Scarring and None Scarring Facial Acne Vulgaris and the Frequency of Associated Skin Diseases


ABSTRACT:BACKGROUND:Acne vulgaris(AV)is chronic inflammatory disease of pilosebaceous unit of young people. Patients with acne with or with out scarring might differ in regard to their immunological background from those free from acne.OBJECTIVES:To evaluate the problem of facial AV especially patients with scarring and to determine the frequency of associated skin diseases and to be compared with acne free control.METHODS:A cross sectional randomized controlled epidemiological study was conducted from Oct.2005-Oct. 2006.Three hundred students from Basra University; 132 (44%) males and 168 (56%) females were enrolled, their ages ranged from 18-25 (20.9±1.8) years. They were divided into: Group A those free from acne (98 individuals),Group B with non scarring facial AV (96 patients), and Group C with scarring facial AV (106 patients). History and examination were done for their acne, scarring acne and associated skin diseases. Allen and Smith grading system for AV were used, and a new invented multiparametric scoring system for scarring acne was applied.RESULTS:AV was in 98(73.24%) males and 104 (61.9%) females. Scarring was 54 (50.95%) males and 52 (49.05%) females. Greasy skin was the most common type among Group B 67 (69.8%) versus 39 (39.8%) among Group A(P=0.000029) and was more common among Group C 84(79.2%) (P=0.00000001).Family history of AV was nearly similar in A and B Groups 55(57.29%) and 56 (52.83%) respectively, while in Group A was 39 (39.79%). Family history of scarring acne was in 35(33.02 %) of Group C, 16 (16.66 %) of Group B, and 3 (3.1%) in Group A; (P=0.00000017). The age of onset was similar in A and B Groups between 15-16 years. Majority of patients in Group B had non inflammatory type or mild inflammatory (papular) 65 (67.8%) patients, most of case were mild and moderate 86 (89.58%) patients, while high percent in Group C had inflammatory type 95 (89.62%), and more than half of them had severe and very severe types upon grading 56 (52.8%). The aggravating factors were similar in A and B Groups with stress and hot weather being the leading aggravating factors. Squeezing and digging habit was in 53 (50%) in Group C versus 23 (23.95%) in Group B (P=0.00024). In most cases of scarring acne, scarring was mild and moderate 85 (80.19%), and the most common type scars was the flat hyperpigmented [50 (47.17%) and 66 (62.26%) respectively].The most common effect of scarring acne on psyche was mild discomfort and mild dysmorphophobia 75 (70.75%).Associated skin diseases were more common among Group A 31 (31. 63%) than among Group B 22 (22.91%) and least common among Group C 14 (13.20%) (P=0.0067) and they were mainly dermatitis and skin infections.CONCLUSION:AV might reflect the immunological status especially among patients with scarring. The frequency of skin diseases was much less among patients with scarring acne