'Your mascara is running'.

Chromhidrosis is a rare disorder, which can have significant psychosocial consequences for patients, particularly when it affects the face, as it can be mistaken for scarring, dirt or erroneous make-up application. Chromhidrosis can be divided into apocrine, eccrine and pseudo subtypes. We present a case of apocrine chromhidrosis localized to the bilateral cheek area. Click https://www.wileyhealthlearning.com/#/online-courses/9c761d0a-20de-4709-a57d-36be93cf64e1 for the corresponding questions to this CME article.

Facial contact dermatitis caused by cosmetic-relevant allergens.

BACKGROUND: Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge. OBJECTIVES: To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic-related allergens and a new test series with cosmetic-relevant natural ingredients (CRNIs). METHODS: This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic-relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life). RESULTS: Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic-induced FD. The most common cosmetic-related allergens were fragrances and preservatives. The most common patch test-positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test-positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life. CONCLUSIONS: Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life.

Anxiety, Depression, and Suicidal Ideation amongst Patients with Facial Dermatoses (Acne, Rosacea, Perioral Dermatitis, and Folliculitis) in Lithuania.

BACKGROUND/OBJECTIVE: Skin diseases, especially those with visible manifestation, are considered to cause a major influence on global mental health. Therefore, we determined the prevalence and severity of anxiety, depression, and suicidal ideation in a large sample of patients with facial dermatoses, namely acne, rosacea, folliculitis, and perioral dermatitis. METHODS: The mental health of patients with facial dermatoses and respective controls was assessed using the Hospital Anxiety and Depression Scale and questions concerning suicidal ideation. RESULTS: The study included 543 patients with facial dermatoses and 497 healthy individuals. Anxiety was present in 37.6% of the patients (14.9% of controls), depression in 21.7% (6.8%), and suicidal thoughts in 9.8% (3.2%) (p < 0.001). Acne patients demonstrated the highest anxiety and depression subscale scores (mean ± standard deviation: 7.1 ± 0.25, 95% confidence interval (CI): 6.58-7.56; controls: 5 ± 0.23, 95% CI: 4.57-5.49). In rosacea 30% of the patients had depression symptoms (adjusted odds ratio (OR): 7.216, 95% CI: 4.122-12.632, p < 0.001), while in folliculitis patients 15.4% (OR: 3.138, 95% CI: 1.241-7.936, p = 0.016) had suicidal thoughts. Patients with anxiety symptoms and suicidal thoughts were on average younger than those without (28.3 ± 0.76 vs. 31.2 ± 0.66 years, p = 0.001 and 25.3 ± 0.98 vs. 30.5 ± 0.55 years, p = 0.007, respectively). CONCLUSION: Acne and rosacea are associated with anxiety, depression, and suicidal ideation in Lithuanian patients. Younger patients are more prone to report such symptoms than older ones.

Distribution of atopic dermatitis lesions in United States adults.

BACKGROUND: The distribution of atopic dermatitis (AD) lesions and its impact on quality of life (QOL) is not well established in the US adult population. OBJECTIVE: To elucidate the distribution of AD lesions and its impact on QOL in US adults with AD. METHODS: A cross-sectional, population-based study of 602 adults was performed. AD was determined using modified UK Diagnostic Criteria, and its lesional distribution was assessed. QOL was assessed using Dermatology Life Quality Index (DLQI). Latent class analysis (LCA) was used to determine distinct phenotypes of AD lesional distribution. Multivariable logistic regression was used to determine the relationship between DLQI and distinct phenotypes. RESULTS: The most common sites of skin lesions were reported to be the popliteal fossae, lower legs, dorsal feet and antecubital fossae. Most persons reported partial (19.0%) or complete (63.0%) symmetry of lesions on the extremities. Lesions on the trunk were significantly more common in blacks and Hispanics. Age ≥ 60 years was associated with significantly lower proportions of active lesions on the face and scalp, and significantly higher proportion of lesions on the buttocks or genitals. LCA identified 5 classes of lesional distribution: 1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites. Class-2 (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 7.19 [3.21-16.07], class-3 (7.11 [3.20-15.80]), class-4 (6.90 [3.07-15.50]) and class-5 (7.92 [3.54-17.71]) were all significantly associated with higher DLQI scores compared to class 1. CONCLUSION: AD is associated with heterogeneous distribution of AD lesions, and distinct phenotypes that are associated with QOL impact.

Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia.

INTRODUCTION: Periorbital hyperchromia (POH) is a multifactorial condition, precipitated or aggravated by sleep disorders, which negatively affects quality of life (QoL). The aim of this study was to evaluate the impact of POH on QoL, sleep quality, and dissatisfaction of affected patients. METHODS: In this cross-sectional study of male and female patients over 18 years, participants were examined, their demographic data were registered, and Dermatology Quality of Life Index (DLQI), Pittsburgh Sleep Quality Index (PSQI-BR), and Visual Analogue Scale (VAS) were used to assess dissatisfaction. RESULTS: Patients (n = 100) were mostly women (91%) with a mean age of 36.9 years and POH duration of 18.32 years. Phototypes II (24%) and III (60%) were predominant. A total of 33% reported 4-6 hours and 66% reported over 6 hours of sleep per night. POH was classified as mild (59%), moderate (37%), or severe (4%). Mean dissatisfaction with POH was 6.9, PSQI was 6.04, and DLQI was 4.92. There was a significant difference in the dissatisfaction scale (P < .005) between men and women. Women reported worse QoL (P < .001) and higher dissatisfaction (P < .0001). A correlation between DLQI and disease duration was found. CONCLUSION: Periorbital hyperchromia negatively impacts patients' QoL. Dissatisfaction is directly related to disease severity.

Development and validation of a multidimensional questionnaire for evaluating quality of life in melasma (HRQ-melasma).

BACKGROUND: Melasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL. OBJECTIVE: To develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma. METHODS: Cross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days. RESULTS: The mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/Appearance, Social/Professional, Psychological, and Treatment. Cronbach's alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01). STUDY LIMITATIONS: Single-center study. CONCLUSIONS: A specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.

Development and validation of a multidimensional questionnaire for evaluating quality of life in melasma (HRQ-melasma)

Abstract: BACKGROUND: Melasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL. OBJECTIVE: To develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma. METHODS: Cross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days. RESULTS: The mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/Appearance, Social/Professional, Psychological, and Treatment. Cronbach's alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01). STUDY LIMITATIONS: Single-center study. CONCLUSIONS: A specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.

A multicentre, open, investigator-initiated phase IV clinical trial to evaluate the efficacy and safety of ingenol mebutate gel, 0·015% on the face and scalp, and 0·05% on the trunk and extremities, in Korean patients with actinic keratosis (PERFECT).

BACKGROUND: Ingenol mebutate gel is a novel, field-directed topical treatment for actinic keratosis (AK). Most pivotal studies have targeted Western populations. No clinical study has been conducted to investigate its efficacy and safety in Asian populations. OBJECTIVES: To evaluate the efficacy and safety of ingenol mebutate gel for treating AK of face/scalp and trunk/extremities in a large Asian (Korean) population. PATIENTS AND METHODS: In this multicentre, open-label, interventional, parallel-group, prospective phase IV study (PERFECT, trial registration no.: NCT02716714), the eligible patients were allocated into either the face/scalp or the trunk/extremities group, according to their selected treatment area location. After application of ingenol mebutate gel, the participants were followed up for 6 months. The primary efficacy endpoint was complete clearance (CC) of AK lesions in the selected treatment area at day 57. Quality of life was evaluated using Skindex-29. Safety endpoints included local skin responses, scar, pigmentation, pain and adverse events. RESULTS: In total, 78·1% [95% confidence interval (CI) 66·86-86·92%] of subjects had CC at day 57, with 76·6% (95% CI 64·31-86·25%) in the face/scalp group and 88·9% (95% CI 51·75-99·72%) in the trunk/extremities group. Among them, CC was sustained in 88·9% (48 of 54, 95% CI 77·37-95·81%) at month 6. The local skin responses significantly increased 1 day after the treatment compared with baseline, and decreased afterwards. Among the total subjects, 7·8% (6 of 77) had hyperpigmentation on the application area. Scars were not reported. CONCLUSIONS: Ingenol mebutate is effective for the treatment of AK in Asians, with tolerable safety profiles.

Patients' self-esteem before and after chemical peeling procedure.

INTRODUCTION: Chemical peeling is a safe method, widely used to treat a variety of skin conditions and reduce the aging effects. This study aims to evaluate self-esteem among adolescents who undergo chemical peelings. MATERIAL AND METHODS: One hundred and twenty six patients constituted the study group. Sixty seven individuals had undergone chemical peeling for therapeutic reasons and 59 individuals for cosmetic reasons. To assess patients' self-esteem, the Rosenberg's Self-esteem Scale (RSES) was used before and after treatment. The control group included 71 healthy, age- and sex-matched volunteers from the general population. They were also asked to complete the RSES, after the same time interval as the patients. RESULTS: The healthy controls (23.01 ± 3.12) presented statistically significantly higher self-esteem than both the groups of individuals who would be submitted to chemical peeling. Furthermore, patients who would undergo peeling for therapeutic reasons (21.58 ± 3.20) had statistically significantly higher self-esteem than those who would undergo the procedure for cosmetic reasons (18.97 ± 3.36). After the chemical peeling sessions, the self-esteem of patients treated for therapeutic reasons (23.48 ± 2.43) and of patients treated for cosmetic reasons (22.83 ± 3.34) improved statistically significantly, while the self-esteem of the healthy controls remained stable, as expected. CONCLUSION: Patients who undergo chemical peelings tend to have low levels of self-esteem. Although facial lesions in skin diseases such as acne, acne scars, rosacea, and melasma seem to have negative effect on individuals' self-consciousness, patients who would be submitted to chemical peeling in order to treat wrinkles, loss of radiance, and skin tone clarity have even lower self-esteem. Chemical peelings were shown to favorably affect patient's self-esteem since all patients showed an increase in self-esteem after treatment, while the control group experienced no change.

Oxidative stress and psychiatric morbidity in patients with facial acne.

BACKGROUND: Acne vulgaris is a common cosmetic problem that is frequently associated with psychosocial disturbances as well as increased oxidative stress. However, oxidative stress and psychological aspects have been studied separately in acne. OBJECTIVE: To evaluate the relationships between oxidative stress, anxiety, depression, and quality of life in acne patients. METHODS: Sixty patients with facial acne and 40 age- and sex-matched healthy individuals were included in the study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) was measured by the Cardiff Acne Disability Index. Disease severity was assessed using the Combined Acne Severity Classification. The serum levels of zinc and malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured in patients and healthy subjects. RESULTS: The mean HADS scores for anxiety and depression were higher in patients than controls (P<.001 for both). Acne patients showed higher serum MDA and lower TAC and serum zinc levels compared with control subjects (P=.019, P<.001, and P=.028, respectively). Anxiety and depression scores did not correlate with oxidative stress parameters. Patients with moderate/severe acne had worse anxiety scores than mild acne (P=.048), and higher anxiety scores were associated with poorer quality of life (r=.436, P=.001). CONCLUSION: Our results indicate that the high levels of anxiety and depression in patients with facial acne were not related to oxidative stress. Anxiety was more common than depression and was directly related to QoL impairment.

Comparison of salicylic acid 30% peel and pneumatic broadband light in the treatment of mild to moderately severe facial acne vulgaris.

Acne patients experience not only a medical disease but also an aesthetic condition, and this latter complication greatly motivates patients to seek out the best treatment regimen to hasten improvement in their appearance. The available clinical procedures for acne treatment include salicylic acid 30% peel and pneumatic broadband light (PBBL). The objective of this study was to compare the efficacy of salicylic acid 30% peel and PBBL treatments in patients with mild to moderately severe facial acne vulgaris. Twelve patients were recruited for a 12-week prospective, single-blind, randomized, split-face study. Patients were treated with a salicylic acid 30% peel on one side of the face and PBBL treatment was administered on the opposite side of the face for 6 consecutive weeks without other acne treatments. At every visit, treatment evaluations were performed using a modified Global Acne Grading Score (mGAGS), acne quality of life (QOL) questionnaire, Wong-Baker FACES Pain Rating Scale (WBPRS) assessments, and clinical photography. Improvement in acne symptoms was observed for both treatment procedures without significant differences and with minimal side effects. Salicylic acid 30% peel and PBBL were well tolerated in our study, and both clinical procedures were efficacious and well-tolerated by the patients.

Hyperhidrosis - Sweating Sites Matter: Quality of Life in Primary Hyperhidrosis according to the Sweating Sites Measured by SF-36.

BACKGROUND: Primary hyperhidrosis has negative impacts on quality of life. The aim of this study was to investigate whether the impacts of primary hyperhidrosis on quality of life are different depending on the localisation of the sweating. METHOD: We compiled background data, Hyperhidrosis Disease Severity Scale (HDSS), and Short-Form Health Survey (SF-36) post hoc results from 2 previous studies. Cases who described only 1 site as their most problematic area of sweating were included (n = 160/188) while individuals with multifocal primary sites of hyperhidrosis were excluded (n = 28/188). RESULTS: Individuals included were 11-62 years old with a mean age of 30.2 ± 10.4 years, and axillary hyperhidrosis (65.6%) was the most common type of hyperhidrosis. Comorbidities were more common when hyperhidrosis was reported in other than the axillary, palmar, and plantar regions. Excluding comorbidities showed the lowest SF-36 mental component summary scores for axillary (41.6 ± 11.6), palmar (40.0 ± 9.4), and plantar hyperhidrosis (41.1 ± 13.7). The HDSS showed the highest proportion of severe cases in axillary (60.6%) and palmar (51.5%) hyperhidrosis (p < 0.01) while mild cases were more often observed in plantar (60%), facial (83.3%), and other sites (85.7%) in primary hyperhidrosis (p < 0.01). CONCLUSION: Our results indicate that impairments in quality of life can be different depending on the manifestation of primary hyperhidrosis on the body. This can have an influence on how patients with hyperhidrosis could be prioritised in health care. Subgroup samples affected by facial hyperhidrosis and other sites of primary hyperhidrosis were however small, and more research is required to verify our findings.

Quality of life in adults with facial port-wine stains.

BACKGROUND: Facial port-wine stains (PWS) are considered by some an aesthetic skin problem, yet impact on quality of life (QoL) has not been objectively documented. OBJECTIVE: We sought to (1) characterize the effect of PWS on QoL in adults, (2) to identify the clinical and demographic factors that affect QoL, and (3) to compare our results with QoL studies in other skin conditions. METHODS: In total, 244 adults with facial PWS completed an online QoL survey, which included the Skindex-29 instrument. RESULTS: QoL in adults with facial PWS was diminished, especially from an emotional perspective. Variables associated with reduced QoL in all Skindex-29 subdomains included comorbid depression, limited facial mobility, and presence of other skin conditions. Persons with hypertrophy had more emotional and symptomatic impairment. The composite dermatologic-specific QoL scores were similar to those of cutaneous T-cell lymphoma, rosacea, alopecia, and vitiligo. LIMITATIONS: Selection bias was a potential limitation, as participants were primarily recruited from patient support groups. CONCLUSION: Our analysis demonstrates that the presence of a facial PWS has a significant negative impact on QoL. Dermatologists caring for patients with PWS should inquire about QoL, provide appropriate support and resources, and consider QoL when discussing treatment options and obtaining authorization for these procedures.

Botulinum Toxin A in Treatment of Facial Flushing.

Flushing is a condition with episodic attacks of redness of the skin with a sensation of warmth or burning, this disease causes emotional and functional problems in patients. There is various treatments for this condition; one of them is the use of botulinum toxin-A (BTA). In this prospective pilot study we studied the effect of Botulinum toxin-A (BTA) effect on DLQI of patients with facial flushing, we compared the DLQI before and after treatment. The number of 24 women with facial flushing admitted to the department of dermatology of Hamadan Farshchian Hospital, with the age range of 18 to 60 was enrolled in the study. Patients completed Dermatology Quality of life Index questionnaire before and one month after treatment. In our study 1 unit of BTA was injected intracutaneously per square cm in both sides of cheeks, to a total dose of 30 units per session. All of 24 patients completed the study. The mean age was 37.79±13.13. In all patients, DLQI decreased, and in two months follow up, the mean of DLQI improved from 8.08±1.17 to 4.5±1.21 (P.value<0.005). Based on this study BTA is an effective and safe treatment for facial flushing.

Systemic sclerosis: rehabilitation as a tool to cope with disability.

In patients with systemic sclerosis (SSc), local disability of the hands and face, due to the involvement of skin, subcutaneous tissues and musculoskeletal system, is scarcely improved by pharmacological therapy, but may be treated efficaciously with rehabilitation, which can prevent and reduce local disability, thus ameliorating global disability and impaired Quality of Life, related to changes in the hands and face. In SSc, in order to be efficacious, rehabilitation should: 1. include and use both local treatments of hands and face and global rehabilitation techniques; 2. be different according to the different SSc phases and subsets; 3. include different techniques to tailor treatment to the personal needs and abilities of the patients.

Laser treatment for female facial hirsutism: are quality-of-life benefits sustainable?

BACKGROUND: Facial hirsutism in women impairs quality of life (QoL). Laser hair removal (LHR) has been shown to confer significant improvements in QoL for up to 6 months after treatment, but the longer-term benefits have not been investigated. AIM: To assess the sustainability of LHR benefits to the QoL of hirsute women up to 30 months after treatment. METHODS: Hirsute women about to undergo National Health Service (NHS)-funded LHR in 2010-2012 (n = 142) completed proforma questionnaires quantifying the burden of hirsutism on their QoL. These included: the Dermatology Life Quality Index (DLQI) (assessing functional impact on QoL), the number of days spent removing hair per week and a 10-point scale assessing how much their condition bothered them (emotional burden on QoL). Postal questionnaires recorded QoL changes up to 30 months after LHR. Improvements in QoL scores for each woman were compared. Responses were then grouped into periods of 0-6, 6-12 and 12-30 months post-treatment, and the magnitude of change between these time groups was compared for each QoL measure. RESULTS: In total, 63 women responded to the post-LHR questionnaire. QoL was severely affected, but improved with LHR. The number of days spent removing hair reverted to baseline at 12-30 months post-LHR, and a significant decline was seen in the magnitude of improvement in emotional burden on QoL over time (P = 0.04). However, no significant difference existed between improvements in DLQI scores (P = 0.12). CONCLUSION: LHR supplies some functional QoL benefits up to 30 months post-treatment. Emotional benefits are less sustainable. Further LHR treatment is required to maintain QoL benefits.

Acne and quality of life - impact and management.

Acne is a common skin disease with a high prevalence in adolescents and young adults. In addition to physical effects such as permanent scarring and disfigurement, acne has long-lasting psychosocial effects that affect the patient's quality of life. Depression, social isolation and suicidal ideation are frequent comorbidities of acne that should not be neglected in the therapy of acne patients. Research evidence suggests that the impairment of quality of life can be alleviated by appropriate topical acne treatment.

Effect of adapalene 0.1%/benzoyl peroxide 2.5% topical gel on quality of life and treatment adherence during long-term application in patients with predominantly moderate acne with or without concomitant medication - additional results from the non-interventional cohort study ELANG.

BACKGROUND: In addition to physical long-lasting effects such as permanent scarring and disfigurement, acne has acute and long-term psychosocial effects that affect the individual's quality of life. As with other chronic diseases, treatment success is often compromised by poor adherence. OBJECTIVE: Two main objectives of this non-interventional study were to assess the long-term effect of the fixed-dose combination adapalene 0.1%/benzoyl peroxide 2.5% (adapalene-BPO gel) on quality of life and treatment adherence. METHODS: Patients with moderate to severe facial acne receiving adapalene-BPO alone or in combination with other drugs were enrolled in this non-interventional study. Data were documented at baseline and after 3 and 9 months of adapalene-BPO treatment. The secondary outcomes reported here include quality of life determined by the Cardiff Acne Disability Index (CADI), treatment adherence assessed by the ECOB (Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux) questionnaire, and patient satisfaction. RESULTS: In total, 5131 patients were included in the efficacy evaluation. After 9 months, mean (±SD) quality of life (CADI) improved significantly from 5.9 ± 3.0 to 2.4 ± 2.7 (P < 0.0001). Patients with more severe acne at baseline tended to achieve a greater improvement in quality of life. Long-term adherence was found to be good in 83.9% of patients. Adherence had a significant effect on efficacy and quality of life (P < 0.0001 respectively). The vast majority of patients (92.1%) reported subjective improvement at the interim analysis. Accordingly, most patients (84.8%) were satisfied or very satisfied with adapalene-BPO by the end of the observation period. CONCLUSION: The clinical improvement of the disease led to an increase in quality of life among acne patients. The treatment success may be a motivation factor for patients to stay adherent over the long-term treatment course, indicating the qualification of adapalene-BPO topical gel as an appropriate medication also in the long-term usage.