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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

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

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
with reduced self-esteem, marred physical appearance and
less social relationships with others (Tasoula et al., 2012).
Several factors have been associated with the development
of acne including hormonal activity such as menstrual
cycles and puberty, genetic predisposition, diet [Carbohy-
drates], infection and stress (Albuquerque et al., 2014;
Cho et al., 2014; Bek-Thomsen et al., 2008; Mahmood
and Bowe, 2014). However, there are only limited studies
that have explored the possible association of stress espe-
cially with study and a lot of work and acne
(Yosipovitch et al., 2007).
The theoretical knowledge about acne among medical
students is relatively limited before they start their clinical
training (Shivaswamy et al., 2014). Forty-four percent of
university students had inadequate knowledge about acne
and most of them believed that the factors responsible
for acne were hormones and stress (Al Robaee, 2005).
Some students also have misconceptions and inadequate
knowledge about acne (Ali et al., 2010).
There is also not enough information in the literature
about acne vulgaris for the medical students in Saudi Ara-
bia. There is a lack of evidence about the association of
acne vulgaris with its causes. Henceforth, this study was
undertaken to assess its prevalence, the level of knowledge
and lifestyle association of acne among medical students.
2. Methods
In this quantitative, observational and cross-sectional
study, the data were collected by using stratified random
sampling technique from undergraduate medical students
at King Saud University, Riyadh, Kingdom of Saudi Ara-
bia, in March 2015. The sample consisted of 375 partici-
pants (250 males and 125 females) who were divided into
15 groups, 5 for females and 10 for males and 25 students
were randomly selected from each group. The undergradu-
ate medical students were included and the postgraduate
doctors were excluded from this study. Mainly, a paper-
based self-administered English questionnaire with an Ara-
bic introduction was used to explain the goal of this
research and to give the participants an important informa-
tion about acne vulgaris with an exception for the first and
fourth year medical students who were given an electronic
questionnaire because of their examinations. This question-
naire also reaffirmed the study participants that this infor-
mation was intended to be kept confidential. The
questionnaire was divided into three sections: Socio-
demographic section, estimating prevalence section and
Table 1
Demographics and prevalence of acne vulgaris.
Gender Age
66.7% (Males) 28% (<21 Years Old)
33.3% (Females) 72% (21 Years Old)
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
assessing knowledge section. A pilot study was also con-
ducted to know the reliability, validity and feasibility of
the questionnaire. Statistical analysis was performed using
Statistical Package for the Social Sciences (SPSS) version
19 software (SPSS Inc., Chicago, IL, USA). Chi-square test
or Fisher’s exact test was used to compare between male
and female groups with respect to all different nominal
variables and also compare different academic years. It
was assumed that there was a statistically significant differ-
ence when the P-value was less than 0.05. This research was
approved by the ethics committee of family and commu-
nity medicine department in King Saud University (see
Table 1).
3. Results
A total number of three hundred and seventy-five med-
ical students were recruited, with more than half of them
had acne vulgaris (n: 208; 55.5%), and less than one third
of them were diagnosed by a physician (n: 75; 20%) see
Table 2. Out of all the participants, there were 250 males
(66.7%) and 125 females (33.3%), the gender factor being
statistically insignificant (p > 0.05). Most of the female stu-
dents around (n: 75; 61%) dealt with acne as a significant
medical condition when compared with only one third 87
of the male students (n: 87; 34%) (P < 0.05). Of all students,
135 (37.2%) think they have adequate knowledge about
acne vulgaris wherein 47 (64.4%) were from the 5th year,
44 (62%) were from the 4th year, 16 (22.5%) were from
the 3rd year, 16 (21.9%) were from the 2nd year and 12
(16%) were from the 1st year, which is statistically signifi-
cant (p > 0.05), see Table 2. Various sources of Acne infor-
mation including information from the Internet were
chosen by 246 (65.6%) participants, and then doctors by
220 (58.7%) were the most common sources of informa-
tion, whereas newspapers were the least one (n: 22; 5.9%),
see Table 3. Eighty-nine females (72.4%) more than males
(n: 104; 41.9%) believed that the stressful environment
played an important role in causing acne vulgaris
(p > 0.05). As to other causes, most of the students (n:
327; 87.2%) were of the opinion that acne vulgaris
increased due to hormonal disturbance and 219 (58.4%)
were of the opinion that it increased due to the consump-
tion of fatty foods, see Table 2. One hundred and twelve
male students (44.8%) thought that having acne affected
their marriage prospectus more than females (n: 39;
31.2%) p < 0.05. Finally, most of the students (n: 276;
73.6%) were of the opinion that acne vulgaris had an
impact on their self-confidence.
Marital status Academic level Prevalence of acne
99.2% (Singles) 40% (1st & 2nd Year) 55.5% (Yes)
0.8% (Married) 60% (3rd, 4th & 5th Year) 44.5% (No)
 A. Alajlan et al. / Journal of Dermatology & Dermatologic Surgery xxx (2017) xxx–xxx
Table 2
Students’ beliefs about acne causes, students’ levels and confidence of knowledge.
Students’ beliefs about acne causes Inadequate sun
exposure
15.7%
Students levels and confidence of 1st & 2nd Academic Year
knowledge about acne
19% (Confident)
81% (Not Confident)
Medical students might choose more than one option.
Table 3
Source of information.
Source All levels (%)
Internet 65.6
Doctors 58.68
Medical books 52.26
Medical journals 34.94
Newspapers 5.9
Others 4
Medical students might choose more than
one option.
4. Discussion
A recent study by Al Mashat et al. (2013) showed the
prevalence of acne among Saudi population at 64.5%.
Two previous studies done by Alrobaee and Al Hoqail
on students showed the prevalence of Acne at 56.2% and
53.4% respectively (Al-Hoqail, 2003; Al Robaee, 2005).
Internationally, a study done in Sindh Medical College in
Karachi, showed that 55.9% of its study participants suf-
fered from Acne (Ali et al., 2010). This was in comparison
with our study which showed 208 (55.5%) medical students
being affected by acne vulgaris.
In our survey 193 students (52%) were of the opinion
that stressful environment played a major role in causing
acne vulgaris, with significant association between males
(n: 104; 41.9%) and females (n: 89; 72.4%) and p
value < 0.05. A study done in Brazil showed that there is
a significant association between acne vulgaris and stress
(Albuquerque et al., 2014), linking with Al Mashat study
which also showed 58.4% of individuals believed that stress
aggravates acne vulgaris (Al Mashat et al., 2013).
This study also showed that 252 (67.9%) students were
of the opinion that diet is one of the etiological factors
causing acne vulgaris. According to another study done
in Turkey, fatty and sugary foods were associated with
increased risk of acne (KokuAksu et al., 2012).
Most of the female students in this study dealt with acne
as a significant medical condition when compared with
only 34% of the male students (P < 0.05) linking with Al
Mashat study which also reported that 53.82% of its study
participants believed that acne was a serious health prob-
lem (Al Mashat et al., 2013).
Our study also showed that 135 (37.2%) medical stu-
dents believed that there is adequate information about
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
3
Inactivity Sugary Inadequate Not eating Genetically Fatty Hormonal
diet sleep healthy related diet disturbances
18.4% 21.3% 26.1% 48.0% 48.0% 58.4% 87.2%
3rd, 4th & 5th Academic Years
74% (Confident)
26% (Not Confident)
acne vulgaris. This belief of adequate information was least
present among the 1st year students (n: 12; 16%) and was
highest among the 5th year students (n: 47; 64.4%), with
significant association (p > 0.05) and is thought that the
dermatology course in the 4th year had broadened their
knowledge about acne vulgaris.
Our study also showed that 246 (65.6%) medical stu-
dents considered searching the Internet as their main
source of finding information about acne vulgaris; 220 stu-
dents (58.7%) obtained their information from doctors and
22 students (5.9%) from newspapers. In Dr. Alrobaee sur-
vey, newspaper was the most preferred source (Al Robaee,
2005) taking into account that this study was done in 2005
when newspapers were more dominant in those days.
It was noticed that the first year medical students used
Internet the most, while the 5th year medical students used
medical journals the most. It is also believed that students
in the fifth year were more aware of the reliability of the
source material and its scientific evidence.
Most of the students (n: 327; 87.2%) were of the opinion
that acne vulgaris increased or was caused by hormonal
disturbances and 219 (58.4%) students were of the opinion
that it increased or was caused by the consumption of fatty
foods. This can be related to the study by Al Mashat who
also reported that 88.2% of his participants believed hor-
mones have an effect on acne and 34.1% of participants
believed acne is increased by consuming certain foods (Al
Mashat et al., 2013).
5. Conclusion/recommendations
More than half of our sample population was affected
by acne vulgaris with two thirds of them not seeking for
any medical advice. Knowledge misconceptions were wide-
spread among medical students, which necessitate further
education in this regards. Medical students in the first
two years need more education about acne vulgaris, when
compared to those in their last three years who felt much
more adequate in their knowledge of acne vulgaris. The
majority of students have the opinion that acne vulgaris
has psychological influences such as loss of confidence, sad-
ness and worry.
Conflict of interest
The authors declared that there is no conflict of interest.
4 A. Alajlan et al. / Journal of Dermatology & Dermatologic Surgery xxx (2017) xxx–xxx
Acknowledgment
We express our thanks to our colleagues in the female
side who helped in collecting the data from female medical
students (Maha AlKubaidan, Khulood AlRaddadi, Aisha
AlRaddadi, Sara AlJasser). We would also use this oppor-
tunity to thank the Investigator Support Unit at College of
Medicine for their help in revision of our paper.
References
Al Mashat, S., Al Sharif, N., Zimmo, S., 2013. Acne awareness and
perception among population in Jeddah, Saudi Arabia. J. Saudi Soc.
Derm. Dermatol. Surg. 17 (2), 47–49.
Al Robaee, A.A., 2005. Prevalence, knowledge, beliefs and psychosocial
impact of acne in University students in Central Saudi Arabia. Saudi
Med. J. 26 (12), 1958–1961.
Albuquerque, R., Rocha, M., Bagatin, E., Tufik, S., Andersen, M., 2014.
Could adult female acne be associated with modern life? Arch.
Dermatol. Res. 306 (8), 683–688.
Al-Hoqail, I.A., 2003. Knowledge, beliefs and perception of youth toward
acne vulgaris. Saudi Med. J. 24 (7), 765–768.
Ali, G., Mehtab, K., Sheikh, Z.A., Ali, H.G., Kader, S.A., Mansoor, H.,
et al., 2010. Beliefs and perceptions of acne among a sample of
students from Sindh Medical College, Karachi. J. Pakistan Med.
Assoc. 60 (1), 51–54.
Bek-Thomsen, M., Lomholt, H.B., Kilian, M., 2008. Acne is not
associated with yet-uncultured bacteria. J. Clin. Microbiol. 46 (10),
3355–3360.
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
Cho, E.B., Ha, J.M., Park, E.J., Kim, K.H., Kim, K.J., 2014. Heredity of
acne in Korean patients. J. Derm. 41 (10), 915–917.
Gonçalves, G., Amado, J., Matos, M., Massa, A., 2012. The prevalence of
acne among a group of Portuguese medical students. J. Eur. Acad.
Dermatol. Venereol. 26 (4), 514–517.
KokuAksu, A., Metintas, S., Saracoglu, Z., Gurel, G., Sabuncu, I.,
Arikan, I., et al., 2012. Acne: prevalence and relationship with dietary
habits in Eskisehir, Turkey. J. Eur. Acad. Dermatol. Venereol. 26 (12),
1503–1509.
Mahmood, S.N., Bowe, W.P., 2014. Diet and acne update: carbohydrates
emerge as the main culprit. J. Drugs Derm.: JDD 13 (4), 428–435.
Shen, Y., Wang, T., Zhou, C., Wang, X., Ding, X., Tian, S., et al., 2012.
Prevalence of acne vulgaris in Chinese adolescents and adults: a
community-based study of 17,345 subjects in six cities. Actadermato-
venereologica 92 (1), 40–44.
Shivaswamy, K.N., Shyamprasad, A.L., Sumathy, T.K., Ranganathan,
C., Kumar, S.P., 2014. Knowledge of acne among medical students:
pretest and posttest assessment. ISRN Derm. 2014
Tasoula, E., Gregoriou, S., Chalikias, J., Lazarou, D., Danopoulou, I.,
Katsambas, A., et al., 2012. The impact of acne vulgaris on quality of
life and psychic health in young adolescents in Greece: results of a
population survey. Anaisbrasileiros de dermatologia 87 (6), 862–869.
Ullah, G., Noor, S.M., Bhatti, Z., Ahmad, M., Bangash, A.R., 2014.
Comparison of oral azithromycin with oral doxycycline in the
treatment of acne vulgaris. J. Ayub Med. College, Abbottabad: JAMC
26 (1), 64.
Yosipovitch, G., Tang, M., Dawn, A.G., Chen, M., Goh, C.L., Chan, Y.
H., et al., 2007. Study of psychological stress, sebum production and
acne vulgaris in adolescents. Actadermato-venereologica 87 (2), 135–
139.