For both adolescents and adults the most important attributes were fast-acting treatments that do not cause irritation and do not bleach clothing. Adolescents felt it was important for a treatment to not contain alcohol; however, this was less important for adults. Adults placed more importance on a treatment that had no specific storage requirements.
Given the low adherence to acne therapies [ 15 ] and the link between dissatisfaction with treatment and non-adherence [ 16 ] , when prescribing treatments it is important to consider the attributes that may lead to increased satisfaction with treatment.
The results of this study support the many other studies that demonstrate the negative impact of acne on HRQL [ 5 — 7 ]. A previous study found that for adults with acne, perceived stigma is a significant predictor of acne-related HRQL, contributing more than factors such as severity, gender, or age [ 31 ]. Participants in the current study reported ways in which acne affects their use of social media.
Although many participants had social media accounts, they did not post pictures of themselves if their acne was visible and avoided having pictures taken as they did not want them to be posted online by others. Previous studies have explored social media in relation to dermatology in terms of it being a source of information or support [ 32 , 33 ]; however, to our knowledge, this is the first study to explore the impact of acne on use of social media. This study illustrates the impact of acne through the development of a conceptual model from qualitative data.
Conceptual models can be useful tools that provide a visual representation of the impact of a condition, allowing the links between concepts to be identified. In addition to highlighting the many areas of HRQL that are affected by acne, the model can be used to identify concepts of interest for future studies, to guide selection of an appropriate instrument to measure the impact on HRQL [ 23 ], or as the basis for the development of a new instrument to assess HRQL in acne.
While existing acne-specific HRQL instruments assess several of the concepts identified in the conceptual model, there were concepts identified as important to participants in the current study that are not assessed by such instruments.
Participants discussed some ways in which their relationships are affected by acne. Although some participants discussed this, many did not report an impact on this area of their HRQL. It may be that adolescents in particular did not feel comfortable speaking about this or that a parent or family member was in the room during the interview, which made participants reluctant to discuss it.
This is a possible limitation of the study, as qualitative telephone interviews may not have obtained the depth of data on this topic that might be expected. Some limitations should be considered when interpreting the findings of this study. The extent to which the findings can be generalized to all adolescents and adults with acne is limited by the small sample size; however, data saturation was reached for both adolescent and adult samples, suggesting that additional interviews may not have introduced new concepts.
Although some participants experienced acne on several areas of their body, the inclusion criteria only required participants to have facial acne; therefore, the results can only be assumed to be relevant to facial acne. In addition, it is possible that experiences of older adolescents and young adults are similar and any differences noted between the adolescent and adult samples are really due to the older adults in the sample.
The German adult sample consisted of teenagers; therefore, the experience of older adults in Germany may not be represented. The study highlights the importance of measuring HRQL in future interventional studies of acne treatments and identifies treatment attributes that are most important to patients.
This study and article processing charges were funded by Meda, a Mylan company. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this manuscript and have given final approval of the version to be published.
Thank you to study participants for their involvement in this study. Gabriella Fabbrocini receives research fees from Meda, a Mylan Company. Giuseppe Monfrecola receives research fees from Meda, a Mylan company. Sara Cacciapuoti has nothing to disclose. Enhanced content. To view enhanced content for this article go to National Center for Biotechnology Information , U.
Journal List Dermatol Ther Heidelb v. Dermatol Ther Heidelb. Published online Feb Author information Article notes Copyright and License information Disclaimer. Gabriella Fabbrocini, Email: ti. Corresponding author. Received Nov 8. This article has been cited by other articles in PMC. Abstract Introduction The negative impact of acne on aspects of health-related quality of life HRQL has been demonstrated in many quantitative studies; however, there has been relatively little qualitative research exploring the impact of acne and the use of topical treatment.
Funding Meda, a Mylan company. Keywords: Acne vulgaris, Conceptual model, Health-related quality of life, Qualitative, Topical treatment. Introduction Acne is a chronic, inflammatory disease of the pilosebaceous unit estimated to affect 9. Participants Interview participants were recruited through a specialist recruitment panel in the UK, Italy, and Germany. Data Collection Procedures Semi-structured interview guides were developed following a literature review of HRQL in acne; separate versions were developed for adult and adolescent interviews.
Analysis Data from the interviews were analyzed using thematic analysis, which uses inductive coding to identify themes across a dataset [ 27 ]. Table 1 Sample demographics. Open in a separate window. Emotional Functioning All except one adolescent reported that acne had a detrimental impact on some aspect of their emotional well-being, particularly on their self-confidence or self-esteem. Social Functioning Over two-thirds of adolescent and all adult participants reported that acne had an impact on their social activities.
Relationships Almost half of adolescents and several adults reported that acne has an impact on them when talking to unfamiliar people. Daily Activities Both adolescents and adults discussed the time-consuming aspect of acne, having to allow time for their skin care and treatment routine each day.
Impact on Sleep Acne had an impact on sleep for a third of adolescent and half of adult participants. Impact on School or Work All of the adolescent participants were at school or college; although most felt that their school work was not affected by acne, some mentioned feeling distracted by their acne when it was at its worst. Conceptual Model A conceptual model was developed from the qualitative data, which illustrates the impact of acne on HRQL and the links between concepts Fig.
Example quotes about the attributes of topical acne treatments. Acknowledgements Funding This study and article processing charges were funded by Meda, a Mylan company. Thanking Patient Participants Thank you to study participants for their involvement in this study.
Compliance with Ethics Guidelines The research was designed to comply with guidelines for conducting research with children and young people [ 24 ]. Footnotes Enhanced content To view enhanced content for this article go to References 1.
Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. Acne vulgaris.
Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. Measuring quality of life in people referred for specialist care of acne: comparing generic and disease-specific measures. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece.
Results of a population survey. An Bras Dermatol. The quality of life impact of acne and rosacea compared to other major medical conditions. J Drugs Dermatol. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey.
Psychological sequelae of acne vulgaris: results of a qualitative study. Can Fam Phys. J Health Psychol. Smith JA. The impact of skin disease on the quality of life of adolescents. Adolesc Med. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group.
Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol. Factors associated with patient satisfaction with care among dermatological outpatients. Conjoint analysis: a novel, rigorous tool for determining patient preferences for topical antibiotic treatment for acne. A randomised controlled trial. Evaluating health-related quality of life in patients with facial acne: development of a self-administered questionnaire for clinical trials.
Qual Life Res. Clin Exp Dermatol. The development of an acne quality of life scale: reliability, validity, and relation to subjective acne severity in mild to moderate acne vulgaris. Acta Derm Venereol. Sex and the skin: a qualitative study of patients with acne, psoriasis and atopic eczema.
Psychol Health Med. Murray CD, Rhodes K. Br J Health Psychol. Patient-reported outcomes: conceptual issues. Value Health. MRS guidelines for research with children and young people internet. September Accessed 11 July Comparing telephone and face-to-face qualitative interviewing: a research note.
Qual Res. Vogl S. Telephone versus face-to-face interviews mode effect on semistructured interviews with children. Sociol Methodol. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. Morse JM. The significance of saturation. Qual Health Res. Araviiskaia E, Dreno B. The role of topical dermocosmetics in acne vulgaris. J Eur Acad Dermatol Venereol.
Del Rosso JQ. The role of skin care as an integral component in the management of acne vulgaris: part 1: the importance of cleanser and moisturizer ingredients, design, and product selection. J Clin Aesthet Dermatol. Liasides J, Apergi FS. Predictors of quality of life in adults with acne: the contribution of perceived stigma. Understanding the influence of social media in medicine: lesson learned from Facebook.
Dermatol Online J. Grade III moderately severe acne showing numerous large painful nodules and pustules as well as some inflamed nodules. Lesions occur primarily on the face, neck, upper back and chest. Grading severity of acne 2 , 3. Different variants of acne exist, including acne conglobata, acne fulminans, acne mechanica, excoriated acne, chloracne, drug-induced acne e.
These variations have a similar clinical and histologic appearance to acne vulgaris, but they are distinguishable by clinical setting, severity and associated symptoms. The common differential diagnosis of acne includes folliculitis, keratosis pilaris, perioral dermatitis, seborrheic dermatitis and rosacea. The diagnosis of acne vulgaris is primarily clinical.
Other dermatologic manifestations of androgen excess include seborrhea, hirsutism and androgenetic alopecia. Endocrinologic testing is not ordered routinely for women with regular menstrual cycles. Treatment for acne vulgaris should aim to reduce severity and recurrences of skin lesions as well as to improve appearance. The approach depends on the severity of the acne, the treatment preferences and age of the patient, and adherence and response to previous therapy Table 2.
Approach to therapy for acne vulgaris 3 , 6. Note: In women with acne, oral contraceptives or androgen receptor blockers e. Many research studies on acne therapies are small trials comparing the active drug with placebo or larger studies comparing different formulations of the same drug. Topical therapy is the standard of care for mild to moderate acne. Such treatments are active at application sites, and they can prevent new lesions. Gels, pledgets medication-soaked pads , washes and solutions tend to be drying and are helpful for oily skin.
Lotions, creams and ointments are beneficial for dry, easily irritated skin. Most topical preparations require at least six to eight weeks before an improvement is seen; they may be used for years as needed. The main target of acne treatment is the microcomedone. Topical retinoid therapy acts on follicular keratinocytes to prevent excessive cornification and follicular blockage.
Patients should be instructed to apply very small amounts initially. Optimal response occurs after 12 weeks. The most commonly available topical retinoids are tretinoin, adapalene and tazarotene. A meta-analysis of five multicentre randomized investigator-blind trials involving patients showed adapalene 0.
One commonly used approach is to start with the lowest concentration and increase as tolerated. Topical antimicrobials, including benzoyl peroxide and antibiotics, are effective in treating inflammatory disease. It is available in various topical preparations, ranging in strength from 2. Any strength can be used initially, although it may be more prudent to start with a lower concentration; stronger preparations are more irritating and not necessarily more effective.
It can be fast-acting, with a response as early as five days. Combination therapy, for example with retinoids and antibiotics, is more effective than either agent used alone. Before seeing a physician, patients frequently use over-the-counter therapies for their acne. Such treatments may be more accessible, cosmetically elegant, less expensive and less irritating than prescription therapies.
The most popular over-the-counter products, such as Proactiv, contain benzoyl peroxide but at lower concentrations than most prescription-strength products. Proactiv, a system of cleansing products in which benzoyl peroxide 2. The makers of Proactiv also market Gentle Formula, which replaces benzoyl peroxide with salicylic acid for people with allergy or intolerance.
There have been few studies assessing the efficacy of the Proactiv system. Although it has been used for many years, well-designed trials of its safety and efficacy are lacking. The evidence for the use of topical zinc, resorcinol, sulfur and aluminum chloride is also either limited or negative.
There is no clear evidence that acne vulgaris is related to poor hygiene or that frequent face washing lessens acne. Patients should be instructed to wash their face gently with warm water and mild soap twice daily; rough scrubbing can cause new lesions because of follicular rupture. The only antibacterial soaps that may be effective are those containing benzoyl peroxide. Patients should ensure that their facial products, including sunscreens, are noncomedogenic.
They should also avoid oil-based makeup. Some topical acne products contain a sunscreen. Patients with mild acne can be treated with topical therapies; however, those with moderate to severe acne will require systemic therapy. Oral antibiotic treatment, hormonal therapies and isotreretinoin are the mainstay systemic therapies for acne. When topical agents are insufficient or not tolerated, or in cases of moderate to severe acne, especially when the chest, back and shoulders are involved, systemic antibiotics are often considered the next line of treatment Table 3.
Oral antibiotic therapy for acne vulgaris 20 , Adverse reactions: gastrointestinal upset; phototoxicity greatest of all tetracyclines. Response to oral antibiotics is usually seen after at least six weeks of therapy. Systemic antibiotics should not be used to treat mild acne because of the risk of increasing resistance.
Treatment with tetracyclines and erythromycin reduces P. Minocycline and doxycycline also inhibit cytokines and matrix metalloproteinases that are thought to promote inflammation and tissue breakdown. Doxycycline and minocycline are considered more effective than tetracycline.
Hormonal agents provide effective second-line treatment in women with acne regardless of underlying hormonal abnormalities. Clinical observation suggests that deep-seated nodules on the lower face and neck are especially responsive to hormonal therapy. Clinical trials have shown that estrogen-containing oral contraceptives can be helpful; 31 — 33 the various formulations are thought to decrease levels of free testosterone by increasing sex-hormone-binding globulin and are considered equally effective.
It is not known whether other estrogen-containing contraceptives e. Contraceptives containing only progesterone may worsen acne. The oral antiandrogen spironolactone can be added if oral contraceptives are not effective. Antiandrogen therapy alone may be successful, but in less than half of women; 36 the acne may recur when it is discontinued. Combination therapy with topical agents or oral antibiotics provides substantially more benefit.
An association with severe skin reactions, such as erythema multiforme, Stevens—Johnson syndrome and toxic epidermal necrolysis, has been reported. Before a patient starts oral isotretinoin therapy, baseline blood work is recommended. In women of childbearing age, two forms of birth control should be used during and for one month after therapy, unless the patient has had a hysterectomy or is sexually abstinent.
Cutaneous side effects of isotretinoin include dry eyes, nose and lips, and dermatitis. Patients should use artificial tears, and generous amounts of moisturizer on the nose, lips and skin. Herbal therapies such as tea tree oil, and topical and oral ayurvedic compounds seem to be well tolerated; however, there are limited data about their efficacy and safety in treating acne.
Physical treatments for acne include comedone extraction, chemical peels and microdermabrasion, intralesion cortico-steroid injection for acne cysts, and high-intensity, narrow-band blue light photodynamic therapy, as well as injectable fillers and laser resurfacing for acne scarring. However, there is limited evidence in peer-reviewed literature to support such treatments.
The treatment of acne in children is similar to that in adults. Because topical therapies may be more irritating in children, initiation with low concentrations is preferred. Systemic treatments should be reserved for more extensive cases. Erythromycin is preferred over tetracyclines for children under nine years of age, because tetracyclines can affect growing cartilage and teeth. Although treatment with isotretinoin has numerous potential minor side effects in patients of all ages, an uncommon complication in young patients is premature epiphyseal closure.
Selecting appropriate treatment in pregnant women can be challenging because many acne therapies are teratogenic; all topical and especially oral retinoids should be avoided. Topical and oral treatment with erythromycin may be considered. Trials are being conducted with currently available therapies, in different strengths and combinations. Combining an allylamine antifungal agent with benzoyl peroxide may prove to enhance the effectiveness of benzoyl peroxide in treating acne while preventing antibiotic resistance.
More studies are needed to resolve the long-standing controversy about the role of diet and acne. As well, further direct treatment comparison and long-term trials are needed to determine the optimal sequence of treatment selection as well as to establish the effects on quality of life and long-term efficacy. Effective therapies for acne target one or more pathways in the pathogenesis of acne, and combination therapy gives better results than monotherapy.
Topical therapies are the standard of care for mild to moderate acne. Systemic therapies are usually reserved for moderate or severe acne, with a response to oral antibiotics taking up to six weeks. Hormonal therapies provide effective second-line treatment in women with acne, regardless of the presence or absence of androgen excess.
Competing interests: None declared. This review was solicited and has been peer reviewed. National Center for Biotechnology Information , U. Author information Copyright and License information Disclaimer. Correspondence to: Dr. This article has been cited by other articles in PMC.
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|Fast food conclusion for essay||Correspondence to: Dr. The pathogenesis of acne is multifactorial and includes abnormal follicular keratinization, increased production of sebum secondary to hyperandrogenism, proliferation of Propionibacterium acnes and inflammation. Selecting appropriate treatment in pregnant women can be challenging because many acne therapies are teratogenic; all topical and especially oral retinoids should be avoided. References 1. Antibiotics When topical agents are insufficient or not tolerated, or in cases of moderate to severe acne, especially when the chest, back and shoulders are involved, systemic antibiotics are often considered the next line of treatment Table 3.|
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|Mla style research paper pdf||Combination therapy with topical agents or oral antibiotics provides substantially more benefit. Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts. References 1. Del Rosso JQ. Acne was reported in 83 percent of teenagers, 54 percent of males and 46 percent of females.|
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