A widespread skin condition called acne vulgaris, which disturbs 9.4% of the world's populace, is most prevalent among teens. In all ethnic groupings, it distresses more than 90% of men and 80% of women [1]. Open and closed comedones, erythematous papules and pustules, and in more serious instances, nodules, deep pustules, and pseudocysts make up the acne lesions [2].

The quality of life decreased self-esteem, and communal communication with others are all negatively impacted by reasonable to serious acne lesions, which could similarly leave overdue post-inflammatory hyperpigmentation or atrophic scars [3]. Additionally, it can cause anxiety, depression, and other emotional trauma that jeopardizes the quality of life [4]. Different nations and ethnic groups have varying rates of adult and teenage acne [5]. In Mainland, China2017, Li D, reported greater proportions of acne among primary and secondary students than undergraduate students. He also reported that men were more likely than women to have acne [6].

In a 2013 research in Yazd, Iran, teens in high school had an overall prevalence of acne of 85.9 percent. Ninety percent of women and 81.4 percent of men had acne, and the severity of the condition had a greater impact on quality of life [7].

El-Hamd (2017) conducted an Egyptian research with 994 teenage secondary school students and discovered that 333 (33.5%) of them had acne vulgaris, with girls having a greater frequency than boys (200, 60% vs. 133, 40%) [8].

In 2014, Al-Nohair and Sharaf, in their study on teenagers in the Qassim region, Saudi Arabia, found that a high percentage have acne misconceptions. The most prevailing misconception was that stress exacerbates acne by 59.9% [9].

Abo El-Fetoh (2016) concluded that 68.2% of female teens in Riyadh, Saudi Arabia, have acne vulgaris. The average age (in years) of acne patients was 21, the average age of acne beginning was 15, and 42.5% of cases had a positive family history of acne vulgaris [10].

In Jeddah, Saudi Arabia, Zari (2017) established that acne is very common in female medical students, with a prevalence rate of 98% [11]. A study carried out in the USA by Dhabhar FS (2003) revealed that emotional strain could amend the immune roles of the skin and then aggravate the appearance of acne vulgaris [12].

A study on young adolescents in Greece (2012) stated that with mild acne, 64.6% with moderate acne, and 89.3% with severe acne, people stated feeling embarrassed and having lower self-esteem due to facial acne. Additionally, 21.3% of people described changing their wardrobe style, and 31.4% conveyed experiencing feelings of worthlessness due to acne. Teenagers' personal and academic lives were disrupted by acne in 21.4% of cases, while their interests were influenced in 19.4%. Due to their facial acne, 19.2% of people reported that their individual and communal natural life, notably the development of relationships, was impacted. (14%) of people evaded swimming and further activities out of shame. 16.6 percent of people with acne conveyed having sleep difficulties [13].

The everyday eating of chocolate, sweetmeats, and smoking was shown to be autonomously and strongly related to an intensification in the occurrence of acne in research to evaluate the impact of food and smoking on acne [14].

In the Northern Borders region of Saudi Arabia, no previous research has been available on acne vulgaris amongst feminine secondary school scholars. So, to ascertain the prevalence and psychological effects of acne vulgaris, our study was carried out. 

Study Objectives

To measure the prevalence of Acne Vulgaris, factors aggravating the appearance of acne vulgaris and its psychological impact on adolescent females in Arar city, Saudi Arabia

Materials and Methods

Study Design, Setting and Period

The cross-sectional study was conducted in Arar city, Northern Saudi Arabia, from June 1 to October 31, 2020.  

Study Sample

The sample size was calculated by Raosoft. The target population is 382, adding 20% non-response, and the minimum sample was 458. The cluster sampling technique was used. Three female secondary schools in Arar city were selected by simple random sampling. From each school, we included students from 3 classes.

Study Tool

Data were gathered using a pre-designed questionnaire. The questionnaire was administered to the class for completion. Age, gender, age of onset, location of acne and its relationship to skin cleansing, smoking, a particular kind of diet, seasonality fluctuation, histories of therapy and its consistency, and histories of cosmetic procedures were among the characteristics covered in the survey.

Ethical Considerations

Permission to conduct the study was obtained from the Research Ethics Committee of the Northern Border University, Arar, Saudi Arabia. Data collectors gave a brief introduction to the students by explaining the aims and benefits of the study. Informed written consent was obtained from all participants. Anonymity and confidentiality of data was maintained throughout the study.

Statistical Analysis

We utilized the statistical package for social sciences, version 16 (SPSS Inc., Chicago, Illinois, USA), to analyze the study data. The results were displayed as counts and percentages. The chi-square (X2) will be used as a significance test, and P < 0.05 indicates significance.

The top three most frequent skin problems among adolescents are always acne. Different nations and ethnic groups have different rates of adult and teenage acne [10]. This research explores the psychological effects of acne vulgaris on teenage girls in Arar, Saudi Arabia, its incidence, and the variables that make it worse.

Results of our study reported 62.9% acne prevalence among studied female adolescents. Our results were comparable to those of cross-sectional research on teenagers in Hail City. It was discovered that 65% of participants had mild to moderate acne [15]. Another Saudi research study in Jeddah, Saudi Arabia, discovered that 64.5 percent of both males and females had acne [16]. This was consistent with research [17] done in Riyadh, Saudi Arabia, which demonstrated that college students had an acne incidence of 56.2%. According to Abo-Elfotoh et al., 53.5% of male pupils in the Northern area of Saudi Arabia have acne vulgaris [10]. Another research stated that the prevalence rate of acne was 51.2% (mild acne was 71.2% and reasonable to serious acne was 28.8%) [18]. In Egypt, 60% of female high school students have acne, according to El-hamd et al. [19]. In another research, all students above 14 developed acne, which had a higher prevalence rate of 96.0% and rose with age [20]. At age 10, there was a frequency of 1.6 percent in China. As people aged, the incidence rose, reaching 46.8% at age 19 [21]. Another study reported prevalence of acne varies from 35-90% among adolescents at some stage [22]. 63.6% was reported in Turkey [23]. Another Chinese research concluded that 53.5% of all teenagers had acne, with men having 51.3% and girls having 58.6% [24]. These findings were substantially lower than those concluded in Lithuania; the prevalence rate of acne among defendants was 82.9%, with the greatest prevalence rates in the age categories of 13-15 and 16-19 years [25]. One more research for the period of adolescence revealed a 23.1% prevalence rate of acne (The rate in girls and boys was 16.1% and 29.2%, correspondingly) [26].

In our studied sample, 45.9% of respondents had acne on the face, 48.9% on the face and back and only 5.2% on the back. Another study reported the prevalence of facial acne at 89.1% and that of acne in the back at 41.3% [18]. In another study, face acne was reported in 99.3% of the cases, which was the commonest site of acne, followed by the back at 3.6% and chest at 2.1% [27]. This was in line with another study that reported the face as the furthermost commonly subjective place at 97.5%, followed by the face and trunk at 2.3% [20].

Regarding risk factors for increased acne, 21.2% of our sample reported a lack of skin hygiene, and 8.4% reported smoking. Stress and genetic susceptibility are correlated with acne and its severity [18]. Factors associated with causes of acne in another study were food, bad skin hygiene and hormonal changes [23]. Nevertheless, another survey identified major risk indicators for acne, such as age, skin condition, poor sleep, and chemical cosmetics usage [26].

Increased acne appearance due to consumption of certain types of food was reported in our study (46.7% fatty meals, 31.4% chocolate, 15.1% spicy food and 6.9% soft drinks). The majority of another study's population reported increased acne when consuming oily food consumption (42.9%), chocolates (30.7%), ice cream (25.7%), and milk consumption (6.4%) [27]. According to another research, a high proportion of respondents had whole milk weekly, twice per week, and consumed fruits. They really consumed chocolates, processed food, fatty meals, and seafood with much the same consistency [15]. Of such replies, 37% consumed nuts relatively regularly. Patients with intermediate to serious acne are more likely to have psychological issues. Teenage females seem to be more susceptible than men to the detrimental psychological consequences of acne, even though acne seems to be more frequent in teenage boys [26].

Psychosomatic impression of acne in adolescents in our study was established to be low self-confidence in 33.3% of participants, 18.5% signs of depression, and 6.9 decreased social relations. The alternative study's contributors' self-reported anxiety rate was 44.6%, indicating a connection between stress and acne (p<0.0001) [18]. Another study confirmed that acne affects anxiety, depression and self-esteem [23].

Topical antibiotics and benzoyl peroxide are effective in treating inflamed acne. In many previous studies, topical erythromycin and clindamycin reduce inflammatory lesions by 46% to 70% [28, 29]. Systemic treatment may be retinoid (e.g., isotretinoin), systemic antibiotics (e.g., azithromycin, clindamycin, co-trimoxazole, doxycycline, erythromycin, levofloxacin, minocycline), hormonal contraceptives or diverse (e.g., clofazimine, corticosteroids, ibuprofen, zinc sulfate) [29, 30]. Oral isotretinoin medication (Roaccutane) is one of the most common medications to prevent extreme acne. The normal period of isotretinoin is 16–24 weeks, with increasing doses used as tolerated until the target dosage, usually between 120 and 150 mg/kg, is met. However, late teenage use has an increased risk of relapse, especially in women with hormonally induced acne and up to 20% of all younger patient populations [31, 32]. In our study, 34.3% of participants take treatment for acne vulgaris (94.9% take medications regularly). Topical agents were used in 72.6% of treated cases, 15.8% used antibiotics, and 11.5% used Roaccutane. A previous study reported that (71.6%) of the studied population was under topical treatment, 13.65% antibiotics, contraceptives in 1.6% and isotretinoin in 1.6% [18]. Another study reported positive treatment history in (47.9%) of patients [27-29, 33]. According to data from another research, 20.6% of people with acne had previously used topical treatments, oral drugs, or "skin washing," whether or not it was related to taking pills and oral medications [20]. El-Fotoh et al. found that (67.6%) of the cases received medical treatment for acne, and only (4.7%) had plastic surgery for acne [10]. Brown spots were reported in 66.6% of our sample as a complication, scars in 54.5%, and redness in place of pimples in 36.2%, comparable to Abo-Elfotoh et al. results about (74.9%) reported the presence of scarring and post-acne hyperpigmentation [10].

According to our result, there was a non-significant connotation among acne and age, social status, father of mother working and educational level. This disagreed with a study that reported age, job, wedding situation, household, and dealing history were associated with acne, while diet, smoking, and alcohol did not [27-29, 33]. Lasek's results found an association between acne and age [34, 35]. Furthermore, a substantial correlation involving parental educational status with acne intensity has been seen observed in other research [20]. In Arar, Saudi Arabia, we discovered a significant positive correlation between tobacco smoke and the development of acne [10]. Being overweight, smoking, under distress, having irregular menstrual cycles, and eating too many nuts could be other factors showing a strong connection for acne [36]. Compared to such findings, research from Italy revealed a link between tobacco and acne [37].

Conclusion