Risk Factors and Epidemiology of Acne Severity and Acne Scar Development: A Comprehensive Clinical Study

Fatma Etgü; Gul Sekerlisoy Tatar

doi:10.5826/dpc.1504a6108

Risk Factors and Epidemiology of Acne Severity and Acne Scar Development: A Comprehensive Clinical Study

Authors

Fatma Etgü Ordu University, Faculty of Medicine, Department of Dermatology, Ordu, Türkiye https://orcid.org/0000-0003-1214-3327
Gul Sekerlisoy Tatar Department of Dermatology, Liv Hospital, Samsun, Türkiye https://orcid.org/0000-0002-3061-7306

Keywords:

Acne, Acne scarring, Acne severity, Acne scar severity, Risk factors

Abstract

Introduction: Acne vulgaris, affecting around 9.4% of the global population, is a common disorder of the pilosebaceous unit. Approximately 95% of affected individuals develop some degree of scarring, which, along with active acne, contributes significantly to psychosocial morbidity.

Objectives: This study aimed to evaluate the factors influencing acne severity, the development of acne scars, and the severity of scarring in patients with acne vulgaris.

Methods: A cross-sectional study was conducted between May and November 2024 at the dermatology outpatient clinic of Ordu University, Turkey. Demographic data, characteristics of acne lesions, treatment history, and various potential risk factors for acne and scarring were recorded. Acne severity and scar severity were evaluated using standardized grading systems.

Results: A total of 269 patients (175 females, 94 males) were included, with acne scars observed in 71.3%. Younger age, earlier, and adolescent-onset acne were significantly associated with greater acne severity and scarring. Male sex and severe acne further increased the risk and severity of scars. Patients with scarring reported higher emotional stress. Post-lesional hyperpigmentation and erythema predicted more severe scarring. Prior use of topical agents and systemic antibiotics was linked to increased scar risk, while systemic isotretinoin had a protective effect.

Conclusions: Early identification of risk factors and timely intervention may help reduce the burden of acne scarring and improve patients' quality of life. Recognizing predictors of acne severity and scarring can guide clinicians in implementing preventive strategies and optimizing long-term outcomes.

References

Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med. 2022;11(10):2744. Published 2022 May 12. DOI:10.3390/jcm11102744. PMID: 35628870; PMCID: PMC9147527.

Vasam M, Korutla S, Bohara RA. Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochem Biophys Rep. 2023;36:101578. Published 2023 Nov 23. DOI:10.1016/j.bbrep.2023.101578. PMID: 38076662; PMCID: PMC10709101.

Meixiong J, Ricco C, Vasavda C, Ho BK. Diet and acne: A systematic review. JAAD Int. 2022;7:95-112. Published 2022 Mar 29. DOI:10.1016/j.jdin.2022.02.012. PMID: 35373155; PMCID: PMC8971946.

Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep. 2020;10(1):5754. Published 2020 Apr 1. DOI:10.1038/s41598-020-62715-3. PMID: 32238884; PMCID: PMC7113252.

Tan J, Kang S, Leyden J. Prevalence and Risk Factors of Acne Scarring Among Patients Consulting Dermatologists in the USA. J Drugs Dermatol. 2017;16(2):97-102. PMID: 28300850.

Jennings T, Duffy R, McLarney M, et al. Acne scarring-pathophysiology, diagnosis, prevention and education: Part I. J Am Acad Dermatol. 2024;90(6):1123-1134. DOI:10.1016/j.jaad.2022.04.021. PMID: 35792196.

Fife D. Evaluation of Acne Scars: How to Assess Them and What to Tell the Patient. Dermatol Clin. 2016;34(2):207-213. DOI:10.1016/j.det.2015.11.009. PMID: 27015781.

Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol. 1997;36(6):416-418. DOI:10.1046/j.1365-4362.1997.00099.x. PMID: 9248884.

Goodman GJ, Baron JA. Postacne scarring--a quantitative global scarring grading system. J Cosmet Dermatol. 2006;5(1):48-52. DOI:10.1111/j.1473-2165.2006.00222.x. PMID: 17173571.

Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. Med Clin North Am. 2021;105(6):1099-1116. DOI:10.1016/j.mcna.2021.06.008. PMID: 34688417; PMCID: PMC8548673.

Ryguła I, Pikiewicz W, Kaminiów K. Impact of Diet and Nutrition in Patients with Acne Vulgaris. Nutrients. 2024;16(10):1476. Published 2024 May 14. DOI:10.3390/nu16101476. PMID: 38794714; PMCID: PMC11124289.

Say YH, Heng AHS, Reginald K, et al. Modifiable and non-modifiable epidemiological risk factors for acne, acne severity and acne scarring among Malaysian Chinese: a cross-sectional study. BMC Public Health. 2021;21(1):601. Published 2021 Mar 27. DOI:10.1186/s12889-021-10681-4. PMID: 33773591; PMCID: PMC8005239.

Heng AHS, Say YH, Sio YY, Ng YT, Chew FT. Epidemiological Risk Factors Associated with Acne Vulgaris Presentation, Severity, and Scarring in a Singapore Chinese Population: A Cross-Sectional Study. Dermatology. 2022;238(2):226-235. DOI:10.1159/000516232. PMID: 34062533.

Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-485. DOI:10.1111/bjd.12149. PMID: 23210645.

Karadağ AS, Balta İ, Saricaoğlu H, et al. The effect of personal, familial, and environmental characteristics on acne vulgaris: a prospective, multicenter, case-controlled study. G Ital Dermatol Venereol. 2019;154(2):177-185. DOI:10.23736/S0392-0488.17.05532-8. PMID: 28704984.

Yan C, Phinyo P, Yogya Y, Chuamanochan M, Wanitphakdeedecha R. Risk Factors Associated with Facial Acne Scarring in Thai Patients with Acne: A Cross-Sectional Study. J Cosmet Dermatol. 2025;24(1):e16695. DOI:10.1111/jocd.16695. PMID: 39601200; PMCID: PMC11704995.

Xue H, Ye D, Huang S, et al. Efficacy and safety of low-dose oral isotretinoin monotherapy versus combined therapy with picosecond laser for the treatment of acne scars in Asian population. Lasers Surg Med. 2023;55(4):359-371. DOI:10.1002/lsm.23646. PMID: 36856028.

Turk CB, Baykara Ulusan M, Döş YM, Manav Baş V, Sarikaya Tellal E, Koku Aksu AE. The Effects of Oral Isotretinoin on Atrophic Acne Scars Measured by Shear-wave Elastography: An Observational, Single-center Study. J Clin Aesthet Dermatol. 2023;16(9):46-51. PMID: 37720196; PMCID: PMC10503936.