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Over-the-counter and Prescription Medications for Acne: A Cross-Sectional Survey in a Sample of University Students in Saudi Arabia

Authors:

Abstract

Introduction and Background Acne is a very common dermatological condition found among the adolescent population in Saudi Arabia. Many patients with acne try various forms of self-medication, over the counter medicines (OTC), and prescription medicines for the same. Materials and Methods This was a cross-sectional study among university students in the Kingdom of Saudi Arabia (KSA). A validated questionnaire was distributed to a convenience sample of university students to evaluate their knowledge and attitudes towards OTC (mainly) as well as prescription medicine for acne. Chi-square and multiple logistic regression tests were used for comparisons between groups. Results Four hundred and twenty valid, completed questionnaires were obtained. A total of 220 (52.4%) used some type of OTC medications at least once, where as 108 (25.7%) used prescription medicines and 92 (21.9%) used both. The most common OTC medications used were cleansers by 250 participants (41.9%). Among prescription medicines, the most common were topical and oral antibiotics (11.4%). Bivariate and multivariate analysis showed that females are statistically more likely to use OTC medicines compared to males (Odds ratio: 1.7). Conclusion The use of self-medications and OTC medications is common among university students in KSA. The most common OTC medicine used for acne was cleanser.
120 © 2017 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow
Introduction
Acne is a common inammatory condition
affecting the pilosebaceous units of the
skin of the face, neck, chest, and upper
back. While managing cases of acne,
dermatologists need to factor in patient
compliance, patient education, economic
aspects as well as availability of a wide
variety of over the counter (OTC) and
alternative medications for the same.[1‑3]
The prevalence of acne varies from 50%[4,5]
to 80% in different studies.[6,7] Unfortunately,
many people with acne may suffer for years
before being referred to a specialist and
majority never seek the advice of a doctor
for managing acne.[8] Many people who
suffer from acne use both prescription and
over‑the‑counter (OTC) acne medications.
Multiple factors such as convenience, lower
cost, and difculty getting appointments
with dermatologists has lead to an increase
in the use of OTC treatments.[9]
OTC acne therapies can be classied into
the following six major groups: cleansers,
leave‑on products, mechanical treatments,
essential oils, vitamins, home remedies, and
herbal treatments. OTCs can be effective
for some patients with mild acne.[10]
Patients tend to have a lot of queries
and confusions regarding acne and the
internet has become an important source of
information regarding these queries.[11] For
dermatologists, it is crucial to understand
these queries. It was felt that the rst
step would be to have a clear picture on
the frequency of use as well as factors
affecting these choices in patients suffering
from acne. Our study attempted to evaluate
the frequency of use of OTC/prescription
medicines for acne and factors affecting
these choices among a sample of university
students in the Kingdom of Saudi Arabia.
Materials and Methods
It was a cross‑sectional, descriptive
study of students in a University in Saudi
Arabia. The total number of students in
the university at the time of the study was
30789. The total number of males was
14892 and the total number of females
was 15897 (Information from Deanship
Abstract
Introduction and Background: Acne is a very common dermatological condition found
among the adolescent population in Saudi Arabia. Many patients with acne try various forms
of self‑medication, over the counter medicines (OTC), and prescription medicines for the
same. Materials and Methods: This was a cross‑sectional study among university students in
the Kingdom of Saudi Arabia (KSA). A validated questionnaire was distributed to a convenience
sample of university students to evaluate their knowledge and attitudes towards OTC (mainly) as
well as prescription medicine for acne. Chi‑square and multiple logistic regression tests were used
for comparisons between groups. Results: Four hundred and twenty valid, completed questionnaires
were obtained. A total of 220 (52.4%) used some type of OTC medications at least once, where
as 108 (25.7%) used prescription medicines and 92 (21.9%) used both. The most common OTC
medications used were cleansers by 250 participants (41.9%). Among prescription medicines, the
most common were topical and oral antibiotics (11.4%). Bivariate and multivariate analysis showed
that females are statistically more likely to use OTC medicines compared to males (Odds ratio:
1.7). Conclusion: The use of self‑medications and OTC medications is common among university
students in KSA. The most common OTC medicine used for acne was cleanser.
Keywords: Acne vulgaris, knowledge‑attitude‑behavior, OTC medications
Over-the-counter and Prescription Medications for Acne: A Cross-
Sectional Survey in a Sample of University Students in Saudi Arabia
Brief Report
How to cite this article: Alshehri MD, Almutairi AT,
Alomran AM, Alrashed BA, Kaliyadan F. Over-the-
counter and prescription medications for acne: A cross-
sectional survey in a sample of university students in
Saudi Arabia. Indian Dermatol Online J 2017;8:120-3.
Received: June, 2016. Accepted: September, 2016.
This is an open access arcle distributed under the terms of the
Creave Commons Aribuon-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creaons are licensed under the idencal terms.
For reprints contact: reprints@medknow.com
Mohja D. Alshehri,
Abdulsalam T.
Almutairi,
Asma M. Alomran,
Batool A. Alrashed,
Feroze Kaliyadan
Department of Dermatology,
College of Medicine, King
Faisal University, Saudi Arabia
Address for correspondence:
Dr. Feroze Kaliyadan,
Faculty of Dermatology,
College of Medicine, King
Faisal University, Saudi Arabia.
E‑mail: ferozkal@hotmail.com
Access this article online
Website: www.idoj.in
DOI: 10.4103/2229-5178.202273
Quick Response Code:
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Alshehri, et al.: Perceptions regarding over-the-counter and prescription medications for acne
121Indian Dermatology Online Journal | Volume 8 | Issue 2 | March‑April 2017
of Admission and Registration of the University for the
year 2015‑16),which included diploma students, bachelor
students, higher diploma students, and postgraduate
students. Our calculated sample size was 379 (inputs:
Condence level = 95%, condence limit = 5, total
population = 30789, precision = 20, and power = 80%). The
questionnaire was randomly distributed to all the university
students both electronically (through social media) and
as hard copies (500 as hard copies). A total of 420 valid
responses were obtained, of which 204 were electronic
responses and 216 hard copies. The response rate could
not be ascertained exactly as the electronic survey might
have reached a much larger sample of students. The
recruitment period was over 2 months. Data analysis was
done using SPSS® version 21(IBM, New York, USA)
and SAS (Statistical Analysis Software, North Carolina,
USA); P < 0.05 was considered to be signicant. The
questionnaire itself had three parts. The rst part was
about personal information including gender, age, marital
status, residential area, and academic year. The second
part addressed details of skin type and acne and the third
part focused on use of prescription and OTC medications
as well as related satisfaction. Cronbach’s alpha was used
to ascertain validity. A mean Cronbach’s alpha of 0.405
was obtained for the questionnaire. The voluntary nature
of participation and assurance of data condentiality was
mentioned explicitly. The study was given ethical clearance
from the Research Ethics Committee, College of Medicine,
King Faisal University.
Results
Mean age of the respondents was 22 years (standard
deviation: 2.95), which included 180 (42.9%)males and
239 (56.9%) females. Of the total,335 (79.8%) were single,
79 (18.8%) were married, and 6 were (1.4%) divorced.
The diagnosis of acne was made by a dermatologist in
211 (50.2%) of the respondents where as 209 (49.8%) were
not diagnosed by a dermatologist. Of males, 86 (47.8%)
were diagnosed by a dermatologist and 94 (52.2%) were
not. For females, 125 (52.2%) were diagnosed by a
dermatologist and 114 (47.85%) were not. There was
no signicant difference between males and females
regarding a formal diagnosis of acne made by a qualied
doctor (P = 0.207). Those who had acne for more than
1 year were more likely to be diagnosed by a doctor
(P = 0.00).
A total of 220 (52.4%) used some form of OTC
medications at least once, where as 108 (25.7%) used
prescription medications and 92 (21.9%) used both. The
most common OTC medications used were cleansers in
250 respondents(59.5%) followed by home remedies,such
as honey masks, lemon juice,and oatmeal in 98 respondents
(23.3%), 63 (15%) used leave‑on products and 47 used
mechanical treatments such as scrubs (11.2%) [Table 1].
The most common reasons for choosing OTC medicines
were due to its perceived effectiveness as per 95 (30.7%)
respondents and its safety according to 90 (29.1%).
A majority of the participants felt that the OTC medications
used were effective for their acne. Among prescription
medicines, the most commonly used were topical and
oral antibiotics (11.4%) [Table 2].The most common
source of information regarding acne medications was the
internet according to 133 students (31.7%), followed by
relatives in 126 (30%), friends in 93 (22.1), pharmacists in
82 (19.5%), and doctors and television each accounting for
46 respondents (11%).
Univariate, bivariate, and multivariate analysis were used
to extrapolate the results of the sample to the whole
population of university students in Saudi Arabia. Chi‑
square and multiple logistic regression tests were used, and
it was found that females were more likely to use OTC
medications compared to males [odds ratio (OR): 1.7,95%
CI: 1.01–2.74), (P = 0.04). Unmarried and married
individuals were equally likely to use OTC medications
(OR: 1.07.95% CI: 0.56–2.04) (P = 0.83); younger students
were more likely to use OTC medicines compared to older
ones (OR: 1.9 95% CI: 1.19–3.13) (P = 0.04).
Discussion
Acne is a common reason for dermatological consultation
globally as well as in the Kingdom of Saudi Arabia.[4]
Studies have shown that acne can signicantly affect the
body image perception. This is one of the possible reason
why many patients try various kinds of self‑medications
for acne. Improper use of self‑medications may not only
be associated with a lack of effect but may also lead to
signicant adverse effects.[12] Our study showed that most
of the respondents did not seek timely medical attention.
Table 1: Common types of over‑the‑counter acne
treatments used by the sample population
OTC Total Male Female
Cleansers 250 (59.5%) 99 (39.6%) 151 (60.4%)
Leave‑on products 63 (15%) 31 (49.2%) 32 (50.8%)
Mechanical treatments 47 (11.2%) 14 (29.8%) 33 (70.2%)
Essential oils 18 (4.3%) 5 (27.8%) 13 (72.2%)
Vitamins 22 (5.2%) 7 (31.8%) 15 (68.2%)
Home remedies and
herbal
98 (23.3%) 23 (23.5%) 75 (76.5%)
Table 2: Common prescription products used by the
sample population
Prescribed medicine Frequency
Topical and oral antibiotics 48 (11.4%)
Topical adapalene 35 (8.3%)
Topical azelaic acid 8 (1.9%)
Isotretinoin (systemic) 24 (5.7%)
Anti‑androgens
(spironolactone)
2 (0. 5%)
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Alshehri, et al.: Perceptions regarding over-the-counter and prescription medications for acne
122 Indian Dermatology Online Journal | Volume 8 | Issue 2 | March‑April 2017
A majority of them used complementary and alternative
therapies for their acne. A study by Magin et al. has also
shown that patients tend to prefer complementary and
alternative products for acne because of the“natural”tag.
The perceived self‑efcacy of these complementary/
alternative medicines was found to be relatively more for
acne as compared to psoriasis and eczema in this study
(which included 26 patients of acne, 29 of psoriasis, and
7 of atopic dermatitis).[13]
The importance of early treatment of acne is that it can
prevent scarring. Of the total respondents, 60.7% of
students suffered from acne for more than 1 year before
seeking medical attention, similar to a study by Tan et al.
from Canada,in which 74% of patients had waited for more
than a year before seeking medical attention for acne.[14]
In the present study, females were found to be signicantly
more likely to use self‑medication. The study by Tan et al.
also suggested that female patients were more likely than
male patients to use self‑medication products such as
facials, acne camouage or cover‑up, and facial masks
for treatment.[14] This may reect preconceived notions
of effectiveness, convenience, and familiarity. The study
by Tan et al. also showed that the most frequent acne
treatments used by patients before seeking medical attention
were cleansers (87%), acne pads containing alcohol‑based
solutions (55%), acne lotions containing alcohol‑ (47%),
acne cover‑up products (27%), masks (27%), and facials of
various types(22%).[14] In our study, the most common OTC
medication used was cleansers (59.5%).
Most of the patients mentioned that they read about acne
medications most frequently from the internet (31.7%). This
is in contrast to the study by Tan et al., where information
on acne was obtained most frequently from family
physicians (71%);other sources mentioned in this study
included magazines 44%, parents 31%, and friends 28%. In
community‑based surveys, the most frequently cited sources
of acne information were television (74%), parents (61%),
friends (47%), and magazines (39%). Of the total respondents,
58.7% of students who used prescribed medication did not
know about the name of the used medication. In the study by
Tan et al. the prescription acne product most often recognized
by patients was isotretinoin (58.3%).[14] It is possible that with
the internet and social media becoming more pervasive, the
primary source of knowledge regarding acne the world over
may shift to the internet. Dermatologists need to play an
important role in ensuring that reliable patient information is
available and easily accessible on the internet.
In our study, a doctor did not make the diagnosis in
approximately half the patients. The early diagnosis and
specialist treatment of acne is important to prevent scarring
as well as to reduce the psychosocial impact of acne,
especially in adolescents.[15‑17] Dermatologists also need
to be aware of all available treatment options for acne,
including OTC products which contain established anti‑
acne molecules such as benzoyl peroxide,[17‑19] and also need
to ensure better adherence to these established medications.
Studies have shown that prescription of a single product
might improve compliance with acne treatment.[15,20]
One of the positive aspects of our study was that none of
the respondents in the study reported having used any kind
of topical steroids for their acne. The misuse of topical
steroids for various conditions including acne is one of the
emerging scourges in some countries like India.[21]
Limitations
Our study did not address issues such as the specic,
detailed contents, effects and possible side‑effects of
common OTC preparations. The sample of university
students is expected to be more aware in general,and
therefore, it may not be reliable to extrapolate the results to
the general population.
Conclusion
The use of self and OTC medications is common among
university students in Kingdom of Saudi Arabia. The most
common OTC medicine used for acne was cleansers. The
most common source of information for acne medications
was the internet. Female students used OTC medicines
more than male students, and young students tend to use
it more than the older students. More studies are warranted
to evaluate the effects and side‑effects of different OTC
medications.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
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... [14] This is one of the probable reasons for self-medication or using alternative therapies (ayurvedic or homeopathic medicine) by the patients. [3] Improper medication use is likely to not only be non-efficacious but may also cause a plethora of adverse reactions. [8,9] Many of our cohorts used alternative medicines and suffered from deterioration in their acne. ...
... Almost similar findings have been reported in acne as well as in other diseases by many workers. [3,11,16,17] This finding indicates the significance of recognizing, and improving the noncompliant behavior of the patients as the medication may not work if not used properly, and also early in the therapy. Therefore, adherence to a proper regimen remains an essential component for the therapeutic efficacy of any acne medication. ...
... Early diagnosis and specialist treatment of acne are important to prevent scarring as well as to reduce the psychosocial impact of acne in all age groups. [3,24] Attempts should also be made to prevent medication misuse and acne patients should be sensitized about significant adverse effects associated with topical steroids use. ...
... Regarding sociodemographic factors, data from our study showed that gender contributed significantly to the frequency of self-medication with females showing a greater tendency to self-treat acne than males. The finding was expected and consistent with other studies assessing self-medication in general, and those assessing self-medication for acne, in particular [6,9,10]. This may be due to the increased concern with self-care in women [11]. ...
... A study in 2011 showed that the mass media and the internet were scarcely picked by respondents as a source of information [3]. However, another study in 2017 reported the internet as the main source of information in 31.7% of participants [10]. In keeping with the finding of the previous author, the outcome of the current study indicated the percentage of those who depended on the media escalated to 41.6%. ...
... According to this study's findings, 77.6% of respondents had a positive attitude towards self-medication, stating that it is part of self-care. Consistent results were noted by some studies [10,20]. Others reported percentages well below ours [7,24,25]. ...
... The present review found that the most common type of CAM used was honey [20] and the most common OTC medications used were cleansers. [21] discussion Based on the number of published articles in this systematic review, AV research in Saudi Arabia has grown substantially over the past decade. ...
... The main source of participants' knowledge about acne was the Internet (65.6%), followed by doctors and other medical staff (62.4%) and TV and radio (47.7%). [12,13,15,21] Perceptions about the causes of acne ...
... One of the important reasons for this was most of the patients believed that OTC medication was effective and safe. [21] Isotretinoin In Western Saudi Arabia, the Dermatology Department in the Faculty of Medicine at King Abdulaziz University evaluated dermatologists' attitudes and practices regarding isotretinoin in the Western area of Saudi Arabia. The majority of dermatologists used isotretinoin to treat severe nodular acne with 0.5 mg per kg for 3-6 months. ...
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Introduction: Acne vulgaris (AV) is one of the most common dermatological disorders. However, data of AV in Saudi Arabia are not well documented. Purpose: To determine the prevalence, potential risk factors, psychological impact, and treatment modality of AV in the Kingdom of Saudi Arabia and highlights the gaps of knowledge related to this disease. Methods: The literature search was performed using the keywords “acne vulgaris,” “Saudi Arabia,” and “KSA” in four electronic databases: PubMed, Google Scholar, Web of Science, and Embase. The search was restricted by the locational filter of Saudi Arabia and a timeframe of 2010–2019. Results: 453 potentially relevant titles and abstracts being identified, of which 18 articles met the inclusion criteria. AV is becoming more prevalent among the Saudi population, particularly among Saudi women. The knowledge and awareness of the public is relatively low. Conclusion: Community-based interventions on acne are needed to increase the awareness and to improve the perception and belief of acne patients. Further studies are needed to evaluate the effects and side effects of different complementary medicine and over-the-counter modalities.
... A single study conducted in Saudi Arabia presented data concerning OTC cosmeceuticals only used in the treatment of acne. 2 The aim of the current study was to determine the prevalence of OTC cosmeceutical self-medication among female students at Princess Nourah bint Abdulrahman University (PNU) in Riyadh, Saudi Arabia. It also aimed to compare the level of knowledge regarding the use of OTC cosmeceuticals based on different students' sociodemographic characteristics and educational backgrounds. ...
... The questionnaire was designed according to data retrieved from a scientific literature search of similar questionnaires performed on the use of OTC products other than cosmeceuticals. 2,6,9 In addition to demographic questions, the questionnaire included questions about the reasons for OTC administration, factors affecting students' choice of OTC cosmeceuticals, their source of knowledge, the frequency of usage, and their source of purchase. The questionnaire also contained additional questions to assess the level of the students' knowledge about OTC drug indications, adverse effects and necessary investigations needed before their use. ...
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Background‎: The reckless use of over-‎the-‎counter (OTC) cosmeceuticals among females is alarming due to possible health hazards, ranging from allergy to fatal anaphylaxis and toxicity. Methods‎: In the current study, we investigated the prevalence of cosmeceutical use among female students at Princess Nourah bint Abdulrahman University (PNU) and tested the effect of a pilot health education program in improving their knowledge. A cross-sectional questionnaire-based study was performed with 515 participants. Results‎: A significantly higher percent (81%) of participants used OTC cosmeceuticals than did not use them. The selection of OTC ‎‎cosmeceuticals was not affected by socioeconomic ‎status, chronic illness, cosmeceutical cost, or possible cosmeceutical side effects. Students from non-health colleges demonstrated poorer knowledge scores for the hazards of cosmeceuticals, which directed our attention to the importance of health education in this field. Therefore, a pilot interventional health education program was conducted with 54 participants to compare their ‎‎knowledge before and after the‎ intervention. At the end of the program, a higher‎ percentage of participants had improved their knowledge and realized the need to ‎consult a physician before using ‎OTC ‎‎cosmeceuticals. Conclusion: The health education program had a significant impact on knowledge ‎concerning the use of cosmeceuticals, and it is recommended that such programs be included in ‎undergraduate extracurricular activity, especially for female students.‎.
... This is necessary as antibiotic resistance in P. acnes is increasing and has become a public health concern. 8 To date, most research exploring prescribing patterns in acne 7,9 and adherence to acne treatments has been quantitative. [10][11][12] Qualitative research would be helpful in exploring perceptions of treatments and reasons for nonadherence but qualitative research on acne has focused mainly on the following: psychological impact, 13,14 psychosocial impact, 15,16 experiences of living with acne, 17-21 causes of acne, 22 sexual life and acne, 23 ambivalence and ambiguity in young people's experience of acne, 24 complementary and alternative medicines for acne 25 and patients' relationships with their doctors. ...
... A recent cross-sectional study with university students in Saudi Arabia found that 58Á7% of students did not know the name of their prescribed acne medication. 9 Our findings suggest that, in addition to this, young people find it difficult to differentiate between cosmetic, over-the-counter and prescribed acne treatments. This perception often resulted in them trying alternative treatments as first-line treatment or not using their treatment appropriately. ...
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Background: Acne vulgaris is a common skin condition affecting approximately 95% of adolescents to some extent. First line treatments are topical preparations but non-adherence is common. A substantial proportion of patients take long courses of oral antibiotics, associated with antibiotic resistance. This study aimed to explore young people's views and experiences of acne and its treatments. Methods: We report a secondary thematic analysis of interview data collected by researchers in HERG, University of Oxford. A total of 25 transcripts from young people aged 13-24 years with acne were included. Results: Acne is often perceived as a short-term self-limiting condition of adolescence and this appears to have implications for seeking treatment or advice. Participants widely perceived topical treatments as being ineffective, which seemed related to unrealistic expectations around speed of onset of action. Many participants felt they had tried all available topical treatments, although were unsure what was in them or unaware of differences between cosmetic and pharmaceutical treatments. They had concerns around how to use topicals 'properly' and how to avoid side effects. They were also concerned about side effects or necessity of oral treatments, though few seemed aware of antibiotic resistance. Conclusion: People with acne need support to manage their condition effectively, particularly a better understanding of different topicals, how to use them and how to avoid side effects. Unrealistic expectations about the onset of action of treatments appears to be a common cause of frustration and non-adherence. Directing people towards accessible evidence-based information is crucial.
... Among educated youth, the self-medication distribution was found to be high, although most of them were aware of the side effects [4]. There is an increase in the use of OTC drugs in Saudi Arabia, and practicing self-medication using OTC drugs is frequent among university students in Saudi Arabia [5][6]. The prevalence of self-medication among those who are aged between 13-18 years old in the capital of Saudi Arabia was found to be 94.5% [7]. ...
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Background: Over-the-counter-drugs (OTC) are drugs that can be obtained by patients without a prescription from a physician. In Saudi Arabia, it has been reported that more than half of university students practiced self-medication and used OTC drugs. Methods: An institutional-based cross-sectional study, among medical and non-medical students in Riyadh. The sample size was 421, by systemic random sampling. A pre-coded pre-tested online questionnaire was used. Data was analyzed using SPSS V 23. P-value ≤ 0.05 was considered significant. Results: There was no significant relationship between what the participants were majoring in and the usage of OTC drugs (p value= 0.373). Gender also had no relation with the use of OTC (p value= 0.168). Panadol appeared as the most commonly used OTC drug 62.9% for the relief of the most commonly mentioned factor which is headache 50.12%. Conclusion: Medical education didn’t have much of an effect on the use of OTC drugs. Moreover, professional guidance or advice was not considered most of the time for taking OTC, but the majority of respondents portrayed good behavior towards usage of OTC.
... 11 A recent study found that 58.7% of college students do not know the name of their prescribed acne medication. 16 Similarly, 60.2% of those in the level 0 and 1 groups of the present study did not know the name, components, or efficacy of the acne medication they used and 43.5% of participants in the level 0 and 1 group did not know how to use their topical medication properly. Topical medications for acne treatment often take weeks or even months of continuous use to produce a significant effect. ...
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Acne is a common skin condition among adolescents and young adults that not only causes cosmetic issues, but is also associated with significant psychological and social problems. However, patient adherence to acne treatment is often poor. Understanding the factors associated with treatment adherence will help to improve treatment efficacy and patient satisfaction. This cross-sectional survey aimed to explore Chinese college students’ perceptions regarding acne and its topical medications, and to evaluate whether these perceptions affect their motivation to seek and adhere to treatments. A 14-item questionnaire was administered via WeChat, and 1,415 responses were received. The prevalence of self-diagnosed acne was 34.1%. The factors associated with a greater likelihood of seeking treatment were being female, having acne for a longer duration, and having severe acne. Nearly two-thirds of the respondents had discontinued topical medication use within 1month, with only 4.8% continuing for over 6months. The main reason for discontinuation was slow onset of action. Patients who considered acne a long-term condition were more likely to seek treatment and use medication for longer periods than those who considered it a short-term condition. Lack of knowledge about medication features, proper usage, and prevention of adverse effects may lead to early discontinuation. Furthermore, 93.8% of the respondents hoped to obtain the above information from doctors. Overall, detailed explanations of acne and medication guidance are necessary to help patients understand the necessity of continuous treatment and the expected efficacy.
... Use of OTC medicines is a global problem including in Saudi Arabia. Use of OTC TCs is common especially among young females [11,12]. This existing scenario underscores the need for understanding the consumers' knowledge and practice regarding use of clobetasol, and suggesting possible interventions. ...
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Aims: The current study aimed to evaluate female consumers' knowledge and practice about harmful effects of topical clobetasol applied on the face for cosmetic purposes. Study Design: Cross-sectional study. Place and Duration of Study: Randomly selected community pharmacies, well known cosmetic shops and shopping malls of Hail region, Saudi Arabia from March 2018 to June 2018. Methodology: We included 391 participants who only used 'clobetasol' as a topical steroid at the time of interview, responses were collected as per the study tool and analyzed using SPSS for Windows, Version 16.0. Chicago, SPSS Inc.. Original Research Article Ansari et al.; JPRI, 31(6): 1-7, 2019; Article no.JPRI.52747 2 Results: Relatives (28.1%), friends (25.6%) and community pharmacists (15.6%) contributed significantly towards using topical clobetasol cream. In 86.2% of the cases, the pharmacists who dispensed clobetasol did not inform the consumer about the harmful effects. Purchasing the cream without prescription (P = 0.025) was significantly associated with age. In the study, 41.9 % of the females experienced adverse effects, with the commonest one being hair growth on face (23%) followed by dermatrophy (14.8%); with a significant association with frequency of use (p<0.001). Conclusion: There was haphazard use of topical clobetasol by females and they were unaware of the adverse effects. Over-the-counter availability of topical clobetasol, lack of knowledge about harmful effects, and lack of counseling on its safety profile by community pharmacists and other healthcare professionals are mainly responsible for its misuse and harmful consequences.
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Background: A lot of cosmetic and Ayurvedic products containing unlabeled depigmenting agent and steroids are available readily over the counter sale. The side effects of these products are not documented and can lead to adverse effects of continuous usage. Objective: By this study, we aimed to find out the true nature of the above problem and it's implication in the Indian rural scenario. Methodology: All patients attending dermatology department during the period of 3 months from May to June 2013 for skin diseases were enquired about unsupervised use of any cosmetic product on their facial skin, duration of use, any side effect experienced through the prescribed questionnaire. Results: Total 50 patients were recruited for the study. Out of which, 48% were males and 52% were females. Seventy-four percent of people had applied topical products/steroids in an attempt of attainment of fair complexion, 14% for melasma, 8% for acne induced hyperpigmentation, and 4% for dark circles. About 80% people had obtained one or the other products over the counter sale, 8% had followed the attractive advertisements, 8% had started the application on the recommendation of friends/family while only 4% people had correctly gone through the proper channel to consult a dermatologist. Conclusion: The problem of topical products or steroids abuse is rampant and significant, and unless and until immediate steps are taken to root out this problem from our setup, the condition will become worse all the more.
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Skin disorders such as acne, which have significant cosmetic implications, can affect the self-perception of cutaneous body image. There are many scales which measure self-perception of cutaneous body image. We evaluated the use of a simple Cutaneous Body Image (CBI) scale to assess self-perception of body image in a sample of young Arab patients affected with acne. A total of 70 patients with acne answered the CBI questionnaire. The CBI score was correlated with the severity of acne and acne scarring, gender, and history of retinoids use. There was no statistically significant correlation between CBI and the other parameters – gender, acne/acne scarring severity, and use of retinoids. Our study suggests that cutaneous body image perception in Arab patients with acne was not dependent on variables like gender and severity of acne or acne scarring. A simple CBI scale alone is not a sufficiently reliable tool to assess self-perception of body image in patients with acne vulgaris. Key words: acne vulgaris, cutaneous body image, self-perception
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Objective. This study was conducted to assess the knowledge, beliefs, and psychosocial effect of acne vulgaris among acne patients attending referral dermatology clinic in Al-Khobar city. Material and Methods. A cross-sectional study was conducted on all Saudi acne patients (males and females) attending referral dermatology clinic in Al-Khobar Governmental Hospital. The data were collected by using a structured self-administered questionnaire. Results. Like other studies conducted before, we found that 58.33% of our sample have poor knowledge about factors that affect acne vulgaris with a significant correlation with both age and gender (P = 0.012 and P = 0.031, resp.). There was significant association of reporting affected social activities with age and educational level (P = 0.023 and P = 0.013, resp.). Variation between both genders regarding reporting feeling stressed due to acne was significant (P = 0.001). The majority of our sample sought medical advice after one year. The most commonly used treatment for acne vulgaris before seeking medical help was peeling products. The majority of our patients thought that acne needs no treatment by physicians. Doctors' treatment is considered guaranteed and safe by the vast majority of our patients. Conclusion. This study showed that knowledge about acne is still insufficient among acne patients.
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Acne is a common dermatological disorder that most frequently affects adolescents; however, individuals may be affected at all ages. Many people who suffer from acne seek treatment from both prescription and over-the-counter acne medications. Due to convenience, lower cost, and difficulty getting an appointment with a dermatologist, the use of over-the-counter acne treatments is on the rise. As the plethora of over-the-counter acne treatment options can be overwhelming, it is important that dermatologists are well-versed on this subject to provide appropriate information about treatment regimens and potential drug interactions and that their patients see them as well-informed. This article reviews the efficacy of various over-the-counter acne treatments based on the current literature. A thorough literature review revealed there are many types of over-the-counter acne treatments and each are designed to target at least one of the pathogenic pathways that are reported to be involved in the development of acne lesions. Many of the key over-the-counter ingredients are incorporated in different formulations to broaden the spectrum and consumer appeal of available products. Unfortunately, many over-the-counter products are not well-supported by clinical studies, with a conspicuous absence of double-blind or investigator-blind, randomized, vehicle-controlled studies. Most studies that do exist on over-the-counter acne products are often funded by the manufacturer. Use of over-the-counter acne treatments is a mainstay in our society and it is important that dermatologists are knowledgeable about the different options, including potential benefits and limitations. Overall, over-the-counter acne therapies can be classified into the following five major groups: cleansers, leave-on products, mechanical treatments, essential oils, and vitamins.
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Acne vulgaris (AV) is the most common skin disorder. It was traditionally thought that AV lesions developed after abnormal desquamation of the keratinocytes that line the sebaceous follicle, leading to hyperkeratinization and microcomedone formation. However, in recent years there has been a paradigm shift with regard to understanding the pathogenesis of AV, and it is now viewed as a primary inflammatory skin disorder. Research has implicated the presence of subclinical inflammation in the normal skin of acne patients, even before microcomedone formation. This article will review the novel concepts that play a role in the new pathogenesis of acne vulgaris. J Drugs Dermatol. 2016;15(1 Suppl 1):s7-s10.
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Background: Over-the-counter acne treatments have assumed more importance for the dermatologist as access and affordability of prescription acne medications has decreased. AIM: This research evaluated the efficacy of a three step acne treatment regimen containing stabilized botanical anti-inflammatory ingredients as compared to a currently marketed acne regimen. METHOD: 80 female/male subjects 12+ years with mild to moderate acne (at least 10 inflammatory and 10 non-inflammatory lesions) were enrolled for 12 weeks and randomized to use the study botanical anti-inflammatory acne regimen or the traditional benzoyl peroxide comparator. Evaluations included investigator global assessment, investigator tolerability assessment, acne lesion characteristics (erythema, lesion height, diameter of inflammation, and amount of pus), subject product assessment, and digital photos at baseline, 2, 4, and 12 weeks. RESULTS: The botanical regimen outperformed the comparator in terms of target lesion erythema, height, inflammation, and pus at weeks 2 and 4, perhaps due to anti-inflammatory ingredients, however parity was reached between the two products by week 12. No difference in lesion counts between the two groups was noted at week 2, however by week 4, there was a lower lesion count with the study regimen in terms of closed comedones ( P <0.001) and inflammatory ( P =0.016) lesions than the comparator. This statistically significant difference continued into week 12 with a reduction in closed comedones ( P =0.006) for the study regimen. CONCLUSION: Modern OTC cosmetic formulation ingredients including emollients, anti-inflammatory/antioxidants, and sensitive skin modulators provided an improved skin appearance, less lesional erythema, and a better overall appearance in subjects with acne treated for 12 weeks. J Drugs Dermatol. 2015;14(12):1418-1421.
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Treatment outcomes depend on adherence to the prescribed regimen. Primary nonadherence refers to not obtaining and starting to take a prescribed medication. The frequency of primary nonadherence to acne treatment has not been well characterized. The complexity of multidrug acne regimens may add to this problem but, to our knowledge, has not been explored. To estimate acne treatment primary nonadherence rates and to determine the relationship between primary nonadherence and the number of acne treatments prescribed. A review of medical records from an outpatient university dermatology clinic identified patients with an acne diagnosis at a dermatology visit in the past 3 months who were prescribed 1, 2, or 3 or more treatments. Patients were excluded if they were not English speakers, were not prescribed treatment for their acne, or did not have an active telephone number. Using randomized lists, these patients were queried via telephone regarding which acne treatments they obtained. The results were analyzed using Fisher exact tests and multivariable logistic regression. For patients who were prescribed 1, 2, or 3 or more treatments, 47, 48, and 48 eligible patients were contacted, respectively. The primary study outcomes were the overall rate of primary nonadherence and the rate for each treatment-number subgroup. Secondary outcomes included the association of sex, age, medication type, and electronic prescription status with primary nonadherence. Overall, 27% of patients did not fill all their prescriptions. Of patients who were given 1, 2, or 3 or more treatments, 9%, 40%, and 31%, respectively, did not fill all their prescriptions. There was no statistically significant difference by sex or age for primary nonadherence in any of the 3 treatment-number groups. Based on multivariable analyses, being prescribed a topical retinoid (odds ratio, 2.9; 95% CI, 1.0-8.0) or an over-the-counter product (odds ratio, 3.6; 95% CI, 1.1-12.3) was associated with primary nonadherence. Based on univariate analysis, there was less primary nonadherence with electronic prescriptions compared with paper prescriptions (P < .001). Primary adherence to an acne treatment regimen is better when only 1 treatment is prescribed. Some patients may not complete acne treatment because 1 or more of their medications were never obtained.
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Benzoyl peroxide (BPO) is a widely used over-the-counter (OTC) topical acne treatment often used in combination with salicylic acid (SA) to achieve better comedone control than that achieved with BPO alone. MaxClarity™ is an OTC acne treatment system comprising BPO and SA in an aqueous foam delivery vehicle, VersaFoam AF™. This paper describes 2 open-label, single-arm studies conducted to assess the efficacy, safety, tolerability, and patient preference of MaxClarity in the treatment of mild, moderate, and severe acne. Subjects applied MaxClarity twice daily for 8 weeks in study 402 and for 12 weeks in study 405. Reductions in all lesion types were seen throughout both studies. At week 8 (study 402), there was a mean reduction from baseline of -56.9 ± 32.7% in total lesions in subjects with mild, moderate, or severe acne. At week 12 (study 405), there was a reduction from baseline of -61.6 ± 22.0% in total lesions in subjects with moderate or severe acne. Overall, both studies demonstrated that MaxClarity is a generally well tolerated and effective treatment for mild, moderate, and severe acne. J Drugs Dermatol. 2013;12(3):259-264.
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Acne is the most common disease of the skin. It affects 85% of teenagers, 42.5% of men, and 50.9% of women between the ages of 20 and 30 years.96,97 The role of hormones, particularly as a trigger of sebum production and sebaceous growth and differentiation, is well known. Excess production of hormones, specifically androgens, GH, IGF-1, insulin, CRH, and glucocorticoids, is associated with increased rates of acne development. Acne may be a feature in many endocrine disorders, including polycystic ovary disease, Cushing syndrome, CAH, androgen-secreting tumors, and acromegaly. Other nonendocrine diseases associated with acne include Apert syndrome, SAPHO syndrome, Behçet syndrome and PAPA syndrome. Acne medicamentosa is the development of acne vulgaris or an acneiform eruption with the use of certain medications. These medications include testosterone, progesterone,steroids, lithium, phenytoin, isoniazid, vitamins B2, B6, and B12, halogens, and epidermal growth factor inhibitors. Management of acne medicamentosa includes standard acne therapy. Discontinuation of the offending drug may be necessary in recalcitrant cases. Basic therapeutic interventions for acne include topical therapy, systemic antibiotics,hormonal agents, isotretinoin, and physical treatments. Generally, the severity of acne lesions determines the type of acne regimen necessary. The emergence of drug-resistant P acnes and adverse side effects are current limitations to effective acne management.