Epidemiological Risk Factors Associated with Acne Vulgaris Presentation, Severity, and Scarring in a Singapore Chinese Population: A Cross-Sectional Study

Abstract

<b><i>Background:</i></b> Acne vulgaris is classified based on the severity of skin lesions and post-healing scar types of these lesions. Numerous epidemiology studies have investigated the risk factors associated with acne presentation and severity, but studies for acne scarring are lacking. <b><i>Objective:</i></b> To investigate the prevalence of acne, severity, and scarring grades and their associated risk factors among Singapore Chinese. <b><i>Methods:</i></b> A total of 3,888 subjects (2,090 cases/1,798 controls; median age = 21 ± 4.589; range 17–71) completed an investigator-administered questionnaire as part of a cross-sectional study, which included sociodemographics, familial medical history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (<i>n</i> = 991) and scarring (<i>n</i> = 988) grades by a trained personnel. <b><i>Results:</i></b> The majority of the acne cases had mild acne/grade 1 scarring, while less than 1% had severe acne/grade 4 scarring. Parental acne was significantly associated with acne presentation and moderate/severe acne, while sibling acne was significantly associated with grade 3/4 scarring. Gender and age affected acne severity and scarring but not acne presentation, while tertiary maternal education level and the possession of ≥3 siblings were particularly associated with acne scarring. Underweight BMI was protective against acne presentation, while atopic diseases (asthma, allergic rhinitis, eczema) were its predisposing factors. Of the evaluated lifestyle factors, computer/TV usage had significant association with acne presentation, while alcohol consumption was significantly associated with acne severity. Frequent milk consumption was associated with a protective effect for moderate-severe acne, while frequent butter consumption had a detrimental effect on acne scarring extent. <b><i>Conclusion:</i></b> Positive familial history is a strong predisposing factor in determining acne presentation, severity, and scarring. Demographic factors (gender, age) and sedentary lifestyle (increased computer/TV usage) influence acne presentation, while dietary habits (milk and butter consumption) influence acne severity and scarring. The predisposing factors revealed in this study could help us to gain insights into acne pathophysiology and hence develop interventions especially targeting modifiable risk factors.

Golgin A7 family member B ( GOLGA7B ) is a plausible novel gene associating high glycaemic index diet with acne vulgaris

“…Data from our previous cross‐sectional study 9 and the current analysis both demonstrated an acne‐protective effect of milk consumption, while other reviews have shown an acne‐promoting effect of milk and dairy product consumption 3,4 9 …”

“…Acne-protective properties of fruits and vegetables could be attributed to their high fibre content, which have been shown to lower the levels of IGF-1, 25 and anti-inflammatory and antioxidant effects of the phytochemicals in them. 26 Data from our previous cross-sectional study 9 and the current analysis both demonstrated an acne-protective effect of milk consumption, while other reviews have shown an acne-promoting effect of milk and dairy product consumption. 3,4 This may be due to the heterogeneity between studies in the assessment of dairy product consumption, which has been discussed previously.…”

“…Cross‐sectional studies aimed to investigate the epidemiology of acne presentation, severity and scarring in the Singapore and Malaysia Chinese population were conducted at National University of Singapore (NUS) in 2014, 2015 and 2019, in Universiti Tunku Abdul Rahman (UTAR), Malaysia, in 2016 and 2018, and in Sunway University, Malaysia, in 2019 8,9 . An investigator‐administered questionnaire designed to collect information on demographics, personal and lifestyle habits, medical history, family history, dietary habits, socioeconomic status and acne history was administered to participants.…”

“…An investigator‐administered questionnaire designed to collect information on demographics, personal and lifestyle habits, medical history, family history, dietary habits, socioeconomic status and acne history was administered to participants. Participants were assessed for acne presentation and were classified as acne cases or controls; acne cases were further assessed objectively for severity and scarring grades by a postdoctoral personnel trained by a dermatologist, and a selected subset of the assessment was further validated by the dermatologist 8,9 . Ethical approval was granted from the Institutional Review Board (IRB) of NUS (NUS IRB‐13‐075, NUS IRBH‐18‐036), Scientific and Ethical Review Committee (SERC) of UTAR (Ref.…”

“…Cross-sectional studies aimed to investigate the epidemiology of acne presentation, severity and scarring in the Singapore and Malaysia Chinese population were conducted at National University of Singapore (NUS) in 2014, 2015 and 2019, in Universiti Tunku Abdul Rahman (UTAR), Malaysia, in 2016 and 2018, and in Sunway University, Malaysia, in 2019. 8,9 An investigator-administered questionnaire designed to collect information on demographics, personal and lifestyle habits, medical history, family history, dietary habits, socioeconomic status and acne history was administered to participants. Participants were assessed for acne presentation and were classified as acne cases or controls; acne cases were further assessed objectively for severity and scarring grades by a postdoctoral personnel trained by a dermatologist, and a selected subset of the assessment was further validated by the dermatologist.…”