FACTORS AFFECTING ACNE VULGARIS IN YOUNG ADULTS-A Questionnaire based Study *Maria Kurian1, Abilasha Ramasubramanian2,Sreedevi Dharman3 1-Graduate Student, Saveetha Dental College & Hospitals, Chennai. 2- Faculty of Oral Pathology Department, Saveetha Dental College & Hospitals, Chennai. *Corresponding author’s id – [email protected] ABSTRACT:BACKGROUND AND AIM: Acne vulgaris is a common chronic skin disease involving blockage or inflammation of pilosebaceous units affecting mostly the face but also the back and chest. The aim of this study is to estimate the factors affecting Acne vulgaris among young adults.OBJECTIVE: The objective of this study is to take into account the various factors that are capable of propagating Acne vulgaris and hence helps in the control of the disease.MATERIALS AND METHOD: Questionnaire will be prepared using the established factors affecting Acne vulgaris . Young adults of age groups between 17-21 years visiting Saveetha Dental College and Hospital will be included for this study. RESULT: It was seen that acne commonly occurs in individuals taking refined food and a large quantity of non-vegetarian food which is 78%. Stress, oily skin and poor skin care can also lead to acne. CONCLUSION: Acne vulgaris is one of the most common type of skin disease found in the population of Chennai. Hence its prevalence and incidence relating to various factors such as location, gender, diet and mental status of the individual by using a validated questionnaire can prove useful for the control and treatment of the disease.Key words: Acne vulgaris, Skin disease, Factor, Stress, Food.INTRODUCTION:Acne vulgaris is a common skin disease affecting up to 80% of adolescents and many adults at some stage. While neither life threatening nor physically debilitating, acne can affect social and psychological functioning 1. Prevalence of acne varies among different populations in different studies from 50% 2,3 to 80% 4-6. Acne is sufficiently common that it often has been termed physiologic. Mild degrees of acne are frequently seen at birth, probably resulting from follicular stimulation by adrenal androgens, and may continue into the neonatal period. However, in the vast majority of cases it is not until puberty that acne becomes a more significant problem. Acne often heralds the onset of puberty. In girls, the occurrence of acne may precede menarche by more than a year. In these very young patients, the predominant lesions are comedones. Acne prevalence hits its peak during the middle-to-late teenage period, with more than 85% of adolescents affected, and then steadily decreases. However, acne may persist through the third decade or even later, particularly in women. There is general recognition that there are many factors in the etiology of acne vulgaris 7. Several factors may be pivotal in the etiology of acne, including increased sebum excretion, stimulation of the sebaceous glands by maternal or neonatal androgens, and colonization of sebaceous glands by Malassezia species. Increased sebum excretion occurs during the neonatal period due to enlarged sebaceous glands, which may result from the substantial production of ?-hydroxysteroids from the relatively large adrenal glands. After 6 months of age, the size of the sebaceous glands and the sebum excretion rate decrease. Both maternal and neonatal androgens have been implicated in the stimulation of sebaceous glands in neonatal acne. Testicular androgens provide additional stimulation to the sebaceous glands, which may explain why neonatal acne is more common in boys. Neonatal acne may be an inflammatory response to Malassezia species. Acne usually occurs around puberty but it may start late in the thirties and forties (in adulthood) 6, 8, 9. Acne is defined as a disorder of the pilosebaceous glands (hair follicles and its sebaceous glands),10,11 which are primarily found on the face, chest and back.12,13 It is characterized by the appearance of: 12,11 Non-inflammatory lesions – comedones (blackheads and whiteheads) and Inflammatory lesions – papules (small raised bumps), pustules (small raised bumps containing pus), nodules (solid, large raised bumps). Acne gives rise to a change in body image, causing many patients to experience feelings of low self-esteem, fear, shame, anxiety, depression and anger 12,14,15,16. Negative effects occur in both older and younger patients,14,15 although adolescents tend to be more vulnerable to bullying and stigmatization by their peers 14. Few studies have evaluated the prevalence of acne in non-westernized societies. However, there is suggestive evidence in nonindustrialized societies that the incidence of acne is lower than in westernized populations. Non-inflammatory acne is the mildest form of disease but can be the hardest to treat. Comedones are usually firmly seated in the follicle, and, if untreated, they cannot often be expressed without some degree of violence. A common misconception by the medical and lay community is that acne is a self limited teenage disease and, thus, does not warrant attention as a chronic disease. Nevertheless, the chronicity of many cases of acne as well as the well documented psychologic effects of chronic acne contributes to the burden of the disease. Tretinoin, adapalene, and tazarotene are topical retinoids which, if applied daily, inhibit formation of comedones and usually clear even severe comedonal acne within a few months. Eucalyptus oil is seen to be efficient in the management of Acne vulgaris 16. Topical retinoids, Topical antibiotics such as picolinic acid and salicylic acid can be used for treatment of acne vulagaris 17.MATERIALS AND METHODS: A study was conducted to assess knowledge and the factors affecting acne among young adolescents residing at Chennai. Data were collected using structured, self-administered questionnaire which was designed after reviewing the recent literature and similar questionnaires and based on the objectives of the study putting in consideration sociocultural backgrounds. The questionnaire was divided into three parts. The first part includes data like age and gender. The second part includes questions to assess the various factors that caused their acne, the third part of the questionnaire consists of questions that assesses the individual’s knowledge about acne. The questionnaire was distributed to 100 young adolescents whose age was within 17-21 years. The questionnaires were distributed and explained to them after obtaining their verbal consent. Questionnaires were collected after being completed. All questionnaires were anonymous, and collected data were kept confidential and not used except for the study purpose. The statistical data was formulated and the percentage of the corresponding data was derived. RESULTS: Acne is seen to affect both sexes equally. It is found that the adolescents of 19 years are more prone to acne. From the survey, it is observed that 59% of the individuals experience mild acne, 32% experience moderate acne and 9% experience severe acne (Fig.1)(Table.3). Around 47% experience mild itch due to acne, 53% experience severe itch due to acne. It is observed that those 47% individuals who get only less than 8 hours of sleep are more prone to acne. Those individuals who indulge in outdoor sport activities have a higher risk of acne. It is also observed that around 78% of the non-vegetarians are affected by acne (Fig 2). It is seen that smokers have severe acne when compared to the non-smokers. 65% of the individuals experience acne due to oily skin . 35% of the female adolescent individuals have reported to experience acne in their pre-menstrual phase of the menstrual cycle (Table.2). 63% of the individuals reported their family members to also suffer from acne. 59% reported their family members who experience acne to be obese. 73% of the individuals suffering from acne reported to be in constant exposure to the sun. 58% of individuals experiencing acne eat fried food constantly (Fig.3). 50% of the individuals eat chocolates regularly and 52% of the individuals with acne have spicy food regularly. 72% of the individuals suffering from acne have reported to be under a lot of stress (Table.1). Only 31% have visited a dermatologist regarding their acne problem whereas 69% have not. 80% of the individuals are not under treatment for acne. Only 20% of the individuals undergo treatment out of which 13% find the treatment helpful. 94% have reported acne to lower their self esteem. 84% of the individuals experiencing acne have normal androgen levels. Based on the knowledge of the individuals about acne, the following results were obtained. 55% of the individuals believed that acne is got through inheritance. 80% believed that fried foods cause acne. 63% believed that chocolates cause acne. 55% of the individuals believed that spicy food causes acne. 80% of the individuals believed that acne is caused due to bad hygiene. 78% of the individuals believed stress to be one of the most common factors for acne. 79% of the individuals believed that cosmetics cause acne. 74% of the individuals believed that acne is caused due to constant sun exposure. 57% of the individuals feel that acne is not a dangerous disease whereas the remaining 43% of the individuals feel that acne is a dangerous disease if not treated. Assumptions on the relation between various factors and acne is seen in Fig 4.