Acne Flares among University Female Students: The Role of Perceived Factors

doi:10.4236/jcdsa.2013.33A2006

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Journal of Cosmetics, Dermatological Sciences and Applications, 2013, 3, 26-29

Published Online November 2013 (http://www.scirp.org/journal/jcdsa)

http://dx.doi.org/10.4236/jcdsa.2013.33A2006

Open Access JCDSA

Acne Flares among University Female Students: The Role

of Perceived Factors

Amal A. Kokandi

Rabegh College of Medicine, King Abdulaziz University, Jeddah, KSA.

Email: [email protected]

Received September 18th, 2013; revised October 15th, 2013; accepted October 23rd, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Objectives: Acne is a common skin disease especially in adolescents and young adults. Several pathogenetic factors are

implicated in causing the disease. Typically acne flares and remits in its course. Several factors can cause flares. The

aim of this study was to assess the perceived factors of acne flares and the idea of sun creams causing skin darkening.

Methods: A questionnaire study of the perceived factors in causing acne flares was studied in university female stu-

dents. These included food, stress, hygiene and menstrual periods. In addition, the effect of sun creams on causing skin

darkening was asked. Results: Food was implicated by 43.2% of patients. Stress and menstrual periods were thought to

exacerbate acne by more than 70% of patients while 80% of patients did not think bad hygiene worsened acne. 40% of

patients thought the use of sun creams cause skin darkening. Conclusion: More controlled studies are needed to explore

the effect of food on acne. Dermatologists need to explain the benefit of using sun creams especially to acne patients

while using standard treatments.

Keywords: Acne; Precipitating Factors; Food; Sun Creams

1. Introduction

Acne is a common skin disease especially in adolescents

and young adults [1]. Several pathogenetic factors are

implicated in causing the disease. Typically acne flares

and remits in its course. Many factors were previously

implicated in causing acne and acne flares. These factors

include food as precipitating agent, stress, menstrual pe-

riods, facial hygiene and marital status [2-4]. Data from

our region are scarce.

Most of the patients will be prescribed one of the reti-

noid creams. These creams are known to make the user

photosensitive [5] necessitating the avoidance of sun and

the use of sun protecting creams. Some adults are reluc-

tant to use sun creams because of the belief that sun

creams cause skin darkening.

In this study perceived factors in causing acne flares

were studied. These included food, stress, hygiene and

menstrual periods. In addition, to the question about sun

creams if they cause skin darkening or not was asked.

2. Methods

Subjects: Female students attending King Abdulaziz uni-

versity medical administration dermatology clinic (fe-

male section) with acne complaints.

Procedure: Verbal informed consent was obtained

from all patients and they were assured that their partici-

pations were voluntary and their responses were anony-

mous and confidential.

A medical history was taken in addition to the acne-

related complaint. An assessment of acne was made us-

ing the global acne grading system or GAGS [6]. GAGS

considers six locations on the face and chest/upper back,

with a factor for each location based roughly on surface

area, distribution, and density of pilosebaceous units. The

severity was graded as mild if the score was 1 - 18, mod-

erate with scores from 19 to 30, severe with scores from

31 to 38, and as very severe if the score is more than 38.

A questionnaire was filled by the investigator by ask-

ing the patients about their opinion and to reply by yes or

no or do not know. They were asked if they think that

food worsens their acne, and if yes which food they think

most does, if acne is worsened by bad hygiene, if acne

worsened by stress, if acne is affected by the menstrual

period, if acne is affected (worsened or improved by

marriage) and if using sun protecting creams cause skin

Acne Flares among University Female Students: The Role of Perceived Factors 27

darkening. This questioned was added because most of

acne treatment modalities necessitate the use of sun pro-

tection cream and some patients were reluctant to use

them. The study protocol was approved by local research

ethics committee.

Analysis: The statistical analysis was performed using

the SPSS software version 16.0.

3. Results

A total of 125 responses were collected. Age of patients

ranged from 16 - 39 years (mean 22.2, SD 3.96). Severity

ranged from 5 - 37 (mean ± SD, 15.54 ± 5.21). Disease

duration ranged from 0.3 - 20 years (mean ± SD, 5.7 ±

3.18 years). The responses to the questions are summa-

rized in Table 1 and Figure 1.

Acne was implicated to be worsened by certain food

by 43.2% of patients. While 49.6% of patients did not

think food was worsening their acne. The main food im-

plicated in worsening acne was chocolate (66.7% of pa-

tients agreeing food is causing acne), followed by fatty

food and chili (31.5% and 20.4% respectively). Less

commonly nuts, fizzy drinks and other food items were

implicated. A list of food items implicated in worsening

acne is presented in Table 2 and Figure 2. Eighty per-

cent of acne patients thought that bad hygiene does not

affect or worsen acne. Stress and menstrual period were

thought be affecting acne flares by 72.8% and 78.4% of

patients respectively. Marriage was thought to be affect-

ing acne by 34.4% of patients, while 28.8% thought that

it does not have a role. Regarding the sunscreen use, 40%

of patients thought that it causes skin darkening and only

27.2% of patients did not think it causes skin darkening.

4. Discussion

Acne is one of the most common complaints in adoles-

cents and early adulthood. Several beliefs still exist re-

garding the cause and the precipitating factors of acne. In

this study some of the factors thought to be related to

acne flares were studied in university female students. In

addition to the question about the concept of sun creams

causing skin darkening was asked.

Food is still debatable issue especially in relation to

acne. The earliest studies performed to declare the effect

of food, namely, chocolates, milk and roasted nuts were

small, uncontrolled and for short periods only [7,8].

Food with high glycemic load are implicated in wors-

ening acne in addition to milk and dairy products [9,10].

Soft drinks were considered the most aggravating food

item by Pakistani students [11]. On the other hand some

food is thought to improve or protect against acne like

fish oil [12] and Mediterranean food [13,14]. In this

study more than 40% accused food of worsening acne.

Interestingly, chocolate followed by fatty food were the

Table 1. Summary of responses of acne patients to the ques-

tions.

Yes (%) No (%) Do not

know (%)

Is acne worsened by food? 54 (43.2) 62 (49.6)9 (7.2)

Is acne precipitated by

bad hygiene? 22 (17.6) 100 (80)3 (2.4)

Is acne worsened by stress? 91 (72.8) 30 (24) 4 (3.2)

Is acne affected by the period?98 (78.4) 24 (19.2)3 (2.4)

Does marriage affect acne

in anyway? 43 (34.4) 36 (28.8)46 (36.8)

Does sunscreen use cause

skin tanning? 50 (40) 34 (27.2)41 (32.8)

% the percentage of responses out of total responses (125).

Figure 1. Summary of responses of acne patients to the

questions.

Table 2. Types of food implicated in worsening acne.

Food Number of cases Percentage

chocolate 36 66.7

fatty food 17 31.5

chili 11 20.4

nuts 8 14.8

fizzy drinks 5 9.3

chips 3 5.6

sweets 2 3.7

dairy products 1 1.9

aubergiene 1 1.9

eggs 1 1.9

bananas 1 1.9

fish 1 1.9

caffiene 1 1.9

pastries 1 1.9

iron deficiency 1 1.9

The percentage is the percentage implicating the food out of total cases

implicating food as a causative agent for acne flare (54).

Open Access JCDSA

Acne Flares among University Female Students: The Role of Perceived Factors

The percentage is the percentage implicating the food out of total cases

implicating food as a causative agent for acne flare (54).

Figure 2. Food items implicated in worsening acne.

most culprits. There is still a need for more controlled

studies regarding the effect of food on acne.

Sometimes the stigma of cleanlessness is feared by

some acne patients [2,4]. In some societies still poor hy-

giene is thought to be a cause of acne [15], or acne to be

relieved by frequent face washing [11]. In this study 80%

of patients thought that bad hygiene does not worsen

acne but still 17.6% of patients thought bad hygiene is a

factor. Acne is known to cause a significant psychologi-

cal burden on patients. The effect of feeling guilty about

worsening it by bad hygiene may cause an added nega-

tive effect on patients.

Stress was reported to be aggravating factor of acne

[15,16]. In this study more than 70% of patients thought

acne was worsened by stress. Similar results were re-

ported by previous studies in different societies [17,18].

Stress seems to be a factor in our society too.

Acne is known to be associated with the polycystic

ovarian syndrome and affecting their quality of life [18].

Period irregularity is one of PCO manifestations and

higher testosterone level than normal subjects are mani-

festations too. More than 78% of patients in this study

claimed that acne flared in relation to the menstrual pe-

riod. This might be explained by hormonal variation

throughout the menstrual cycle. Only 34.4% of patients

thought that acne is related to the marital state. Appar-

ently there is not a link between marital state or sexual

activity, and acne flares.

Most acne patients will be prescribed topical or sys-

temic treatment that will cause them photosensitive. This

necessitates the use of sun protecting creams. There is a

misconception of sun creams causing darkening of skin.

This concept might came from the fact that some sun

cream users are feeling sun safe and exposing themselves

to the sun for longer times. The other explanation might

be that some sun cream users are not applying the creams

in enough amounts or not renewing the application as

needed. In this study 40% of patients thought that sun

protecting creams cause skin darkening and only 27.2%

think that it does not. This might warrant dermatologist

to explain the benefit of using sun protecting creams to

avoid sun burning or unwanted facial tanning especially

for patients on treatments with photosensitizing agents.

The counseling should be individualized [19].

5. Conclusion

More than 40% of acne patients think that food is a

causative factor and more than 70% of patients think that

stress and menstrual period is an exacerbating factor.

More research is needed in regard to food as causative or

precipitating acne lesions. Counseling regarding the use

of sun protecting creams should be part of the clinical

management of acne patients especially if they will be on

treatments specially retinoids.

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