Knowledge, Belief, and Perception among Youths with Acne Vulgaris.

BACKGROUND: Acne vulgaris is one of the commonest dermatological challenges faced by the youth. It lasts several years, running a chronic course with complications such as scarring. The fact that this occurs most commonly on the face, leads to profound psychological implications, that cause emotional trauma and affect a person's quality of life. Anxiety and depression are common issues arising from this. A lot of myths tend to float around acne in society, and people use all kinds of indigenous and home made remedies, as well as the wrong kinds of treatment, such as topical steroid based creams, which further worsen the situation. AIMS AND
OBJECTIVES: To assess the awareness levels amongst youths, to understand the various beliefs and perceptions related to acne, so that we may be able to tackle this condition better.
MATERIALS AND METHODS: We carried out a cross-sectional study in 150 patients with acne vulgaris attending the Dermatology Out Patient Department from May 2017 to June 2018.
RESULTS: Amongst other findings, we found that a majority of people in our study believed stress and hormones to be the major aggravating factors. Most patients preferred treatment options like healthy lifestyle and cleansers and toners in our study. Amongst the treatment options, clindamycin was more commonly used than benzoyl peroxide followed by retinoids.
CONCLUSION: There are several misconceptions and a gross lack of knowledge about acne amongst our younger population, that needs to be addressed.

Introduction

Acne vulgaris is a common malady affecting individuals in the adolescent age group. It is a chronic, self-limiting inflammatory disorder of the pilosebaceous units.[1] It is a very common condition with a prevalence rate of around 91% in adolescent males and 79% in adolescent females. In adulthood, it is more common in women.[1] The oil that normally lubricates the skin gets trapped in blocked oil ducts and results in what we know as pimples, blackheads, and whiteheads on the surface of skin. Sometimes, it also includes deeper skin lesions called cysts.[2]

Acne lasts for several years and thus may significantly influence the lives of those affected. For many teens, the disease creates cosmetic, physical, and psychological scarring, fueling anxiety, depression, and other emotional trauma that threaten their quality of life.[3]

Despite the fact that acne is a very common dermatological condition, very few studies have been done regarding the knowledge, beliefs, and perceptions about the various treatment modalities and causative factors of acne particularly from southern part of India.

Objectives

The objective of the study was to assess the knowledge, misconceptions, and beliefs about acne among the youth and to provide a baseline understanding of the awareness levels about acne in the population.

Materials and Methods

We carried out a cross-sectional study in 150 patients of acne vulgaris attending the dermatology outpatient department from May 2017 to June 2018. The participants were selected by systematic random sampling technique. Institutional ethical committee clearance was obtained. All participants above the age of 16 years and below 35 years of either sex completed the questionnaire anonymously during outpatient department time. The participation was totally voluntary in nature. The aim of the study was to evaluate knowledge, beliefs, and perceptions of patients toward acne. A questionnaire adapted from Brigitte et al. was administered to the participants.[4] Various parameters were assessed in the questionnaire, including duration of disease, various beliefs, practices, and perceptions about treatment modalities including topical steroid use in acne, source of information and impact of acne on self-image, relationships and occupation, the time taken for visible reduction in acne, and the compliance to treatment.

Results

A majority (62%) of the participants were female aged between 16 and 25 years with a mean age of 18.5. Most of the participants (68%) were students suffering from acne for more than a year.

About 57% of the participants believed that acne required treatment, 22% had no knowledge about acne and its treatment and the rest 21% believed that acne was a transient condition and resolved spontaneously. The sources of information were family and friends in 64%, literature in 29%. Only 35% consulted doctors and came to know about acne [Table 1].

Table 1

Sources of information about acne

	No	No (%)	Yes	Yes (%)
Family and friends	54	36.00	96	64.00
Medical literature	106	70.70	44	29.30
TV newspaper	112	74.70	38	25.30
School	125	83.30	25	16.70
Doctors	97	64.70	53	35.30

Opinions about acne and factors influencing it

In our study, 21% of participants believed acne to be contagious, whereas 17% believed that only teenagers could be affected by acne. About 76% believed acne to be a curable condition and 43% people believed acne is a self-limiting problem and will fade off after certain age.

Hormones and diet were the two main aggravating factors believed by the subjects in this study, as seen in Table 2. The other aggravating factors were environmental change (57.30%), stress (54.70%), makeup (39.30%), and the practice of squeezing lesions (34.70%).

Table 2

Aggravating factors of acne

	No	No (%)	Yes	Yes (%)
Stress	68	45.30	82	54.70
Fatty food	60	40.00	90	60.00
Makeup	91	60.70	59	39.30
Hormones	26	17.30	124	82.70
Environmental change	64	42.70	86	57.30
Squeezing lesions	98	65.30	52	34.70

Care of acne

More than half (54.6%) of the patients of our study believed the treatment of acne to last for a maximum of 6 months and 8% believed that there is an immediate cure for acne. The common modalities of treatment according to their belief are depicted in Table 3.

Table 3

Common modalities of treatment

	No	No (%)	Yes	Yes (%)
Cleansers and toners	76	50.70	74	49.30
Clindamycin	99	66.00	51	34.00
Benzoyl peroxide	93	62.00	57	38.00
Retinoids	133	88.70	17	11.30
Drugs prescribed by doctor	87	58.00	63	42.00
Healthy lifestyle	65	43.30	85	56.70
Cleansing agents	82	54.70	68	45.30
Ointment from chemist	117	78.00	33	22.00
Makeup	144	96.00	6	4.00

Forty-two percent believed that acne should be treated by a doctor, 56% believed healthy lifestyle could improve the symptoms of acne, and 50% people relied only on cleanser and toners.

Cleansers and toners (49.3%) followed by benzoyl peroxide (38%) were the most common modality of topical treatment used in our study. Sixty-two percent of the patients believed that acne occurs only at puberty and last for 1–2 months.

Use of topical steroids in acne

In our study, 44% people had not heard of topical steroid, whereas 47% had heard but gave no history of using topical steroids. About 10% had used topical steroids for treatment and noticed worsening of lesions.

Discussion

In this study, we found that females were more affected by acne than males, which was similar to studies by Tallab et al.[5] and Ali et al.[2]

We found that the most common source of information about acne was friends and family (64%) followed by doctors (35%). This was similar to a study by Rigopoulos et al., which showed that parents (31%) were the most common source of information followed by doctors (26.7%).[6]

A majority of people in our study believed stress and hormones to be the major aggravating factor, whereas other studies showed diet to be believed as the most common triggering factor. A study done by Yahya et al. showed fatty foods (52.5%) as the most common aggravating factor,[7] whereas a study done by Brigette et al. showed more than 40% population believing that bad hygiene and fatty food to be the most common causes of acne.[4]

Most patients preferred treatment options like healthy lifestyle and cleansers and toners in our study. This was similar to a study by Smithard et al. who concluded that cleanliness (82%) and diet change (50%) were the major factors in the treatment of cases.[8] In a study done by Nijsten et al., more than one-third people used cleanser and toners, and benzoyl peroxide was the most commonly used topical medication.[9] In our study, clindamycin was more commonly used than benzoyl peroxide followed by retinoids. We found that most people thought acne spots were the most troublesome features. In a study by Gokdemir et al., acne scars were the most common complaint, with 84% people having moderate-to-severe impact of acne scars on their lives.[10] Many people in our study believed acne to be contagious (21%) and others came with the hope of immediate cure for acne. Gokdemir's study found that 80% people believed acne to be curable. These results show that the knowledge about acne is lacking in present-day youth. The impact on people's lifestyle from this pubertal problem can be modified by providing people with basic information and treatment. Very few people in our study gave a history of using topical steroid cream usage. In a study by Kaushik et al., 87% people had used topical steroid creams ranging from a duration of 1 to 6 months.[1] In another study about topical steroid abuse, 24% people used topical steroid creams to treat acne and 90% people presented with severe adverse effects of topical steroid cream usage.[11]

Conclusion

There are several misconceptions and a gross lack of knowledge about acne amongst our younger population. An educational program, specially designed for young people about the causes, complications, and the importance of treatment for acne, would be very beneficial in reducing the major impact on the youth post puberty.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.