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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 24  |  Issue : 1  |  Page : 33-37

Prevalence of acne vulgaris, its contributing factors, and treatment satisfaction among the saudi population in Riyadh, Saudi Arabia: A cross-sectional study


1 Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Division of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Date of Submission13-Nov-2019
Date of Acceptance11-Dec-2019
Date of Web Publication27-Mar-2020

Correspondence Address:
Dr. Tammam M Alanazi
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 7654, Riyadh 13318
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_71_19

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  Abstract 


Introduction: Acne vulgaris is one of the most common inflammatory disorders worldwide and mainly affects young people. The frequency of acne and how it is treated in Saudi Arabia is not well characterized. Purpose: The aim of the study was to determine the prevalence of acne vulgaris among the Saudi population in Riyadh, Saudi Arabia. Methods: This was a cross-sectional survey study that was carried out in Riyadh, Saudi Arabia, in the period from March to July 2019. The questionnaire was filled by a convenience sample of 346 Saudi participants aged 15–30 years. The survey questions were related to acne prevalence, associated factors, treatment practices, and depression. Results: Seventy-eight percent of the participants reported having acne. Females were more commonly affected (86.1%) than males (69.9%, P < 0.001). Only 31.5% of the individuals who had acne consulted a dermatologist in the past 12 months. The most frequently prescribed medication was isotretinoin (19.2%), and 71.4% were happy with the results of using it compared to only 38.2% who used topical antibiotics (P= 0.012). Males reported a less depression (21.5%) compared to females (46.3%, P < 0.001). Conclusions: Acne vulgaris has a high prevalence in Saudi Arabia, but only one-third are getting treated by health-care providers. Efforts should be made to increase awareness about acne vulgaris and its treatment.

Keywords: Acne vulgaris, impact, prevalence, Saudi Arabia, treatment practices


How to cite this article:
Alanazi TM, Alajroush W, Alharthi RM, Alshalhoub MZ, Alshehri MA. Prevalence of acne vulgaris, its contributing factors, and treatment satisfaction among the saudi population in Riyadh, Saudi Arabia: A cross-sectional study. J Dermatol Dermatol Surg 2020;24:33-7

How to cite this URL:
Alanazi TM, Alajroush W, Alharthi RM, Alshalhoub MZ, Alshehri MA. Prevalence of acne vulgaris, its contributing factors, and treatment satisfaction among the saudi population in Riyadh, Saudi Arabia: A cross-sectional study. J Dermatol Dermatol Surg [serial online] 2020 [cited 2020 Aug 14];24:33-7. Available from: http://www.jddsjournal.org/text.asp?2020/24/1/33/281431




  Introduction Top


Acne vulgaris mostly starts in adolescence. Between the ages of 13 and 18 years, the prevalence of acne was 60.7%.[1] Thirty-eight percent of the population aged 15–19 years in China suffered from acne.[2] In Saudi Arabia, several studies were conducted regarding acne. A study was carried out in Jeddah in 2013, aimed at assessing awareness and perception of the population toward acne, showed that 64.5% had acne, and 28.4% of the respondents thought that the diet plays the largest role in causing acne.[3]

Fifty-five percent of medical students suffered from acne, and most of the students (87.2%) believed that hormonal disturbance is a major factor in the pathophysiology of acne.[4] About 41.7% of female medical students had truncal acne and 60.9% had acne scar.[5] The face was the most common area to have acne (43%), and 72.1% of the students who had acne suffered from psychological impact.[6]

The studies in the kingdom of Saudi Arabia had some limitations. Many of them have focused on specific populations of medical students. Some studies have selected only females as research participants. Furthermore, treatment practices and satisfaction with treatment have not been well characterized. The aim of this study was to determine the prevalence of acne vulgaris among the Saudi population of Riyadh. Other objectives included identifying causative factors (gender, family history, use of cosmetic products, and specific diet) of acne, treatment practices, satisfaction, physical, and psychological comorbidity.


  Materials and Methods Top


This was a cross-sectional survey study in the public areas located in Riyadh, Saudi Arabia, including shopping malls and walking areas. The study was conducted from March to July 2019. The questionnaire was completed by a convenience sample of 346 participants. The sample size was calculated based on acne prevalence expected an outcome distribution of 64.5%,[5] at the 95% confidence interval (CI) with a margin of error of ± 5%. The inclusion criteria were male and female Saudi citizens aged 15–30. No exclusion criteria were applied. After fulfilling the inclusion criteria, participants were selected from the population using nonprobability convenience sampling technique. The objectives of the research and full information were explained to the study participants, and informed consents were signed. The research was approved ethically by the Institutional Review Board of the King Abdullah International Medical Research Center.

Instrument

The participants completed the Arabic version of a self-administered questionnaire consisting of 15 questions. The first section of the questionnaire assessed whether the participant is suffering from acne at the time of completing the survey and the body site affected. Furthermore, factors that may play a role in acne development were investigated, including gender, family history, use of cosmetic products, and diet. The questions also checked whether the patients had consulted a physician regarding their acne, the prescribed medications for acne, and satisfaction of them. The second section was regarding the development of acne physical and psychological complications. The content validity of the questionnaire was assessed by two experts in the field of dermatology by removing some items and adding others. The questionnaire was validated through a pilot study on 46 patients before distributing it to the population.

Statistical analysis

The Statistical Package for the Social Sciences (SPSS) version 25 software (IBM Corp., Armonk, NY, USA) was used to analyze the data. Numerical data were described by mean and standard deviation, whereas categorical data were described by frequencies and percentages. 95% CI was used for presenting the prevalence of acne vulgaris. The Chi-square test was used to compare the prevalence of acne vulgaris and its complications between genders and different age groups. Logistic regression was used to assess the risk factors of acne vulgaris. A test with P ≤ 0.05 was considered statistically significant.


  Results Top


A total of 346 subjects participated in the study and completed the questionnaire. The mean age was 22.4 ± 4.4. The number of males was 173 (50%). About 20.8% of participants were smokers [Table 1].
Table 1: Baseline characteristics (n=346)

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Two hundred and seventy (78%) of the participants reported having acne vulgaris (95% CI [74–82]). Forty-seven percent had mild acne with very few pimples, and 4% had very many pimples [Table 2]. Acne was mainly reported to affect the face in 82.5%, followed by the back (34.8%) and the chest (14.8%) [Table 3].
Table 2: Acne prevalence (n=270)

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Table 3: Acne site distribution (n=270)

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Acne associated factors

86.1% of females reported acne compared to 69.9% of males (P < 0.001) [Figure 1]. Similarly, patients who had a first-degree family member with acne reported higher prevalence (82.1%) compared to those with no family history (68%, P = 0.004). Participants who used cosmetic products occasionally reported acne less frequently (75.3%) than participants who used it almost on a daily basis (91.9%, P = 0.046). About 63% of those with acne did not link any type of food with acne, 11.1% and 7.4% linked their disease with eating chocolate and junk food, respectively.
Figure 1: Acne prevalence by gender

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Prescribed medications and treatment satisfaction

About 30% have previously used medication for acne without a prescription. Only 31.5% of those with acne had visited a dermatologist in the past 12 months. The most frequently prescribed medication was isotretinoin (19.2%), followed by topical antibiotics (18.7%), tretinoin (17.6%), and benzoyl peroxide (15.9%). The most satisfying medication for the patient was isotretinoin, and 71% were happy with the results of using it compared to only 38% who used topical antibiotics (P = 0.012) [Figure 2].
Figure 2: Medications and medication satisfaction

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Acne complications among different age groups

Of the total acne patients, 71.1% had scars and 61.1% had postinflammatory hyperpigmentation (PIH). 63.5% of the younger age group (15–20 years) had scars compared to the other groups (21–25 years) 75.5% and (26–30 years) 76.5% (P = 0.04). Nevertheless, when comparing the development of PIH, shyness, depression, and social isolation among the different age groups, no statistically significant difference was noted [Table 4].
Table 4: Acne complications among age groups

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Psychological impact of acne among genders

Females reported being shyer (63%) than males (44%, P = 0.002). Similarly, females were more depressed (46%) than males (22%, P < 0.001). No difference was noted between genders regarding social isolation caused by acne (P = 0.21) [Figure 3].
Figure 3: Psychological impact of acne among genders

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Multivariable analysis

Increase in age by 1 year decreases the chance of having acne by 7%. Being a female was associated with three times increased the risk to report acne. Moreover, having family history and oily skin were significantly associated with acne [Table 5].
Table 5: Multiregression analysis for factors associated with acne

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  Discussion Top


In this study, 78% reported having acne which is higher than the previously reported prevalence in the kingdom, 64.5% and 55.5%.[3],[4] This difference might be explained by our study including only people from the age of 15 to 30 due to acne persist mainly up to the 30 years.[7] We found that the face is the most common area of the body to be affected by acne followed by the back and the chest as previously reported.[6]

Acne prevalence in Pakistan was slightly higher in females.[8] In the current study, females reported a higher prevalence of acne. This is in contrast to another study, in which gender was not associated with a significant difference in the prevalence of acne.[9] Males are more likely to have acne than females during adolescence, but females are more likely to report it.[10],[11]

Previously, studies have suggested that genetic factors might contribute to an earlier onset of acne.[12],[13] Our results showed that those with a family history of acne had two times increased the risk to report acne compared to those with no family history. About 69% of people thought that makeup and cosmetics were associated with acne.[6] In our study, the more frequent cosmetic products were used, the more acne prevalence was reported.

28.4% thought that diet is the most common etiology for acne.[3] Despite the findings in the literature that acne was not found to be associated with dietary habits,[2] in our study, 11.1% and 7.4% mentioned that their acne increases after eating chocolate and junk food, respectively. Acne patients need more education about their condition and the factors that are associated with it.

Only one-third of those with acne had visited a dermatologist in the past 1 year. Similarly, 41% of medical students with acne had sought a medical advice from a dermatologist.[5] These findings support that acne is undertreated, and the effort should be made to increase awareness before complications occur. The small number of patients following with dermatologists could be because of acne patients neglect their disease and believe that it is a condition that has no complications and can be treated by over the counter medications.

Although most of those with acne in the current study had mild-to-moderate acne (82%), the most prescribed medication in our study was isotretinoin (19.2%). Isotretinoin is a Vitamin A derivative that is approved for use in severe or refractory acne vulgaris,[14] and some participants in this study might had used it just to have faster results. Oral isotretinoin is an effective medication for preventing acne scars[15] and decreasing the associated psychological impacts.[16]

Delay in the treatment of acne can result in complications. About 60.9% of female students reported scars and 72.8% reported PIH.[5] Furthermore, in the current study, scars and PIH were present in 71.1% and 61.1%, respectively. Acne is thought to be associated with a negative effects on self-confidence, social life, and psychological well-being.[3],[4],[9],[17] We found that more than half of those with acne (54.4%) felt shy because of their condition, 35.2% were depressed, and 14.1% felt that acne made them socially isolated as previously reported.[6],[8]

Limitations of the study include that self-reported acne was considered, while clinical examination would have been optimal to diagnose acne vulgaris.


  Conclusion Top


Acne vulgaris affects large percentage of the young population in Saudi Arabia (78%). Yet, only one-third are getting treated by health-care providers. Efforts should be made to increase the awareness about acne vulgaris, its treatment, and complications and also to provide proper management plans using a step-wise approach for those who are undertreated. Moreover, future studies should determine the prevalence of acne vulgaris and its severity using clinical examination.

Acknowledgment

The authors would like to thank the department of medical education at the college of medicine, for helping with the statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aksu AE, Metintas S, Saracoglu ZN, Gurel G, Sabuncu I, Arikan I, et al. Acne: prevalence and relationship with dietary habits in Eskisehir, Turkey. J Eur Acad Dermatol Venereol 2012;26:1503-9.  Back to cited text no. 1
    
2.
Shen Y, Wang T, Zhou C, Wang X, Ding X, Tian S, et al. Prevalence of acne vulgaris in Chinese adolescents and adults: A community-based study of 17,345 subjects in six cities. Acta Derm Venereol 2012;92:40-4.  Back to cited text no. 2
    
3.
Al Mashat S, Al Sharif N, Zimmo S. Acne awareness and perception among population in Jeddah Saudi Arabia. J Saudi Soc Derma Dermatol Surg 2013;17:47-9.  Back to cited text no. 3
    
4.
Alajlan A, Turki AY, AlHazzani Y, Alhowaish N, AlEid N, Alhozaimi Z. Prevalence level of knowledge and lifestyle association with acne vulgaris among medical students. J Derma Dermatol Surg 2017;21:58-61.  Back to cited text no. 4
    
5.
Zari S, Turkistani A. Acne vulgaris in Jeddah medical students: Prevalence, severity, self-report, and treatment practices. J Cosmet Dermatol Sci Appl 2017;7:67-76.  Back to cited text no. 5
    
6.
Allayali AZ, Asseri BN, Al Nodali NI, Alhunaki RN, Algoblan SF. Assessment of prevalence, knowledge, attitude, and psychosocial impact of acne vulgaris among medical students in Saudi Arabia. J Clin Exp Dermatol Res 2017;8:4. [DOI: 10.4172/2155-9554.1000404].  Back to cited text no. 6
    
7.
Lynn DD, Umari T, Dunnick CA, Dellavalle RP. The epidemiology of acne vulgaris in late adolescence. Adolesc Health Med Ther 2016;7:13-25.  Back to cited text no. 7
    
8.
Ali G, Mehtab K, Sheikh ZA, Ali HG, Abdel Kader S, Mansoor H, et al. Beliefs and perceptions of acne among a sample of students from Sindh Medical College, Karachi. J Pak Med Assoc 2010;60:51-4.  Back to cited text no. 8
    
9.
Al-Hoqail IA. Knowledge, beliefs and perception of youth toward acne vulgaris. Saudi Med J 2003;24:765-8.  Back to cited text no. 9
    
10.
Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol 2001;137:1252-3.  Back to cited text no. 10
    
11.
American Academy of Dermatology. Skin Conditions by the Numbers. American Academy of Dermatology. Available from: https://www.aad.org/media/stats-numbers. [Last accessed on 2019 Nov 24].  Back to cited text no. 11
    
12.
Di Landro A, Cazzaniga S, Parazzini F, Ingordo V, Cusano F, Atzori L, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol 2012;67:1129-35.  Back to cited text no. 12
    
13.
Ballanger F, Baudry P, N'Guyen JM, Khammari A, Dréno B. Heredity: A prognostic factor for acne. Dermatology 2006;212:145-9.  Back to cited text no. 13
    
14.
Layton A. The use of isotretinoin in acne. Derm Endocrinol J 2009;1:162-9.  Back to cited text no. 14
    
15.
Layton AM, Seukeran D, Cunliffe WJ. Scarred for life? Dermatology 1997;195 Suppl 1:15-21.  Back to cited text no. 15
    
16.
Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol 1999;140:273-82.  Back to cited text no. 16
    
17.
Pearl A, Arroll B, Lello J, Birchall NM. The impact of acne: A study of adolescents' attitudes, perception and knowledge. N Z Med J 1998;111:269-71.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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