Adolescents’ self perceived acne-related beliefs: from myth to science<sup>,</sup>

Markovic, Milica; Soldatovic, Ivan; Bjekic, Milan; Sipetic-Grujicic, Sandra

doi:10.1016/j.abd.2019.02.005

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Investigation • An. Bras. Dermatol. 94 (6) • 2019 • https://doi.org/10.1016/j.abd.2019.02.005 copy

Adolescents’ self perceived acne-related beliefs: from myth to science^☆ ☆ How to cite this article: Markovic M, Soldatovic I, Bjekic M, Sipetic-Grujicic S. Adolescents’ self perceived acne-related beliefs: from myth to science. An Bras Dermatol. 2019;94:684-90. ^,^☆☆ ☆☆ Study conducted at the Institute of Epidemiology, University of Belgrade, Belgrade, Serbia.

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

KEYWORDS
Acne vulgaris; Adolescent; Perception

Acne-related belief	Influence on acne in surveyed adolescents	Comment and evidence-based recommendation	Main reference
Sweating, exercise	Triggers	Individually based, NS	Poli F et al.,¹⁹19 Poli F, Auffret N, Beylot C, Chivot M, Faure M, Moyse D, et al. Acne as seen by adolescents: results of questionnaire study in 852 French individuals. Acta Derm Venereol. 2011;91:531-6. Short RW et al.²¹21 Short RW, Agredano YZ, Choi JM, Kimball AB. A single-blinded, randomized pilot study to evaluate the effect of exercise-induced sweat on truncal acne. Pediatr Dermatol. 2008;25:126-8.
Inadequate face wash	Triggers	Wash twice daily with cleanser	Choi JM et al.,²⁵25 Choi JM, Lew VK, Kimball AB. A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris. Pediatr Dermatol. 2006;23:421-7. Magin et al.¹⁴14 Magin P, Pond D, Smith W, Watson A. A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Fam Pract. 2005;22:62-70.
Emotional stress	Triggers	Proven bidirectional relationship	Chiu A et al.,¹⁶16 Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139:897-900. Yosipovitch G et al.¹⁷17 Tang M, Dawn AG, Chen M, Goh CL, Huak Y, et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87:135-9.
Dietary change towards healthier foods	Improves	Recently supported	Burris JB et al.,³⁰30 Burris J, Rietkerk W, Woolf K. Relationships of self-reported dietary factors and perceived acne severity in a cohort of New York young adults. J Acad Nutr Diet. 2014;114:384-92. Melnik et al.,³¹31 Melnik BC. Diet in acne: further evidence for the role of nutrient signalling in acne pathogenesis. Acta Derm Venereol. 2012;92:228-31. Tan et al.¹1 Tan JKL, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(Suppl. 1):3-12.
Diet - sweets	Triggers	Dietary counseling	Burris JB et al.,³³33 Burris J, Rietkerk W, Shikany JM, Woolf K. Differences in dietary glycemic load and hormones in New York City adults with no and moderate/severe acne. J Acad Nutr Diet. 2017;117:1375-83. Ghodsi et al.,²⁴24 Ghodsi SZ, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol. 2009;129:2136-41. Suh DH et Kwon HH²⁸28 Suh DH, Kwon HH. What's new in the physiopathology of acne? Br J Dermatol. 2015;172(Suppl. 1):13-9.
Cosmetic treatment (comedo extraction)	Improves	Insufficient evidence - supports medical therapy	Taub AF,⁴⁶46 Taub AF. Procedural treatments for acne vulgaris. Dermatol Surg. 2007;33:1005-26. Chilicka K et al.⁴⁷47 Chilicka K, Maj J, Panaszek B. General quality of life of patients with acne vulgaris before and after performing selected cosmetological treatments. Patient Prefer Adherence. 2017;11:1357-61.
Sun, UVA	Improves	NS comedogenesis and carcinogenesis	Zouboulis et al.,³⁸38 Thielitz A, Gollnick HPM. Natural and artificial suntanning. In: Zouboulis CC, Katsambas AD, Kligman AM, editors. Pathogenesis and treatment of acne and rosacea. Berlin, Heidelberg: Springer-Verlag; 2014. p. 185-8. De Luca C et al.³⁹39 De Luca C, Valacchi G. Surface lipids as multifunctional mediators of skin responses to environmental stimuli. Mediators Inflamm. 2010;2010:321494.
Drinking water	Improves	Not investigated elsewhere
Premenstrual flare^a a Girls only. NS, not supported (by literature data); N/A, not available.	Triggers	Highly probable, dermocosmeceuticals efficient	Ghodsi et al.,²⁴24 Ghodsi SZ, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol. 2009;129:2136-41. Saint-Jean M⁵⁰50 Saint-Jean M, Khammari A, Seite S, Moyal D, Dreno B. Characteristics of premenstrual acne flare-up and benefits of a dermocosmetic treatment: a double-blind randomised trial. Eur J Dermatol. 2017;27:144-9.
Cosmetics^a a Girls only. NS, not supported (by literature data); N/A, not available.	Triggers	Avoid cosmetics when prone to acne	Perera MPN et al.⁴⁸48 Perera MPN, Peiris WMDM, Pathmanathan D, Mallawaarachchi S, Karunathilake IM. Relationship between acne vulgaris and cosmetic usage in Sri Lankan urban adolescent females. J Cosmet Dermatol. 2018;17:431-6.

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[1] * Corresponding author. E-mail:drmilicadermatolog@gmail.com (M. Markovic).