Authors: Diane V. Lagda, MD, DPDS, Ricky H. Hipolito MD, DPDS, Ma. Teresita G. Gabriel, MD, FPDS, Marie Socouer M. Oblepias, MD, FPDS, Emmerson Gale S. Vista, MD, FPDS and Luella Joy A. Escueta, MD, DPDS
Background: Acne is a common disorder, which mostly affects adolescents. There is still little knowledge on the factors that affect patients’ decision to seek dermatologic consult.
Objectives: To determine the association of socio-demographic factors, knowledge, beliefs, disease severity, and quality of life to treatment- seeking behavior among acne patients seen at the Outpatient Department of the Research Institute for Tropical Medicine.
Methods: A cross-sectional study was conducted among patients ages 11–50 years-old. Patients completed a self-administered questionnaire and were examined by a dermatologist. Patients’ demographic data, knowledge and perceptions on acne, acne severity, quality of life and treatment-seeking behavior were measured using frequencies. Treatment delay and sex association was assessed using Mann-Whitney test. Treatment delay association with age groups, education, income groups, source of information on acne, severity grade, Dermatology Life Quality Index (DLQI) groups, Cardiﬀ Acne Disability Index (CADI) groups, and scarring grouped in quartiles were analyzed using Kruskal-Wallis.
Results: Four hundred five patients (117 males and 288 females; 11-50 years-old, mean age: 22.44 ± 6.60 years) with mild, moderate, moderately severe and very severe acne were included in the study. The mean treatment delay (MTD) was longer in patients aged 36- 40 (6.09 ± 4.69). Overall MTD in years was 2.78 ± 2.46 in males and 3.05 ± 3.34 in females. MTD was shorter in patients from the upper income than lower income class (1.17 ± 2.25 vs. 4.44 ± 3.80) and in patients with radio (0.97 ± 0.89), non-dermatology physicians (1.64 ± 2.09), family (2.51 ± 2.43), friends (2.79 ± 2.67) and internet (2.79 ± 3.17) as their source of information than those whose sources were from brochures (6.95 ± 4.69), cosmetologists (6.10 ± 3.97), commercial establishments (5.23 ± 6.97) and magazines (4.30 ± 5.29). The MTD was longer in patients with very severe acne (3.5±1) based on modified Leeds Revised Acne Grading System compared to moderate acne (2.85±3.14). Using the DLQI, 153 (37.78%) revealed that acne had moderate effect on their lives (7.37±4.82). Based on the CADI, 183 (45.2%) patients had moderate impairment level. Majority of the patients (57.53%) have scars. There were significant correlations between MTD and age (p value= 3.599×10-06), income class (p value= 1.62 x10-14), source of information (p value= 0.003642) and scarring (p value= 0.003642).
Conclusion: We found out that majority of patients have false perceptions about acne so there is a need to educate them to prevent inappropriate treatment and self-medication. It was also noted that treatment delay was significantly longer in older patients, lower income patients and patients with scars. Therefore, it is prudent to inform patients to seek dermatologic consult in treating acne for proper management and decrease risk for scarring.
Lagda, D, Hipolito ,R, Gabriel ,MT, Oblepias,MS, Vista,EG, & Escueta, LJ. (2017). Factors related to treatment-seeking behavior among acne patients seen in a tertiary hospital in the Philippines: A cross-sectional study. Journal of the Philippine Dermatological Society, 26(1), 12-22.
acne, beliefs, treatment-seeking, perceptions, treatment delay
1. Burton JL, Cunliffe WJ, Stafford I. Prevalence of Acne Vulgaris in Adolescence. Br J Dermatol. 1971; 85(2):119-126.
2. Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ, et al. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. J Am Acad Derm. May 2009; 60(5).
3. Handog EB, Datuin ML, Singzon IA. Chemical Peels for Acne and Acne Scars in Asians: Evidence Based Review. J Cutan Aesthet Surg. 2012 Oct-Dec; 5(4):239-246.
4. Handog EB, Macarayo MJ, Gabriel MT. Acne scars in Asian patients. 1st edition. In: Tosti A, De Padova M, Beer K, editors. Acne scars: Classification and treatment (Series in dermatological treatment). UK: Informa Healthcare. 2009:90.
5. Kwon HH, Yoon HS, Suh DH, Yoon JY, Park SK, Lee ES, et al. A nationwide study of acne treatment patterns in Korea: Analysis of patient preconceived notions and dermatologists suggestion for treatment. Acta Derm Venereol. 2012; 92.
6. Brajac I, Bilic-Zulle L, Tkalcic M, Loncarek K, Gruber F. Acne vulgaris: myths and misconceptions among patients and family physicians. Patient Educ Couns. 2004; 54:21-25.
7. Suh DH, Shin JW, Min SU, Lee DH, Yoon MY, Kim NI, et al. Treatment – seeking behaviors and related epidemiological features in Korean acne patients. J Korean Med Sci. 2008; 23:969-74.
8. Tan JKL, Vasey K, Fung KY. Beliefs and perceptions of patients with acne. J Am Acad Dermatol. March 2001; 44(3).
9. Darwish M, Al-Rubaya A. Knowledge, Beliefs, and Psychosocial Effect of Acne Vulgaris among Saudi Acne Patients. ISRN Dermatology. 2013; 1-6.
10. O’Brien SC, Lewis JB, Cunliffe WJ. The Leeds Revised Acne Grading System. J Dermatol Treat. 1998; 9:215-20.
11. Dreno B, Khammari A Orain N, Noray C, Merial-Kieny C, Mery S, et al. ECCA grading scale: an original grading scale for clinical practice in dermatology. Dermatology. 2007; 214:46-51.
12. Finlay A Y, Khan G K. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19:210-216. J Phil Dermatol Soc • May 2017 • ISSN: 2094-201X 19
13. Motley RJ, Finlay AY. Practical use of a disability index in the routine management of acne. Clin Exp Dermatol. 1992; 17:1-3.
14. Zaenglein AL, Thiboutot DM. Acne vulgaris, 3rd edition. In: Bolognia, J, Jorizzo, J, Schaffer J, editors. Dermatology. Connecticut: Elsevier. 2003; 545-558.
15. Rasmussen JR, Smith SB. Patient concepts and misconceptions about acne. Arch Dermatol. 1983; 119:570-2.
16. Poli F, Auffret N, Beylot C, Chivot M, Faure M, Moyse D, et al. Acne as seen by adolescents: results of questionnaire study in 852 French individuals. Acta Dermato-Venereol. 2011; 91(5):531-536.
17. Zaenglein AL, Graber EM, Thiboutot DM. Acne vulgaris and Acneiform Eruptions. 7th edition. In: Wolff, K, Goldsmith L, Katz S, Gilchrest B, Paller A, Leffel D, editors. Fitzpatrick’s Dermatology in General Medicine. United States of America: McGraw-Hill. 2008; 897-916.
18. Monfrecola G, Annunziata MC. Environmental Factors. In: Schwartz RA, Micali G, editors. Acne.India: Macmillan. 2013; 23.
19. Tedeschi A, Mambrin A, Francesconi L, Fabbrocini G, Micali G. Environmental Factors. In: Schwartz RA, Micali G, editors. Acne. India: Macmillan, 2013; 143.
20. Al-Hoqail I.Knowledge, beliefs and perception of youth toward acne vulgaris. Saudi Med J. 2003; 24(7):765-768.
21. Yap FB. Cardiff Acne Disability Index in Sarawak, Malaysia. Ann Dermatol. 2012; 24(2):158-161.
22. Layton RJ, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol. 1994; 19(4)303-8.
23. Leelavathi M, Tan HC, Puah JWD, Apipi M, Sohami AE, Mahat NF. Acne Disability, Self-Management and Help-Seeking Behavior among Medical Students. Med & Health. 2015; 10(1):1-9.
24. Chuah SY, Goh CL. The impact of post-acne scars on the quality of life among young adults in Singapore. J Cutan Aesthet Surg. 2015; 8:153-8.