Several Risk Factors, Including PAE, Associated with Acne Scarring in Thai Patients

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An investigative study observed what risk factors are commonly associated with facial acne scarring, specifically in Thai patients.¹ It was found that the greatest risk factors are the severity of acne, the squeezing and picking of acne spots, and post acne erythema (PAE).

The exploratory risk factor research was conducted via a cross-sectional design and a self-reported online questionnaire. The survey was distributed through Google Forms between September and December 2023. Clinical photographs of scars were also uploaded and validated by a clinician.

Participants 18 years of age and older were diagnosed with acne at a dermatology outpatient clinic in a university hospital in Bangkok, Thailand. Out of these 225 participants, 61.33% had a prevalence of acne scarring. This case group included 138 patients while the control cohort had 87.

Researchers identified significant demographic data such as sociodemographic factors (ie, age of onset, sex, family history), clinical factors of acne (ie, duration, severity), lifestyle and dietary habits, and previous oral and topical treatments including benzoyl peroxide, clindamycin, antibiotics, and isotretinoin. Univariable and multivariable logistic regression was implemented.

According to the initial univariable analysis, those who were diagnosed with moderate to very severe acne at an age of ≤ 15 years had a higher risk of scarring. Additionally, those with a family history of acne, a previous use of topical and oral therapies, and/or a pattern of post acne erythema, had a greater risk.

The multivariable analysis identified some similar independent risk factors but also recognized some differences. Those with severe-to-very severe acne showed the highest mOR at 8.98 (95% CI 2.71–29.73, p < 0.001) while those with moderate acne severity reported a mORof 3.51 (95% CI 1.31–9.40, p = 0.012). A pattern of PAE showed a mORof 4.46 (95% CI 1.96–10.14, p < 0.001) while picking and squeezing behaviors reported a mORof 2.69 (95% CI 1.08–6.68, p = 0.033).

In this multivariable analysis, no significant associations were found between acne scarring and previous oral treatment, age at onset, smoking, alcohol consumption, sex, BMI, or family history. There were also no observations related to the duration of acne.

“Individuals who experience mild acne over an extended period may not develop acne scars, whereas those with extensive acne may develop them within a shorter timeframe,” the authors wrote. “Further research is required to examine the correlation between the duration and severity of acne.”

There were some limitations in the study design, such as the self-reported results and possible recall bias. Additionally, the use of a single study site can limit the generalizability of these results in the Thai population.

Early treatment is crucial to reduce scarring, as nearly half of all patients with acne get scars.² According to the investigators, these persistent and long-term scars can have substantial physical, psychological, psychological, social, and economic consequences.³

According to researchers, these results align with similar studies in recent years that recommend timely diagnosis and treatment, especially in patients with a high susceptibility and history of PAE and scarring. This can assist with formulating future therapies and approaches that can help diminish acne scarring on the face. The authors also suggest a further investigation of the weaker correlations and potential influence of factors such as genetics, lifestyles, and treatment methods, that were identified in this research.

References

1. 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. Published online November 27, 2024. doi:10.1111/jocd.16695

2. Heng AHS, Say YH, Sio YY, et al. 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

3. Layton AM, Thiboutot D, Tan J. Reviewing the global burden of acne: how could we improve care to reduce the burden?. Br J Dermatol. 2021;184(2):219-225. doi:10.1111/bjd.19477