Acne is a common skin disorder of teenagers and continues into adulthood. Research has been limited regarding acne prevalence, perception and health care utilization in Saudi Arabia. The objective of this study was to assess acne prevalence in final year female medical students in Jeddah, Saudi Arabia using the global acne grading system (GAGS) compared with student’s self-report of their acne. This is a cross-sectional study conducted among 151 students during 2016, in which students were interviewed subjectively and examined objectively by a trained physician. This study showed that acne was reported subjectively by 83.4% of female students compared to 98% of students assessed objectively by the global acne grading system. 14.6% of students claimed having no acne while it was objectively present, which was statistically significant (Χ 2 = 15.4, P < 0.001). 41% visited a dermatologist and 28.5% waited 1 year until seeking a dermatologist. However, 35.8% of students got an over-the-counter drug for their acne. Surprisingly, treatment duration expectation was <1 week in 9.9% compared to >2 months in 39.1% of students. Acne was present in 41.1% of the students parents compared to 83.4% in their siblings. A total of 41.7% of student had trunk acne. 60.9% of students had scarring and 72.8% of them had pigmentation. Moderate to severe acne students had higher siblings acne history of 95.2% (Χ 2 = 5.85, P < 0.05), higher scaring of 73.8% (Χ 2 = 4.05, P < 0.05), and higher pigmentation of 85.7% (Χ 2 = 4.87, P < 0.05) which was statistically significant. Our study confirms that acne is very common in female medical students in Jeddah, Saudi Arabia with a prevalence rate of 98%. Knowledge regarding acne treatment was inadequate demonstrating the need for educational and awareness programs about early treatment that will prevent suffering from acne scarring or pigmentation.
Acne is one of the most common inflammatory chronic skin diseases that affect teenagers and continues into adulthood. Women are most commonly affected with a mean age for presentation of 24 years [
Also, there is relatively few information in the medical literature on the prevalence, clinical severity and self-report of acne among medical students in Saudi Arabia. This study reports the prevalence and clinical severity of acne in comparison with the self-report of acne in final year female medical students in King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. The secondary outcome measures of the percentage of students who visited a dermatologist, how long they waited before seeking treatment, percentage of students who got an OTC drug, treatment duration expectation, family history of acne in parents and siblings, most common areas affected by acne, and the percentage of scarring and pigmentation resulting from their acne were recorded in a questionnaire.
A questionnaire-based cross-sectional study was conducted among 151 final year female medical students attending the medical faculty at King Abdulaziz University during 2016 followed by an objective evaluation of their acne (see Appendix). The study was approved by the Ethics Committee at KAUH and the Research Committee at the University of Jeddah Faculty of Medicine.
Final year female medical students were interviewed using a confidential, anonymous interviewing questionnaire to collect personal data, knowledge, perception and practice regarding their acne. After students oral consent, they were given a questionnaire to complete. All the students completed the questionnaire that was distributed to them. Upon completion of the questionnaire by students, an intern who was trained earlier by the consultant dermatologist examined the students for the presence of acne lesions. The trained intern then graded the acne severity and was blinded to the study outcome.
Clinical classification of acne severity was done using the Global Acne Grading System (GAGS). Each type of lesion was given a value depending on severity: no lesions = 0, comedones = 1, papules = 2, pustules = 3 and nodules = 4. The score for each area (Local score) is calculated using the formula: Local score = Factor x Grade (0 - 4). The global score is the sum of local scores, and acne severity was graded using the global score. A score of 1 - 18 is considered mild; 19 - 30, moderate; 31 - 38, severe; and >39, very severe [
According to the GAGS, students were classified into four groups: None, mild, moderate, and severe acne. Individuals with moderate and severe acne were included in one group for some evaluations. The primary outcomes of the study were the prevalence and clinical severity of acne in comparison with the self- report of acne in final year female medical students in Jeddah, Saudi Arabia.
The association between clinical acne grade as the dependent variable and other factors as explanatory variables were analyzed by chi-squared test. Analysis of data was done using SPSS Version 13 (SPSS, Inc., Chicago, IL, USA). Data were presented by OR and 95% CI. P values of <0.05 were considered statistically significant.
Using the GAGS to examine the students, acne was present in 148/151 (98%) of female medical students involved in the study. 106/151 (70.2%) had mild acne, and 36/151 (23.8%) moderate, and 6/151 (4%) had severe acne present (
According to the Acne self-rating question in the questionnaire, 126 out of 151 (83.4%) medical students have acne. As 91/151 (60.3%), 30/151 (19.9%) and 5/151 (3.3%) rated their acne as mild, moderate and severe respectively (
Comparing between patient self-assessment and objectively assessing patient acne by the global acne grading system, it was found in our study that 14.6% (22 students) claimed to have no acne while they were having acne objectively which was statistically significant (Χ2 = 15.426, P < 0.001), OR = 6.727 (95% CI 4.575 - 9.892) (
Frequency | Percent | Cumulative Percent | |
---|---|---|---|
None | 3 | 2.0 | 2.0 |
Mild | 106 | 70.2 | 72.2 |
Moderate | 36 | 23.8 | 96.0 |
Severe | 6 | 4.0 | 100.0 |
Total | 151 | 100.0 |
Frequency | Percent | Cumulative Percent | |
---|---|---|---|
None | 25 | 16.6 | 16.6 |
Mild | 91 | 60.3 | 76.8 |
Moderate | 30 | 19.9 | 96.7 |
Severe | 5 | 3.3 | 100.0 |
Total | 151 | 100.0 |
Self assessment | Total | ||||
---|---|---|---|---|---|
None | Acne | ||||
Objective assessment | None | Count | 3 | 0 | 3 |
% within objective assessment | 100.0% | 0.0% | 100.0% | ||
Acne | Count | 22 | 126 | 148 | |
% within objective Assessment | 14.9% | 85.1% | 100.0% | ||
Total | Count | 25 | 126 | 151 | |
% within objective Assessment | 16.6% | 83.4% | 100.0% |
Our study conduct showed a total of 63 (41.7%) students with truncal acne (chest and back). 54 students have more acne on their back compared to 33 students who had more acne on their chest area (
Only 62 out of 151 (41%) students visited a dermatologist regarding their acne (
The treatment duration expectation was less than 1 week in 15/151 (9.9%) of students compared to more than 2 months in 59/151 (39.1%) (
Acne was present in 62/151 (41.1%) of the students parents compared to 126/151 (83.4%) in their siblings (
Questionnaire Number (QN) | Variable | Yes | No | Total | P value Χ2 test |
---|---|---|---|---|---|
2 | Presence of acne on the back | 54 | 97 | 151 | <0.001 |
3 | Presence of acne on the chest | 33 | 118 | 151 | <0.001 |
5 | Visiting a dermatologist regarding acne | 62 | 89 | 151 | 0.028 |
6 | Getting acne treatment without a prescription | 54 | 97 | 151 | <0.001 |
9 | Acne presence in parents | 62 | 89 | 151 | 0.028 |
10 | Acne presence in siblings | 126 | 25 | 151 | <0.001 |
11 | Presence of scars | 92 | 59 | 151 | 0.007 |
12 | Presence of post inflammatory hyperpigmentation | 110 | 41 | 151 | <0.001 |
QN | Variable | None | Forehead | Right cheek | Left cheek | Nose | Chin | More than one side | Total | P value Χ2 test |
---|---|---|---|---|---|---|---|---|---|---|
4 | Acne location on the face | 14 | 21 | 5 | 10 | 3 | 13 | 85 | 151 | <0.001 |
QN | Variable | None | Less than 3 months | 3 to 6 months | 6 to 12 months | More than one year | Total | P value Χ2 test |
---|---|---|---|---|---|---|---|---|
7 | Waiting before seeing a doctor | 47 | 15 | 28 | 18 | 43 | 151 | <0.001 |
QN | Variable | None | Less than 1 week | 1 week to 1 month | 1 - 2 months | More than 2 months | Total | P value Χ2 test |
---|---|---|---|---|---|---|---|---|
8 | Acne treatment duration expectation | 24 | 15 | 27 | 26 | 59 | 151 | <0.001 |
Scars were present in 92/151 (60.9%) of students (
Risk Estimate | |||
---|---|---|---|
Value | 95% Confidence Interval | ||
Upper | Lower | ||
Odds ratio for modified grading (none & mild vs. moderate & severe) | 0.187 | 0.042 | 0.832 |
For cohort brothers and sisters acne (none & mild) | 0.828 | 0.736 | 0.932 |
For cohort brothers and sisters acne (moderate & severe) | 4.431 | 1.092 | 17.976 |
Number of valid cases | 151 |
Risk Estimate | |||
---|---|---|---|
Value | 95% Confidence Interval | ||
Upper | Lower | ||
Odds ratio for modified grading (none & mild vs. moderate & severe) | 0.451 | 0.206 | 0.989 |
For cohort scars (none & mild) | 0.758 | 0.593 | 0.969 |
For cohort scars (moderate & severe) | 1.681 | 0.970 | 2.914 |
Number of valid cases | 151 |
Risk Estimate | |||
---|---|---|---|
Value | 95% Confidence Interval | ||
Upper | Lower | ||
Odds ratio for modified grading (none & mild vs. moderate & severe) | 0.352 | 0.136 | 0.914 |
For cohort pigmentation (none & mild) | 0.792 | 0.662 | 0.947 |
For cohort pigmentation (moderate & severe) | 2.248 | 1.021 | 4.950 |
Number of valid cases | 151 |
Acne prevalence was reported to be 85% in the population age of 12 to 24 years [
Our study showed that 41.7% of students had truncal acne (chest and back). This goes with a previous study that showed that 41% of women have truncal acne [
Moderate and severe acne students in our study had a higher percentage in seeking a dermatologist regarding their acne. 28.5% of students in our study waited more than 1 year to see a dermatologist. Although there is an abundant availability of acne treatments, there is underutilization of them. According to one study, treatment of acne is used in only 18% of adolescents suffering from acne [
Our study is compatible with another study that showed undergraduate students to have acne by 78% heritability in first-degree relative’s [
Our study showed that scaring was present in 60.9% of our student’s population, in which we postulate that not seeking a dermatologist for treatment is the main reason. A large percentage of students had post inflammatory hyperpigmentation (72.8%); which is likely due to the Middle Eastern ethnic group; who are mostly Fitzpatrick skin types 3 and 4. Also, using over the counter treatments such as exfoliating products or strong toners can contribute to PIH by causing skin irritation [
One of the limitations of our study is that all the students are females with no male participants. We believe that the results from our female study sample are representative of females in Saudi Arabia of a similar age group. The high acne prevalence in our study compared to other studies may be due to the fact that it was done in a classroom setting and was not clinic based, which allowed us to include many students with mild acne who would not usually seek medical advice. Acne is usually considered a disorder of adolescence. However, there are not many data on the prevalence of acne in the adult population [
Our study confirms that acne is very common in female medical students in Jeddah, Saudi Arabia with a prevalence rate of 98%. This is the first study in Saudi Arabia to compare acne prevalence and severity using an objective assessment by the GAGS compared to the students self-report of acne. Our study showed a discrepancy between the self-assessment of acne and objective assessment by the physician. Our study also showed that there is a delay in seeking medical advice and that students with higher acne grade were more likely to visit a dermatologist. The importance of having patient’s knowledge and treatment practices regarding their acne is fundamental in creating awareness about the treatments effectiveness. This will also lead to the prevention of unnecessary suffering from acne scaring or pigmentation, which was highly prevalent in patients with moderate to severe acne in our study.
Thanks to Prof. Talal Zari for performing the statistical analysis for this study.
Zari, S. and Turkistani, A. (2017) Acne Vulgaris in Jeddah Medical Students: Prevalence, Severity, Self- Report, and Treatment Practices. Journal of Cosmetics, Dermatological Sciences and Applications, 7, 67-76. https://doi.org/10.4236/jcdsa.2017.71007
Questionnaire content distributed to medical students:
1) How would you rate your current acne?
1. ☐ None 2. ☐ Mild 3. ☐ Moderate 4. ☐ Severe
2) Do you have pimples in your back?
1. ☐ Yes 2. ☐ No
3) Do you have pimples in your chest?
1. ☐ Yes 2. ☐ No
4) Where is the location of your acne on the face?
0. none 1. ☐ forehead 2. ☐ Right cheek 3. ☐ Left cheek
4. ☐ Nose 5. ☐ Chin 6. More than one side
5) Have you visited a dermatologist regarding your acne in the past year?
1. ☐ Yes 2. ☐ No
6) Have you visited a pharmacy and got medicine without a prescription?
1. ☐ Yes 2. ☐ No
7) How long did you wait before seeing a doctor?
0. none 1. ☐ Less than 3 months 2. ☐ 3 to 6 months
3. ☐ 6 to 12 months 4. ☐ More than 1 year
8) How long do you expect your acne treatment to take?
0. none 1. ☐ Less than 1 week 2. ☐ 1 week to 1 month
3. ☐ 1 - 2 months 4. ☐ more than 2 months
9) Did any of your parents have acne in the past?
1. ☐ Yes 2. ☐ No
10) Did any of your brothers and sisters have acne in the past?
1. ☐ Yes 2. ☐ No
11) Is your acne causing any scars?
1. ☐ Yes 2. ☐ No
12) Is your acne causing any pigmentation?
1. ☐ Yes 2. ☐ No