Abstract
BACKGROUND: In recent years, the aesthetic appearance of the skin has emerged as a crucial factor influencing perceptions of beauty and contributing to self-confidence. The pursuit of flawless skin represents a prevalent focus within beauty regimens. Adult-onset acne (AOA) is the development of acne between the ages of 26 to 50 and it is emerging as a prevalent dermatological concern among this population. Individuals perceiving their skin as falling short of an 'ideal' standard may let it affect their quality of life. Significant gaps in our understanding persist regarding the contributing risk factors for AOA. OBJECTIVE: The study aims to assess both established and novel risk factors potentially influencing the onset of adult acne. Additionally, it seeks to calculate the odds ratio (OR) for AOA in both females and males exposed to the surveyed risk factors over a 24-month period. MATERIALS AND METHODS: Various risk factors were assessed, including stress, hormonal markers, psychological factors, environmental exposures, dietary habits, and cosmetic use. A total of 140 participants, consisting of 70 healthy individuals were selected. Discordant groups were analyzed for AOA. Detailed interviews were conducted to obtain a comprehensive medical history, focusing on potential risk factors, for patients diagnosed with acne. The OR was calculated to determine the likelihood of association between risk factors and the development of AOA. A proper protocol was devised, and statistical data was analyzed using Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY, USA). RESULTS: The most significant risk factors in the development of AOA in the Indian population based on OR and confidence interval (CI) were positive personal history of acne (OR 3.12 [95% CI 1.20 - 8.03]), positive family history of acne (OR 10.24 [95% CI 2.89 - 36.1]), overweight BMI (OR 6.16 [95% CI 2.56 - 14.76]), hormonal imbalance (OR 9.27 [95% CI 2.03 - 42.29]), menstrual irregularity in females (OR 12.94 [95% CI 3.59 - 46.53]), exposure to mineral oil or halogenated hydrocarbon use (OR 4.13 [95% CI 1.28 - 13.24]), less than six hours of sleep (OR 4.16 [95% CI 1.10 - 15.64]), chemical peels in females (OR 11.28 [95% CI 2.45 - 51.90]), diet consisting mainly of carbohydrates, high salt, saturated fats (OR 29.97 [95% CI 3.84 - 227.25]) and less than 2 liters of water intake in patients (OR 19.18 [95% CI 1.08 - 339.04]). Risk factors that were associated with a decreased likelihood of AOA included normal menstruation (OR 0.03 [95% CI 0.01 - 0.12]), healthy oral intake (OR 0.04 [95% CI 0.00 - 0.17]), no psychological stressors/depression/anxiety (OR 0.43 [95% CI 0.21 - 0.85]), no environmental factors (OR 0.07 [95% CI 0.02 - 0.24]), no associated cosmetic use (OR 0.45 [95% CI 0.22 - 0.90]), normal BMI (OR 0.18 [95% CI 0.07 - 0.39]), no history of acne (OR 0.12 [95% CI 0.05 - 0.26]). CONCLUSION: AOA is a complex and multifactorial condition, and most of the risk factors mentioned in this study on Indian skin type contribute to its development. The approach for AOA should be holistic. In addition to following a recommended treatment protocol, education should be provided about lifestyle modification, stress management, exercise, and environmental factors to help prevent and manage AOA.