acne-related beliefs in adolescents in order to focus on misconceptions and develop proper recommendations. Methods: A cross-sectional community-based study on representative sample of 2516 schoolchildren was conducted in six randomly selected secondary schools in Belgrade, Serbia. Only schoolchildren with present or past acne history participated. Factors believed to aggravate or ameliorate acne were recorded and analyzed, and the comparisons between girls and boys were evaluated using Pearson's chi-squared test. Results: A total of 1452 schoolchildren with acne participated, aged 14-18 years, among them 801 (55.2%) girls and 651 (44.8%) boys. Boys significantly more frequently believed that sweating, exercise, and dairy foods aggravate acne, whereas girls significantly more frequently blamed emotional stress, sweets, fatty foods, sun, and lack of sleep. The top four amelioration factors were as follows: comedone extraction, healthy diet, sun exposure, and increased water consumption. Acne regression was more frequently perceived to be linked with cigarettes in boys, but with sun exposure and weight loss in girls. Study limitations: The narrow age span of adolescents (14-18 years) and exclusion of acne-free adolescents are limitations due to study design. Conclusion: This survey is part of the first epidemiological study on a representative sample in the Western Balkan region. The significance of the most frequent acne-related beliefs is discussed and myths about acne are highlighted.

Abordaje del acné desde atención primaria / Approaching acne from primary care

El Acné es un motivo de consulta dermatológica frecuente en la población joven de atención primaria (APS), que sin ser una patología de urgencia, se asocia a complicaciones estéticas y/o psicológicas que tienen un gran impacto en la calidad de vida del paciente. En su fisiopatología interactúan una serie de factores tales como: la queratinización anormal de la piel, y consiguiente obstrucción de la unidad pilosebácea, con posterior formación de microcomedones. El aumento del sebo, permite la colonización del P. Acnes y la consecuente cascada inflamatoria. Aunque no existe un consenso en cuanto a la clasificación, estas se pueden dividir en lesiones inflamatorias (pápulas, pústulas, nódulos o quística) o no-inflamatoria, (comedoniano). El tratamiento está orientado al tipo de lesión y su severidad. El arsenal farmacológico en APS considera el tratamiento tópico (retinoides y/o antibióticos) indicado a través de recetas magistrales y antibióticos orales para casos más avanzados. Sin embargo, a pesar de ser una patología manejable en APS, se debe tener en consideración la necesidad de derivación en casos determinados.

Acne is a frequent reason for dermatological consultation in the young population of primary care (PHC), which without being an emergency pathology, is associated with aesthetic and/or psychological complications that have a great impact on the quality of life of the patient. A series of factors interact in its physiopathology, such as: abnormal keratinization of the skin, and consequent obstruction of the pilosebaceous unit, with subsequent formation of microcomedons. The increase of sebum allows the colonization of P. Acnes and the consequent inflammatory cascade. Although there is no consensus as to the classification, these can be divided into inflammatory (papules, pustules, nodules or cystic) or non-inflammatory (comedonian) lesions. Treatment is oriented to the type of lesion and its severity. The pharmacological arsenal in APS considers topical treatment (retinoids and/or antibiotics) indicated through master prescriptions and oral antibiotics for more advanced cases. However, despite being a manageable pathology in PHC, the need for referral in certain cases must be taken into consideration.

Tratamiento del acné en la adolescencia / Treatment of acne in adolescents

El acné es la enfermedad dermatológica más común de la adolescencia. Aunque casi todos los casos remiten alrededor de la tercera década de la vida, cuando este problema conlleva una carga emocional para el paciente se requiere indicar tratamiento. En esta actualización, los autores revisan los distintos grados de compromiso de esta patología, el tratami-ento y los niveles de evidencia que tiene cada uno de ellos, con el objetivo de facilitar a los médicos de atención primaria el manejo de los pacientes que presentan esta enfermedad. (AU)

Acne is the most common dermatological condition in adolescents. Even though almost all cases will resolve around the third decade of life, treatment is indicated when this health problem carries an emotional burden for the patient. In this update, the authors review the grades of involvement of the disease and the available treatments according to levels of evidence, with the aim of helping primary care physicians to manage the patients presenting this illness. (AU)

Psychosocial impact of acne and postinflammatory hyperpigmentation

Abstract: Background: Acne is one of the most common skin diseases. It has significant effect on self-image and negative impact on quality of life. Postinflammatory hyperpigmentation is an acquired hypermelanosis that occurs after a skin injury or cutaneous inflammation. It is common sequelae in acne patients. Objectives: This study aimed to investigate the psychosocial impact of acne and postinflammatory hyperpigmentation among patients treated in a dermatology outpatient clinic at the University of Miami Hospital. Methods: The study had the participation of 50 patients with acne and postinflammatory hyperpigmentation. All participants volunteered to complete an anonymous questionnaire containing socio-demographical information, questions about patient's attitudes toward postinflammatory hyperpigmentation caused by acne, the Cardiff Acne Disability Index and the Dermatology Life Quality Index. Results: Postinflammatory hyperpigmentation was more predominant in the face. Makeup was frequently used to conceal the imperfections and the majority of patients felt embarrassed due to their condition. Interestingly, the majority of our patients did not have their quality of life impacted for acne and postinflammatory hyperpigmentation. Study limitations: A limitation of the study was the relatively small sample size. For this reason, the findings of the study should not be generalized to the broader community. Conclusion: The current medical literature has many studies analyzing the psychological impact of acne. This study is the first study in the literature that analyzed the psychosocial impact of acne and postinflammatory hyperpigmentation caused by acne.

Translation, cultural adaptation and validation for Brazilian Portuguese of the Cardiff Acne Disability Index instrument

Abstract BACKGROUND: The Cardiff Acne Disability Index was originally developed in English for measuring quality of life of acne patients. Considering the psychosocial impact of this disease, it is important to have instruments culturally and linguistically validated for use in Brazilian adolescents. OBJECTIVE: To translate the Cardiff Acne Disability Index into Brazilian Portuguese, culturally adapt it, and verify its reliability and validity in adolescent patients with acne. METHODS: In the first step, the Cardiff Acne Disability Index was translated and validated linguistically to Brazilian Portuguese in accordance with international guidelines published. In the second step, the validation of the Cardiff Acne Disability Index into Brazilian Portuguese instrument was performed, when patients aged from 12 to 20 years with acne were selected. The participants were interviewed to collect demographic data, submitted to the classification of acne by the Global Acne Grading System and invited to respond the Cardiff Acne Disability Index into Brazilian Portuguese version and DLQI (>16 years) or CDLQI (≤16 years). The internal consistency of Cardiff Acne Disability Index into Brazilian Portuguese was assessed by Cronbach’s alpha coefficient and concurrent validity was measured by the Spearman correlation coefficient and Student ‘s t-test for paired samples. RESULTS: The study included 100 adolescents. The Cardiff Acne Disability Index into Brazilian Portuguese version showed good reliability and internal consistency (Cronbach’s alpha = 0.73). The concurrent validity of the scale was supported by a strong and significant correlation with CDLQI / DLQI instruments (rs=0.802;p<0.001). CONCLUSIONS: Cardiff Acne Disability Index into Brazilian Portuguese version is a reliable, valid and valuable tool to measure the impact of acne on quality of life in adolescent patients.

Psicodermatología en la atención primaria / Psychodermatology in primary care

The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

Quality of life, self-esteem and psychosocial factors in adolescents with acne vulgaris

AbstractBackground:Dermatological diseases, among which acne vulgaris, have psychological impact on the affected generating feelings of guilt, shame and social isolation.Objectives:To compare quality of life, self-esteem and other psychosocial variables amongst adolescents with and without acne vulgaris, and between levels of severity.Methods:Cross-sectional observational study in a sample of 355 high school students from the city of João Pessoa. Data collection was performed with questionnaires and clinical-dermatological evaluation. The primary variables were the incidence of AV; quality of life, set by the Children's Dermatology Quality of Life Index and Dermatology Quality of Life Index; and self-esteem, measured by the Rosenberg Self-Esteem Scale. For calculation of statistical tests, we used the SPSS 20.0 software, considering p=0.05.Results:The sample, with an average age of 16, showed 89.3% prevalence of acne vulgaris. The most prevalent psychosocial issue was "afraid that acne will never cease", present in 58% of affected youth. The median score of Quality of Life in Children's Dermatology Index was different amongst students with and without acne vulgaris (p=0.003), as well as the Quality of Life in Dermatology (p=0.038) scores, so that students with acne vulgaris have worse QoL. There was a correlation between the severity of acne vulgaris and worse quality of life. Self-esteem was not significantly associated with the occurrence or severity of acne vulgaris.Conclusions:acne vulgaris assumes significance in view of its high prevalence and the effect on quality of life of adolescents, more severe at the more pronounced stages of disease (p<0.001). The psychosocial impact of acne vulgaris should be valued in the management of patients with this condition.

Dissatisfaction and acne vulgaris in male adolescents and associated factors

BACKGROUND: Acne vulgaris has high prevalence, disturbing quality of life during adolescence. OBJECTIVES: To measure dissastifaction and acne in 18-year-old male individuals and its associated factors. METHODS: A questionnaire was applied by trained interviewers to all boys during selection for the military service. Dissatisfaction and acne was evaluated using a self-administered face scale. Facial, prestrernal and dorsal acne were evaluated separately. RESULTS: A total of 2,200 adolescents, aged 18 years, were interviewed. Among these, 1,678 had acne on the face and 974 (54.05%) showed some degree of dissatisfaction. Regarding the impact of acne located on the chest, 326 out of 686 adolescents (47.52%) reported dissatisfaction. For acne located on the back, 568 out of 1,103 affected individuals (51.50%) showed dissatisfaction. Facial / dorsal acne and dissatisfaction were statistically associated with lower income, lower education levels and with non-whites. Presternal acne and dissatisfaction were statistically asssociated with lower income and lower education levels. CONCLUSION: This population-based study found a high prevalence of acne on the face, back and chest, with high rates of dissatisfaction. .

Acne-specific quality of life questionnaire (Acne-QoL): translation, cultural adaptation and validation into Brazilian-Portuguese language

BACKGROUND: many studies about the psychosocial impact of acne have been reported in international medical literature describing quality of life as a relevant clinical outcome. It is well known that the patient's perception about the disease may be different from the physician's evaluation. Therefore, it is important to use validated instruments that turn the patient's subjective opinion into objective information. OBJECTIVES: to translate into Brazilian-Portuguese language and to culturally adapt a quality of life questionnaire, the Acne-Specific Quality of Life Questionnaire (Acne-QoL), as well as to evaluate its reliability and validity. METHODS: measurement properties were assessed: 1) validity: comparison between severity and Acne-QoL domain scores, correlations between acne duration and Acne-QoL domain scores, and correlation between Acne-QoL domain scores and SF-36 components; 2) internal consistency: Cronbach's α coefficient; 3) test-retest reproducibility: intraclass correlation coefficient and Wilcoxon test. RESULTS: Eighty subjects with a mean age of 20.5 ± 4.8 years presenting mild (33.8%), moderate (36.2%) and severe (30%) facial acne were enrolled. Acne-QoL domain scores were similar among the different acne severity groups except for role-social domain. Subjects with shorter acne duration presented significant higher scores. Acne-QoL domains showed significant correlations, both between themselves and with SF-36 role-social and mental health components. Internal consistency (0.925-0.952) and test-retest reproducibility were considered acceptable (0.768-0.836). CONCLUSIONS: the Brazilian-Portuguese version of the Acne-QoL is a reliable and valid satisfactory outcome measure to be used in facial acne studies. .

The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece: results of a population survey / O impacto da acne vulgar na qualidade de vida e saúde psíquica em jovens adolescentes na Grécia: resultados de uma pesquisa populacional

BACKGROUND: Acne vulgaris can severely affect social and psychological functioning. OBJECTIVE: The aim of this study was to investigate the impact of acne vulgaris and its severity on Quality of Life of young adolescents in Greece. METHODS: We conducted a questionnaire based survey among 1560 adolescent between the ages of 11 and 19 years old and 1531 of these were completed. Adolescents with acne filled all the questions including the Children Dermatology Life Quality Index. Adolescents without acne filled the questions about age, family history of acne, stress and smoking. Data were analyzed with Pearson Chi Square test. RESULTS: Acne prevalence was 51.2% affecting both sexes equally. Self reported mild acne was present in 71.2% and moderate-severe acne in 28.8% of the study population. The mean age of the study population was 15.77y. The median score of Children Dermatology Life Quality Index was 4.02. The impact of acne on quality of life is associated with the severity of the acne (p<0.0001). Patients with moderate/severe acne experience greater psychosocial and emotional impairment (p<0.0001). Body image is modified proportionally to the severity of acne (p<0.0001). Symptoms and treatment of acne are factors that also influence their quality of life. Girls and boys are equally affected. Stress and heredity are correlated with acne and its severity (p<0.0001). We didn't find any correlation between smoking and acne. CONCLUSION: Acne affects Quality of Life of young adolescents in Greece. The impact is proportional to the severity of acne. More severe acne is associated with greater effect on quality of life with implications for self esteem, body image and relationships with others.

FUNDAMENTOS: Acne vulgar pode afetar seriamente o funcionamento social e psicológico. OBJETIVO: O objetivo deste estudo foi investigar o impacto da acne vulgar e sua gravidade na Qualidade de Vida de jovens adolescentes na Grécia. MÉTODOS: Nós conduzimos uma pesquisa baseada em questionário entre 1560 adolescentes com idades entre 11 e 19 anos e 1531 destes foram completados. Adolescentes com acne completaram todas as questões incluindo o Children Dermatology Life Quality Index (CDLQI). Adolescentes sem acne completaram as questões sobre idade, história familiar de acne, estresse e tabagismo. Os dados foram analisados pelo teste de chi-quadrado de Pearson. RESULTADOS: A prevalência de acne foi de 51.2%, afetando igualmente ambos os sexos. O auto relato de acne leve estava presente em 71.2% e de acne moderada a grave em 28.8% da população. A idade média da população em estudo foi de 15.77 anos. O escore médio do Children Dermatology Life Quality Index foi de 4.02. O impacto da acne na Qualidade de Vida está associado à gravidade da acne (p<0.0001). Pacientes com acne moderada/grave experimentam maior piora psico-social e emocional (p<0.0001). A imagem corporal é modificada proporcionalmente à gravidade da acne (p<0.0001). Sintomas e tratamento da acne são fatores que também influenciam sua qualidade de vida. Meninas e meninos são afetados igualmente. Estresse e hereditariedade estão correlacionados à acne e sua gravidade (p<0.0001). Nós não encontramos nenhuma correlação entre tabagismo e acne. CONCLUSÃO: Acne afeta a qualidade de vida de jovens adolescentes na Grécia. O impacto é proporcional à gravidade da acne. A acne mais grave está associada a um maior efeito na qualidade de vida com implicações na auto-estima, imagem corporal e relacionamento com outros.

La consejería oral y escrita es un instrumento útil para mejorar la adherencia al tratamiento a corto plazo en sujetos con acné vulgar: ensayo clínico randomizado - simple ciego / Counseling in therapeutic adherence in patients with acne vulgaris: randomized controlled trial - single blind

Introducción: El éxito de los tratamientos del acné no depende solo de la elección apropiada de los fármacos, sino también de la adherencia terapéutica. La falta de adherencia es un problema muy importante en Dermatología, pero existen escasos trabajos que analicen la utilidad de algunas intervenciones destinadas a incrementar la adherencia en pacientes con patologías cutáneas Objetivo: Evaluar el impacto de la consejería oral y escrita en la adherencia a tratamiento en pacientes con acné vulgar. Pacientes y Métodos: Ensayo clínico randomizado que aleatorizó en dos grupos a pacientes que consultaban por primera vez en nuestro Servicio por acné, entre noviembre de 2008 y febrero de 2009. El grupo control recibió la consejería oral habitual realizada en nuestro Servicio. El grupo intervención recibió la consejería oral habitual, consejería en forma escrita en la primera consulta y un refuerzo vía telefónica a los 15 días. La medición de los resultados se realizó mediante una encuesta telefónica, no ciega, a los 30, 60 y 90 días para evaluar adherencia. Resultados: De un total de 80 pacientes, se randomizaron en forma aleatoria 40 pacientes al grupo control y 40 al grupo intervención. Al primer mes se observó un mayor reporte de buena adherencia (uso del tratamiento todos los días) en el grupo intervención con un 80 por ciento a diferencia del grupo control con un reporte de 60 por ciento (p = 0,043). A los dos meses el 56 por ciento del grupo intervención y el 51 por ciento del grupo control reportaban buena adherencia (p = 0,4 I). A los tres meses el 56 por ciento del grupo intervención y el 38 por ciento del grupo control reportaban buena adherencia (p = 0,08 7). Conclusión: La consejería oral y escrita con un refuerzo telefónico a los 15 días incrementa la adherencia al mes de tratamiento y muestra una tendencia a favorecerla al segundo y tercer mes de seguimiento.

Introduction: The success of treatments in acne depends not only on the appropriate choice of therapeutic agent, but also on therapeutic adherence. Lack of adherence is a problem in dermatology. Few studies are available that evaluate the value of some interventions in order to increase adherence in patients with cutaneous diseases. Objective: To evaluate the impact of counseling in therapeutic adherence in patients with acne. Patients and Methods: Randomized controlled trial, with 2 groups of outpatients that had a first consultation for acne at our Center between November 2008 and February 2009. The control group received our regular oral counseling. The intervention group received the regular oral counseling plus written counseling in the first visit and phone reinforcement IS days later. The measurement of results to evaluate treatment adherence was done through a phone survey, not blinded, 30, 60 and 90 days after treatment Results: Of a total of 80 patients, 40 were randomized to the control group and 40 to the intervention group. At the end of the first month there was a greater account of good therapeutic adherence (use of treatment every day) in the intervention group (80 percent), in contrast with the control group (60 percent [p = 0.043]). At the end of the second month 56 percent in the intervention group and 51 percent in the control group reported good adherence (p = 0.4 I). At the third month 56 percent in the intervention group and 38 percent in the control group reported good adherence (p = 0.087). Conclusion: The oral and written counseling with a phone reinforcement 15 days later increases treatment adherence after I month and shows a tendency to benefit the some during the second and third months of treatment.

Psychosocial impact and personality predictors of coherence feeling among girls with acne.

OBJECTIVE: The extent to which acne influences the emotional life of adolescents is a matter of discussion; but people with acne are prone to emotional and psychological disturbances. METHODS: 54 adolescent girls with acne were studied for their personality variables that are related to high coherence. Sense of coherence, e.g. meaningfulness of life, is crucial to cope successfully with stressors of living: it expresses the belief that a high probability exists that things will work out as well as can reasonably be expected. 58 adolescent girls without acne were in the control group. RESULTS: Neuroticism (anxiety level) was the first predictor of the sense of coherence measure for girls with acne, explaining 19% of the variance. Extraversion was the next predictor, explaining an additional 2 3% of the variance and psychoticism was the third predictor, explaining together 27% of the variance. There was a lack of difference between groups with respect to other personality variables. CONCLUSION: These predictors have to be taken into consideration while treating adolescents acne. Dermatologists, pediatricians and other physicians treating adolescents' acne should be familiar with emotional and psychosocial disturbances that accompany acne in order to effectively assist these patients.

Actualidades terapéuticas en acné / Managament currents in acne

Una revisión bibliográfica de los últimos años sobre terapéutica en acné nos muestra que constantemente se están probando sustancias para encontrar el medicamento tópico ideal, el cual debe ser comedolítico, antiinflamatorio no irritante, bien tolerado y aceptado por los pacientes. Esto aún no se ha logrado. Las tetraciclinas orales han demostrado su gran beneficio en el control del acné inflamatorio. Actualmente es posible controlar el acné severo con los retinoides orales; creo que serán usados más frecuentemente en un futuro próximo.

Acné y depresión / Acne and depression

Se estudiaron 53 pacientes con acné buscando depresión y ansiedad mediante la escala de Zung y el cuestionario DIS. Se compararon los resultados con los de un grupo control formado por 50 pacientes de consultorio externo de Traumatología. Se asumió que muchos pacientes que llegan a consulta por acné son portadores de algún grado de disconfort emocional al ver alterada su imagen corporal. 52.8 por ciento presentaron depresión leve y 26.41 por ciento depresión moderada. Mediante la prueba Z de comparación de medias se halló una diferencia estadísticamente significativa con el grupo control. Los niveles de depresión encontrados son mayores que los aceptados en la literatura para la población general y los reconocidos para otros trastornos médicos. No se encontró asociación con algún trastorno psiquiátrico definido, Consideramos al acné como un factor de riesgo para el desarrollo de depresión y ansiedad. es así que se plantea la necesidad de un análisis de riesgo en cada paciente que acude a consulta por acné, en el que se determine sus posibles estresores psicosociales, el rol del acné en ese marco y el probable desarrollo de un trastorno depresivo