Systematic review of the epidemiology of acne vulgaris

Abstract

A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong association was observed between several risk factors -family history, age, BMi and skin type -and acne presentation or severity in multiple studies. The pooled odds ratio of 2.36 (95% CI 1.97-2.83) for overweight/obese BMI with reference to normal/underweight BMI and the pooled odds ratio of 2.91 (95% CI 2.58-3.28) for family history in parents with reference to no family history in parents demonstrate this strong association. In addition, a pooled odds ratio of 1.07 (95% CI 0.42-2.71) was obtained for sex (males with reference to females). However, the association between other factors, such as dietary factors and smoking, and acne presentation or severity was less clear, with inconsistent results between studies. Thus, further research is required to understand how these factors may influence the development and severity of acne. This study summarizes the potential factors that may affect the risk of acne presentation or severe acne and can help researchers and clinicians to understand the epidemiology of acne and severe acne. Furthermore, the findings can direct future acne research, with the hope of gaining insight into the pathophysiology of acne so as to develop effective acne treatments. Acne epidemiologyThe Global Burden of Disease Study 2010 found that acne vulgaris (henceforth acne) is the eight most common skin disease, with an estimated global prevalence (for all ages) of 9.38% 1 . In different countries and among different age groups, the prevalence of acne varies, with estimates ranging from 35% to close to 100% of adolescents having acne at some point 2 . Symptoms and impacts of AcneAcne patients typically present with comedones, papules and pustules 3 . Comedones can be subdivided into two types -open comedones (blackheads), which are clogged follicles with openings exposing its contents to the air, and closed comedones (white heads), which are clogged follicles without an opening 4 . Papules are raised lesions on the skin that are smaller than 1 cm in diameter while pustules are similar to papules but inflamed and filled with pus 4 . In patients with severe acne, nodules and cysts -inflamed, swollen lesions that are at least 5 mm large -may be present 3,4 . In addition, other symptoms such as the scars, erythema and hyperpigmentation may be observed in acne patients 4 .On top of discomfort due to the clinical symptoms of acne, patients may experience other negative impacts. A study observed significantly higher unemployment rates among acne cases relative to controls, suggesting a correlation between acne and employment 5 . Further, acne has been found to adversely affect the social life 6 , self-esteem and body image of individuals and is often co-morbid with psychological disorders including depression and anxiety 3 . Additionally, acne is associated with substantial financial costs, with one study estimating that...

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