Title : Predictive factors of acne scarring and post-acne hyperpigmentation: A retrospective cohort study
Abstract:
Background: Acne vulgaris, a prevalent dermatological condition, often results in long-term complications such as scarring and hyperpigmentation. While extensive research has focused on treatment modalities, there is a notable gap in understanding the factors contributing to the development of acne scarring and post-acne hyperpigmentation. This study aimed to identify predictive factors associated with these complications among Acne Vulgaris patients.
Methods: This retrospective cohort study, conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, analyzed data from 417 patients with Acne Vulgaris between 2016 and 2023. Patients aged 18 and older were included, and a comprehensive dataset was obtained from the hospital's health information system, BESTCare. Statistical analysis was performed using RStudio (R version 4.3.1). Statistical significance was considered at p < 0.05.
Results: The majority of the 417 analyzed patients were female (79.1%), with a mean age of 25.58 ± 6.53 years. Acne complications included scarring (22.8%), post-inflammatory hyperpigmentation (PIH) (22.3%), and a combination of both (36.2%). Smoking showed a significant association with acne complications (p=0.004), particularly with scarring only (7.4%) and scarring with PIH (4.0%). Acne severity exhibited a significant difference among groups (p<0.001), with those experiencing both scarring and PIH having a higher proportion of severe acne (21.6%). Isotretinoin use demonstrated a highly significant association with PIH only (69.5%, p<0.001). Vitamin D levels varied significantly among complication groups (p<0.001). While hemoglobin (Hgb) levels differed significantly among the acne complications groups (p=0.010), with the no scarring or PIH group having a higher mean value (14.84 ± 15.23) compared to acne scarring only (13.43 ± 1.64), PIH only (12.83 ± 1.48), and acne scarring and PIH (12.81 ± 1.50). Multinomial logistic regression identified adapalene gel as protective against scarring only, while isotretinoin use (OR = 0.49, 95% CI 0.24 to 0.99, p = 0.047) and high ALT (OR = 0.94, 95% CI 0.90 to 0.99, p = 0.010) were protective against scarring with PIH.
Conclusion: This retrospective study sheds light on factors influencing acne scarring and PIH among Acne Vulgaris patients. Notably, the severity of acne, low vitamin D, and HgB levels, and isotretinoin use were associated with complications. While Adapalene gel exhibited a protective effect against scarring. These findings provide valuable insights for tailoring interventions and advancing our understanding of acne vulgaris complications in the future.
Keywords: Acne vulgaris, acne scarring, post-inflammatory hyperpigmentation, predictive factors, retrospective cohort study, isotretinoin, adapalene gel, vitamin D, smoking.
