Introduction
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous units. Acne vulgaris is the most common skin condition seen in adults and adolescents, mostly affecting face, midchest, back, shoulders and upper arms of the body. This disease involves development of multiple lesions like comedones, papules, nodules, cysts and scars. Acne vulgaris occurs in all races worldwide, affecting about 90% of people in their lifetime.1 The Japanese people are affected less than Americans 2 and cystic acne is more common in whites.3 The age of onset is at puberty or a few months before puberty. The peak incidence is between 14 to 17 years in women and 16 to 19 years in men. Acne is more common and more severe in males than in females, relating it to androgen activity. Patients with genotypes XYY were more severely affected as shown in one study.4 Neonatal lesions related to circulating maternal hormones are also known.5 Acne was found to be more common in urban boys than in their rural counterparts.6 Genetic factors influence the susceptibility to acne.7
Materials and Methods
The present study is a hospital based observational study carried out from November 2019 to January 2020 in a tertiary care hospital after obtaining institutional ethical committee clearance. A total of 200 consenting patients attending the Dermatology OPD with clinical features of Acne vulgaris was included in the study. Pregnant women and Patients with drug induced acne vulgaris were excluded from the study (ex: Corticosteroids, Isoniazid, phenytoin, lithium carbonate, cyclosporine, disulfiram). Since this study is clinical observational study no laboratory investigations were carried out. The following datas were collected in a predesigned proforma after getting consent from the patient which included age, gender, marital status, age of onset, duration, body sites involved, number and severity of acne lesions, menstrual history, features of androgenicity, post inflammatory hyperpigmentation and scarring.
Acne vulgaris were graded into 4 grades based on a grading system as follows:
GRADE 1 - comedones, occasional papules
GRADE 2 - papules, comedones, pustules
GRADE 3 - predominant pustules, nodules
GRADE 4 - mainly cysts, abscess, scarring
Observations and Results
The following observations were obtained in the study and the results were analysed.
Table 1
Age and sex distribution
A total of 200 patients with clinical features of Acne vulgaris were studied out of which 59% patients were males (n=118) and 41% patients were females (n=82). Thus the male to female ratio is approximately 3:2.
According to age distribution majority of patients affected were above 18 years and they constituted 51% of study group. The second most common age group is between 14 and 18 years which constitutes 38% of the study population. The least affected age group is between 9 to 12 years which constituted only 2% in our study group.
Table 2
Involvement of anatomical region
| Body site | Males (n) | Females (n) | Total n (%) |
| Face | 48 | 42 | 90(45%) |
| Neck | 12 | 14 | 26(13%) |
| Trunk | 22 | 14 | 36(18%) |
| Chest | 18 | 6 | 24(12%) |
| Arms | 14 | 10 | 24(12%) |
According to anatomical regional distribution, face is the commonly affected site with 45% involvement followed by trunk 18%. The arm and chest are equally involved with 12% of patients showing skin involvement.
Table 3
Grades of severity
| Grade | Males n | Females n | Total n (%) |
| 1 | 22 | 16 | 38(19%) |
| 2 | 24 | 18 | 42(21%) |
| 3 | 68 | 38 | 106(53%) |
| 4 | 6 | 8 | 14(7%) |
Among grades of severity, 106 patients (53%) are affected in grade 3 followed by grade 2 (21%), grade 1 (19%), and grade 4 (7%).
Table 4
Androgenetic features
| Androgenetic features | Males n | Females n | Total n (%) |
| Alopecia | 12 | 16 | 28(14%) |
| Obesity | 8 | 2 | 10(5%) |
| Hirsutism | 0 | 8 | 8(4%) |
| Pcod | 0 | 4 | 4(2%) |
| Amenorrhea | 0 | 2 | 2(1%) |
| Infertility | 0 | 1 | 1(0.5%) |
In this study androgenetic features like alopecia (14%) was noticed followed by obesity (5%), hirsutism (4%), PCOD (2%), amenorrhea (1%) and Infertility (0.5%).
Discussion
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous units. It is the most common skin condition seen in adults and adolescents. Acne vulgaris occurs in all races worldwide, affecting about 90% of people in their lifetime.1 The disease is occurring in both the sexes but seen more widely in females over 40 years according to one study.8 However this study showed male predominance (59%) [Table 1] as in case of another study done in south Indian population.9 Also this study shows more number of females affected in the pubertal age group and less number of females affected after 18 years.[Table 1] This is in contrast to males, where less number was affected in pubertal age and more numbers affected among greater than 18 years. In this study adult acne case were (51%) [Table 1] whereas in another study conducted in south India where only 9.3% adult acne cases were reported.9 The common age group involving both males and females affected in this study were 18 years and above (51%) [Table 1] where as it was 16 to 20 years [60%] in the other study.9 In our study, involvement of anatomical region shows majorly face involvement (45%) followed by trunk involvement (18%), neck involvement (13%), chest and arms (12%) [Table 2]. These findings were similar to the earlier study. 9, 10, 11, 12[10 to 12] Our study shows majority of patients with grade 3 acne (53%) followed by grade 2 (21%) [Table 3]. These findings were in contrast to the study done by Hazarika N and Rajaprabha R K.13 and also study done by Durai and Nair which showed maximum patients with grade 1 acne14 In this study androgenetic features like alopecia (14%) followed by obesity (5%) and hirsutism (4%), PCOD (2%), amenorrhea (1%) and Infertility (0.5%) was observed. [Table 4]. This is in contrast to another study done in South Indian population where the incidence of hirsuitism and menstrual disturbances were reportedly 9.48% and 10.2% respectively.9 Khunger et al, in their study of adult acne also found similar findings as the other study.15 Thus among these studies there is no association between severity of acne and features of androgenicity.
Conclusion
This study of Acne vulgaris patients shows that males were affected more than females. People of age above 18years were affected more than below 18 years. Face, trunk, neck were affected more commonly followed by other sites. Acne vulgaris Grade 3 and grade 2 were more frequently seen. Among androgenetic features females were affected more than males and Alopecia is a common presenting feature. Thus from this study we have found males above 20 years were more affected than females relating to their androgen activity and this helps in providing greater understanding of Acne vulgaris.
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