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Journal of Dermatology & Dermatologic Surgery xxx (2017) xxx–xxx

Prevalence, level of knowledge and lifestyle association with acne

vulgaris among medical students
Abdulmajeed Alajlan a,⇑, Yousef A. Al Turki b, Yasser AlHazzani c, Nasser Alhowaish c,
Naif AlEid c, Zeyad Alhozaimi c, Wael Al Saleh c, Abdulaziz Bin Yahya c, Yazed Alkriadees d,
Sami Alsuwaidan a
a
Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
b
Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
c
College of Medicine, King Saud University, Riyadh, Saudi Arabia
d
AlMaarefa Colleges, Saudi Arabia

Received 7 December 2016; accepted 9 January 2017

Abstract

Objectives: To estimate the prevalence, knowledge and lifestyle association with acne among medical students at King Saud University,
Riyadh, Kingdom of Saudi Arabia. Methods: This quantitative, observational and cross-sectional study was conducted among medical
students in March 2015 by using self-administered questionnaire survey. Statistical analysis was performed using p-value. Results: A total
of three hundred and seventy-five medical students were recruited, and more than half of them had acne vulgaris (n: 208; 55.5%) with less
than one third of them being diagnosed by a physician. Most of the female students (n: 75; 61%) dealt with acne as a significant medical
condition when compared with only third (n: 87; 34%) of the male students (P < 0.05). Eighty-nine female students (72%) believed more
than male students (n: 104; 41%) that stressful environment played a significant role in acne vulgaris (p > 0.05). One hundred and twelve
male students (44.8%) believed more than females (n: 39; 31%) that acne affects their marriage prospectus p < 0.05. Conclusion: Interest-
ingly, more than half of our sample population was affected by acne vulgaris with two thirds of them not seeking for medical advice.
Knowledge misconceptions were widespread among medical students, which necessitate further education in this regards.
Ó 2017 Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest Diseases and Tuberculosis. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Acne; Vulgaris; Prevalence; Lifestyle and KSU

1. Introduction 2014). A Study done in Portugal 2012 showed that its

prevalence was about 62.2% among medical students with
Acne is a common human skin disorder which affects no significant gender predilection (Gonçalves et al., 2012).
people of all races and ages (Ali et al., 2010; Ullah et al., Another study done on adolescent and Adults Chinese
population estimated that up to 10.4% of males and 6.1%
⇑ Corresponding author at: College of Medicine, King Saud University, of females are affected by acne among the general popula-
Riyadh, Saudi Arabia. tion (Shen et al., 2012). However, several studies conducted
E-mail address: drajlan@yahoo.com (A. Alajlan). in Saudi Arabia found that more than half of its school and
Peer review under responsibility of King Saud University. university students suffered from acne while this estimate
was up to 64.5% among the general population
(Al-Hoqail, 2003; Al Robaee, 2005; Al Mashat et al., 2013).
Production and hosting by Elsevier

http://dx.doi.org/10.1016/j.jdds.2017.01.001
2352-2410/Ó 2017 Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest Diseases and Tuberculosis.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Alajlan, A. et al., Prevalence, level of knowledge and lifestyle association with acne vulgaris among medical students,
Journal of Dermatology & Dermatologic Surgery (2017), http://dx.doi.org/10.1016/j.jdds.2017.01.001
2 A. Alajlan et al. / Journal of Dermatology & Dermatologic Surgery xxx (2017) xxx–xxx

Moderate to severe acne greatly affects the quality of life assessing knowledge section. A pilot study was also con-
with reduced self-esteem, marred physical appearance and ducted to know the reliability, validity and feasibility of
less social relationships with others (Tasoula et al., 2012). the questionnaire. Statistical analysis was performed using
Several factors have been associated with the development Statistical Package for the Social Sciences (SPSS) version
of acne including hormonal activity such as menstrual 19 software (SPSS Inc., Chicago, IL, USA). Chi-square test
cycles and puberty, genetic predisposition, diet [Carbohy- or Fisher’s exact test was used to compare between male
drates], infection and stress (Albuquerque et al., 2014; and female groups with respect to all different nominal
Cho et al., 2014; Bek-Thomsen et al., 2008; Mahmood variables and also compare different academic years. It
and Bowe, 2014). However, there are only limited studies was assumed that there was a statistically significant differ-
that have explored the possible association of stress espe- ence when the P-value was less than 0.05. This research was
cially with study and a lot of work and acne approved by the ethics committee of family and commu-
(Yosipovitch et al., 2007). nity medicine department in King Saud University (see
The theoretical knowledge about acne among medical Table 1).
students is relatively limited before they start their clinical
training (Shivaswamy et al., 2014). Forty-four percent of 3. Results
university students had inadequate knowledge about acne
and most of them believed that the factors responsible A total number of three hundred and seventy-five med-
for acne were hormones and stress (Al Robaee, 2005). ical students were recruited, with more than half of them
Some students also have misconceptions and inadequate had acne vulgaris (n: 208; 55.5%), and less than one third
knowledge about acne (Ali et al., 2010). of them were diagnosed by a physician (n: 75; 20%) see
There is also not enough information in the literature Table 2. Out of all the participants, there were 250 males
about acne vulgaris for the medical students in Saudi Ara- (66.7%) and 125 females (33.3%), the gender factor being
bia. There is a lack of evidence about the association of statistically insignificant (p > 0.05). Most of the female stu-
acne vulgaris with its causes. Henceforth, this study was dents around (n: 75; 61%) dealt with acne as a significant
undertaken to assess its prevalence, the level of knowledge medical condition when compared with only one third 87
and lifestyle association of acne among medical students. of the male students (n: 87; 34%) (P < 0.05). Of all students,
135 (37.2%) think they have adequate knowledge about
2. Methods acne vulgaris wherein 47 (64.4%) were from the 5th year,
44 (62%) were from the 4th year, 16 (22.5%) were from
In this quantitative, observational and cross-sectional the 3rd year, 16 (21.9%) were from the 2nd year and 12
study, the data were collected by using stratified random (16%) were from the 1st year, which is statistically signifi-
sampling technique from undergraduate medical students cant (p > 0.05), see Table 2. Various sources of Acne infor-
at King Saud University, Riyadh, Kingdom of Saudi Ara- mation including information from the Internet were
bia, in March 2015. The sample consisted of 375 partici- chosen by 246 (65.6%) participants, and then doctors by
pants (250 males and 125 females) who were divided into 220 (58.7%) were the most common sources of informa-
15 groups, 5 for females and 10 for males and 25 students tion, whereas newspapers were the least one (n: 22; 5.9%),
were randomly selected from each group. The undergradu- see Table 3. Eighty-nine females (72.4%) more than males
ate medical students were included and the postgraduate (n: 104; 41.9%) believed that the stressful environment
doctors were excluded from this study. Mainly, a paper- played an important role in causing acne vulgaris
based self-administered English questionnaire with an Ara- (p > 0.05). As to other causes, most of the students (n:
bic introduction was used to explain the goal of this 327; 87.2%) were of the opinion that acne vulgaris
research and to give the participants an important informa- increased due to hormonal disturbance and 219 (58.4%)
tion about acne vulgaris with an exception for the first and were of the opinion that it increased due to the consump-
fourth year medical students who were given an electronic tion of fatty foods, see Table 2. One hundred and twelve
questionnaire because of their examinations. This question- male students (44.8%) thought that having acne affected
naire also reaffirmed the study participants that this infor- their marriage prospectus more than females (n: 39;
mation was intended to be kept confidential. The 31.2%) p < 0.05. Finally, most of the students (n: 276;
questionnaire was divided into three sections: Socio- 73.6%) were of the opinion that acne vulgaris had an
demographic section, estimating prevalence section and impact on their self-confidence.

Table 1
Demographics and prevalence of acne vulgaris.
Gender Age Marital status Academic level Prevalence of acne
66.7% (Males) 28% (<21 Years Old) 99.2% (Singles) 40% (1st & 2nd Year) 55.5% (Yes)
33.3% (Females) 72% (21 Years Old) 0.8% (Married) 60% (3rd, 4th & 5th Year) 44.5% (No)

Please cite this article in press as: Alajlan, A. et al., Prevalence, level of knowledge and lifestyle association with acne vulgaris among medical students,
Journal of Dermatology & Dermatologic Surgery (2017), http://dx.doi.org/10.1016/j.jdds.2017.01.001
 A. Alajlan et al. / Journal of Dermatology & Dermatologic Surgery xxx (2017) xxx–xxx 3

Table 2
Students’ beliefs about acne causes, students’ levels and confidence of knowledge.
Students’ beliefs about acne causes Inadequate sun Inactivity Sugary Inadequate Not eating Genetically Fatty Hormonal
exposure diet sleep healthy related diet disturbances
15.7% 18.4% 21.3% 26.1% 48.0% 48.0% 58.4% 87.2%
Students levels and confidence of 1st & 2nd Academic Year 3rd, 4th & 5th Academic Years
knowledge about acne
19% (Confident) 74% (Confident)
81% (Not Confident) 26% (Not Confident)
Medical students might choose more than one option.

Table 3 acne vulgaris. This belief of adequate information was least

Source of information. present among the 1st year students (n: 12; 16%) and was
Source All levels (%) highest among the 5th year students (n: 47; 64.4%), with
significant association (p > 0.05) and is thought that the
Internet 65.6
Doctors 58.68 dermatology course in the 4th year had broadened their
Medical books 52.26 knowledge about acne vulgaris.
Medical journals 34.94 Our study also showed that 246 (65.6%) medical stu-
Newspapers 5.9 dents considered searching the Internet as their main
Others 4
source of finding information about acne vulgaris; 220 stu-
Medical students might choose more than dents (58.7%) obtained their information from doctors and
one option.
22 students (5.9%) from newspapers. In Dr. Alrobaee sur-
vey, newspaper was the most preferred source (Al Robaee,
4. Discussion 2005) taking into account that this study was done in 2005
when newspapers were more dominant in those days.
A recent study by Al Mashat et al. (2013) showed the It was noticed that the first year medical students used
prevalence of acne among Saudi population at 64.5%. Internet the most, while the 5th year medical students used
Two previous studies done by Alrobaee and Al Hoqail medical journals the most. It is also believed that students
on students showed the prevalence of Acne at 56.2% and in the fifth year were more aware of the reliability of the
53.4% respectively (Al-Hoqail, 2003; Al Robaee, 2005). source material and its scientific evidence.
Internationally, a study done in Sindh Medical College in Most of the students (n: 327; 87.2%) were of the opinion
Karachi, showed that 55.9% of its study participants suf- that acne vulgaris increased or was caused by hormonal
fered from Acne (Ali et al., 2010). This was in comparison disturbances and 219 (58.4%) students were of the opinion
with our study which showed 208 (55.5%) medical students that it increased or was caused by the consumption of fatty
being affected by acne vulgaris. foods. This can be related to the study by Al Mashat who
In our survey 193 students (52%) were of the opinion also reported that 88.2% of his participants believed hor-
that stressful environment played a major role in causing mones have an effect on acne and 34.1% of participants
acne vulgaris, with significant association between males believed acne is increased by consuming certain foods (Al
(n: 104; 41.9%) and females (n: 89; 72.4%) and p Mashat et al., 2013).
value < 0.05. A study done in Brazil showed that there is
a significant association between acne vulgaris and stress 5. Conclusion/recommendations
(Albuquerque et al., 2014), linking with Al Mashat study
which also showed 58.4% of individuals believed that stress More than half of our sample population was affected
aggravates acne vulgaris (Al Mashat et al., 2013). by acne vulgaris with two thirds of them not seeking for
This study also showed that 252 (67.9%) students were any medical advice. Knowledge misconceptions were wide-
of the opinion that diet is one of the etiological factors spread among medical students, which necessitate further
causing acne vulgaris. According to another study done education in this regards. Medical students in the first
in Turkey, fatty and sugary foods were associated with two years need more education about acne vulgaris, when
increased risk of acne (KokuAksu et al., 2012). compared to those in their last three years who felt much
Most of the female students in this study dealt with acne more adequate in their knowledge of acne vulgaris. The
as a significant medical condition when compared with majority of students have the opinion that acne vulgaris
only 34% of the male students (P < 0.05) linking with Al has psychological influences such as loss of confidence, sad-
Mashat study which also reported that 53.82% of its study ness and worry.
participants believed that acne was a serious health prob-
lem (Al Mashat et al., 2013). Conflict of interest
Our study also showed that 135 (37.2%) medical stu-
dents believed that there is adequate information about The authors declared that there is no conflict of interest.

Please cite this article in press as: Alajlan, A. et al., Prevalence, level of knowledge and lifestyle association with acne vulgaris among medical students,
Journal of Dermatology & Dermatologic Surgery (2017), http://dx.doi.org/10.1016/j.jdds.2017.01.001
4 A. Alajlan et al. / Journal of Dermatology & Dermatologic Surgery xxx (2017) xxx–xxx

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students (Maha AlKubaidan, Khulood AlRaddadi, Aisha KokuAksu, A., Metintas, S., Saracoglu, Z., Gurel, G., Sabuncu, I.,
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1503–1509.
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Please cite this article in press as: Alajlan, A. et al., Prevalence, level of knowledge and lifestyle association with acne vulgaris among medical students,
Journal of Dermatology & Dermatologic Surgery (2017), http://dx.doi.org/10.1016/j.jdds.2017.01.001