Abstract
Introduction
Differences between adolescent and postadolescent acne are increasingly being recognized. This study aimed to document the clinical profile of facial acne vulgaris and, additionally, to compare adolescent to postadolescent acne and any gender-based differences.
Methods
Cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted from February 2021 to March 2022 at three dermatology clinics. Patients had their anthropometric measurements, type of acne lesions, and severity and scarring assessed.
Results
A total of 261 patients (75.5% females) with a mean age of 24.5 (±7.4) years were diagnosed to have facial acne vulgaris. The severity of acne was mild in 44.8%, moderate in 48.3%, and severe in 6.9%. Acne was noninflammatory in 69.7%, inflammatory in 13.0%, and mixed in 17.2%. Adolescent and postadolescent acne significantly differed in the type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences included BMI, lesions of acne, and severity.
Conclusion
There is an increasing prevalence of postadolescent acne with persistent being the most common category. There are significant differences between adolescent and postadolescent acne: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and postadolescent acne.
Keywords: Postadolescent acne, Adolescent acne, Acne, Acne scars
Introduction
Acne vulgaris is a common chronic inflammatory skin disease which accounts for 5–15% of dermatologic consultations [1, 2]. Most of the literature on acne has been on adolescents [3–5] but increasingly, postadolescent acne (PAA) which is acne in adults is being recognized and documented [6–9]. PAA is said to differ from adolescent acne (AA) and is defined as presence of acne beyond the age of 25 years, irrespective of the age at onset of acne [8–10]. Three types of PAA are defined: late-onset, persistent, and returning acne [8, 10, 11]. Persistent acne is said to be acne which starts in teenage years and persists into adulthood, while late-onset acne is acne which starts at or after the age of 25 years. Returning acne is defined as acne which has cleared in adolescence but reoccurs in adulthood. This form of acne is also called acne tarda [8–11].
Although, an increasing incidence of PAA, especially in women is reported [6, 7], there are limited studies of PAA in males [6, 7, 12]. The prevalence of PAA is reported to be 12% in females and 3% in males [13], and the prevalence of AA varies between 42% and 96% [4, 5, 7]. Females have more acne than males irrespective of age and the prevalence of acne decreases with age.
Differences between AA and PAA have been reported. These differences include anatomical site, type of lesions, family history, and severity of acne [5, 7, 14]. PAA have fewer number of comedones and total number of acne lesions compared to AA [15]. Additionally, there are more inflammatory lesions and cysts in PAA than in AA [5]. A gender-based difference in prevalence, severity, and site of acne is recorded. The anatomical site of acne is predominantly the whole face in both PAA and AA, but truncal acne is also reported in males and adolescents [7, 9, 12].
Most studies of acne have been in adolescents and recently in adult females [3, 5, 6]. Reports of the differences between AA and PAA are few, and even fewer are reports of the differences in acne between males and females [5, 7, 14, 16]. This multicenter study is aimed at documenting the clinical profile of facial acne vulgaris. In addition, to document differences between adolescent and PAA, differences between males and females, and to compare PAA between males and females.
Materials and Methods
This prospective, cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted following ethical approval by the Lagos State University Teaching Hospital Ethical Committee from February 2021 to March 2022. The study was conducted in three dermatology clinics: Lagos State University Teaching Hospital, Kaduna State University Teaching Hospital, Kaduna, and the GastroDerm Clinic, Lagos. Verbal and written informed consents were obtained from the participants. Consecutive patients who consented to the study were recruited. Sociodemographic parameters (sex, age, duration of acne, age at onset, family history of acne) were documented using a data collection pro forma. A full examination to assess for facial acne vulgaris (type of acne lesions, number of acne lesions, acne sequelae, and severity of acne) was conducted by the researchers. Acne sequelae were classified as acne-induced hyperpigmentation (AIH), atrophic and hypertrophic scars. The severity of acne was graded using the Combined Acne Severity Scale (CASS) into mild, moderate, and severe [17]. The type of acne lesions was categorized as inflammatory (pustules, cysts, nodules, erythematous papules) and noninflammatory (comedones). Total lesion count was the sum of inflammatory and noninflammatory lesions. Acne was classified as persistent, late-onset, recurring acne, and AA [8–10]. In this study, patients aged 20 years and below were regarded as having AA, while those aged 25 years and above were regarded as having PAA [8–10]. Anthropologic measurements were taken for body mass index calculation.
Data were analyzed in R Studio 2023 version. Categorical variables were summarized using frequency and percentages, while numerical variables were summarized using mean and standard deviation (SD). Comparison of variables between dichotomized groups was done using χ2 and Fisher’s exact tests for categorical variables and unpaired t test for numerical variables. Statistical significance was defined as a p value of less than 0.05.
Results
A total of 1,521 (594 males and 927 females) new patients attended the clinics during the study period. The population was 194 adolescents (98 females and 96 males) and 1,036 PAA (401 males and 635 females). Over the study period, 261 patients, 75.5% (197/261) of whom were female, were diagnosed as having facial acne vulgaris giving a prevalence of 17.2%. Acne was diagnosed in 10.8% of males and in 21.3% of females. A diagnosis of acne was made in 51% of adolescents and in 15.6% of PAA. In a subgroup analysis, acne was diagnosed in 26% of adolescent males and in 75.5% of adolescent females. In the PAA group, acne was diagnosed in 5.5% of males and 14.8% of females. The mean age (SD), mean age (SD) at onset, and mean (SD) duration of acne were 24.5 (7.4), 18.1 (6.7), and 6.4 (6.4) years, respectively. Most of the patients were aged 21–30 years in 42.5% and acne decreased with age; Table 1. Age of onset was 11–20 years in 69.7% and onset of acne decreased with age; Table 1. The duration of acne was ≥5 years in almost half of the patients. A family history of acne was recorded in half the patients. Premenstrual flare of acne was reported in over half of the females. The mean BMI (SD) of the patients was 23.6 (4.5) and most of the patients had a normal weight; Table 1.
Table 1.
Sociodemographic variables
| Variable | Frequency (n = 261) | % |
|---|---|---|
| Age group, years | ||
| <20 | 99 | 37.9 |
| 21–30 | 111 | 42.5 |
| 31–40 | 40 | 16.5 |
| >40 | 8 | 3.1 |
| Mean (SD) | 6.4 (6.4) | |
| Age at onset, years | ||
| <10 | 10 | 3.8 |
| 11–20 | 182 | 69.7 |
| 21–30 | 54 | 20.7 |
| >30 | 15 | 5.7 |
| Mean (SD) | 18.1 (6.7) | |
| Duration of acne, years | ||
| <1 | 42 | 16.1 |
| 1–2 | 45 | 17.2 |
| 3–4 | 66 | 25.3 |
| ≥5 | 108 | 41.4 |
| Mean (SD) | ||
| Gender | ||
| Male | 64 | 24.5 |
| Female | 197 | 75.5 |
| BMI grade | ||
| <18.5 | 22 | 9.0 |
| 18.5–<25 | 147 | 60.2 |
| 25–30 | 50 | 20.5 |
| >30 | 25 | 10.2 |
| Family history of acne | ||
| Yes | 132 | 50.6 |
| No | 106 | 40.6 |
| I do not know | 23 | 8.8 |
| Premenstrual flare | ||
| Yes | 123 | 66.5 |
| No | 62 | 33.5 |
The severity of acne was mild in 44.8% (117/261), moderate in 48.3% (126/261), and severe in 6.9% (18/261). Noninflammatory acne was diagnosed in 69.7% (182/261), inflammatory acne in 13.0% (34/261), and mixed in 17.2% (45/261). AA accounted for 38.7% in the categorization of acne. The types of acne lesions were 93.5% comedones, 49.2% pustular, 8.2% nodules, and 7.0% cystic. Acne sequelae were present in 70.1% and the scars were mostly AIH. The site of acne occurrence was the whole face in most of the patients; Table 2.
Table 2.
Clinical features of the patients
| Variable | Frequency (n = 261) | % |
|---|---|---|
| Category of acne | ||
| Persistent | 72 | 27.6 |
| Late onset | 47 | 18.0 |
| Recurring | 41 | 15.7 |
| Adolescent | 101 | 38.7 |
| Pattern of acne | ||
| Inflammatory | ||
| Whole face | 31 | 91.2 |
| Forehead | 1 | 2.9 |
| Cheeks | 2 | 5.8 |
| Chin | 1 | 2.9 |
| Noninflammatory | ||
| Whole face | 203 | 83.2 |
| Cheeks | 11 | 4.5 |
| Chin | 2 | 0.8 |
| Forehead | 10 | 4.4 |
| Total lesion count | ||
| Noninflammatory | ||
| 1–50 | 150 | 61.9 |
| 51–100 | 61 | 25.2 |
| 101–150 | 23 | 9.5 |
| 151–200 | 8 | 3.3 |
| Inflammatory | ||
| 1–50 | 130 | 90.3 |
| 51–100 | 12 | 8.3 |
| 101–150 | 2 | 1.4 |
| Acne sequelae in percentage | ||
| Keloids | 5 | 2.7 |
| Atrophic scars | 35 | 19.1 |
| AIH | 143 | 78.1 |
When adolescent and PAA were compared, there were significant differences in the type of acne, BMI, type of acne lesions, and acne scarring. AA was mostly comedonal and PAA was more inflammatory; pustules, cysts, and nodules were more in PAA. PAA were more overweight and obese compared to adolescents. Acne scars were present in 42.4% (42/99) of AA and in 79% (92/116) of PAA. There was no difference in the severity of acne, family history of acne, and premenstrual flare; Table 3.
Table 3.
Comparison of AA to PAA
| <20 years, n (%) | 25 years and above, n (%) | p value | |
|---|---|---|---|
| Positive family history | 56/99 (56.6) | 55/116 (47.4) | 0.113 |
| Menstrual flare | 50/75 (66.7) | 55/84 (65.5) | 1.000 |
| Severity of acne | 0.151 | ||
| Mild | 46/99 (44.4) | 49/116 (42.2) | |
| Moderate | 49/99 (49.5) | 54/116 (46.6) | |
| Severe | 4/99 (4.0) | 13/116 (11.2) | |
| Type of acne | 0.034* | ||
| Noninflammatory | 79/99 (79.8) | 74/116 (63.8) | |
| Inflammatory | 8/99 (8.1) | 15/116 (12.9) | |
| Mixed | 12/99 (12.1) | 27/116 (23.3) | |
| BMI band | <0.001* | ||
| <18.5 | 16/94 (17.0) | 3/106 (2.8) | |
| 18.5–<25 | 63/94 (67.0) | 53/106 (50.0) | |
| 25–30 | 14/95 (14.9) | 28/106 (26.4) | |
| >30 | 1/94 (1.1) | 22/106 (20.8) | |
| Mean BMI (SD) | 21.5 (3.15) | 25.6 (4.81) | <0.001* |
| Lesions of acne | |||
| Total noninflammatory | 95/99 (96.0) | 106/116 (91.4) | 0.280 |
| Pustules | 35/99 (35.4) | 74/116 (63.8) | <0.001* |
| Nodules | 5/99 (5.1) | 18/116 (15.5) | 0.024* |
| Cysts | 2/99 (2.0) | 13/116 (11.2) | 0.018* |
| Acne sequelae | |||
| Keloid | 1/99 (1.0) | 1/116 (0.9) | 1.000 |
| Atrophic scars | 5/99 (5.1) | 18/116 (15.5) | 0.015* |
| AIH | 36/99 (36.4) | 73/116 (62.9) | <0.001* |
*Statistically significant at p value of <0.05
Gender-based differences were seen in the patients. The mean BMI in females significantly differed from that of males; overweight and obesity were more in the females. Pustular acne was more in males, although the severity and type of acne lesions did not significantly differ; Table 4. On comparing adolescent males to adolescent females, acne was significantly more severe in males. Males had more inflammatory lesions and pustules; Table 5. When PAA males and females were compared, mean BMI and type of acne significantly differed. The mean BMI was higher in females, and inflammatory lesions were found more in females; Table 6.
Table 4.
Comparison of all males to all females
| Male, n (%) | Female, n (%) | p value | |
|---|---|---|---|
| Positive family history | 37/64 (57.8) | 95/197 (48.2) | 0.096 |
| Severity of acne | 0.393 | ||
| Mild | 24/64 (37.5) | 93/197 (47.2) | |
| Moderate | 35/64 (54.7) | 91/197 (46.2) | |
| Severe | 5/64 (7.8) | 13/197 (6.6) | |
| Type of acne | 0.237 | ||
| Noninflammatory | 40/64 (62.5) | 142/197 (72.1) | |
| Inflammatory | 12/64 (18.8) | 22/197 (11.2) | |
| Mixed | 12/64 (18.8) | 33/197 (16.8) | |
| BMI band | <0.008 | ||
| <18.5 | 8/57 (14.0) | 14/187 (7.5) | |
| 18.5–<25 | 40/57 (70.2) | 107/187 (57.2) | |
| 25–30 | 9/57 (15.8) | 41/187 (21.9) | |
| >30 | 0/57 (0.0) | 25/187 (13.4) | |
| Mean BMI kg/m2 (SD) | 21.9 (3.1) | 24.1 (4.7) | <0.001* |
| Lesions of acne | |||
| Total noninflammatory | 61/64 (95.3) | 193/197 (98.0) | 0.771 |
| Pustules | 40/64 (62.5) | 92/197 (42.7) | 0.040* |
| Nodules | 6/64 (9.4) | 22/197 (11.2) | 0.865 |
| Cysts | 7/64 (10.9) | 12/197 (6.1) | 0.265 |
Table 5.
Comparison of adolescent males to adolescent females
| Adolescent male, n (%) | Adolescent female, n (%) | p value | |
|---|---|---|---|
| Positive family history | 17/25 (68.0) | 39/74 (52.7) | 0.328 |
| Severity of acne | 0.016* | ||
| Mild | 6/25 (24.0) | 40/74 (54.1) | |
| Moderate | 17/25 (68.0) | 32/74 (43.2) | |
| Severe | 2/25 (8.0) | 2/74 (2.7) | |
| Type of acne | 0.002* | ||
| Noninflammatory | 14/25 (56.0) | 65/74 (87.8) | |
| Inflammatory | 5/25 (20.0) | 3/74 (4.1) | |
| Mixed | 6/25 (24.0) | 6/74 (8.1) | |
| BMI band | 0.558 | ||
| <18.5 | 6/23 (26.1) | 10/71 (14.1) | |
| 18.5–<25 | 14/23 (60.9) | 49/71 (69.0) | |
| 25–30 | 3/23 (13.0) | 11/71 (15.5) | |
| >30 | 0/23 (0.0) | 1/71 (1.4) | |
| Mean BMI kg/m2 (SD) | 20.8 (3.1) | 21.7 (3.2) | 0.217 |
| Lesions of acne | |||
| Total noninflammatory | 23/25 (92.0) | 72/74 (97.3) | 0.264 |
| Pustules | 17/25 (68.0) | 18/74 (24.3) | <0.001* |
| Nodules | 3/25 (12.0) | 2/74 (2.7) | 0.101 |
| Cysts | 2/25 (8.0) | 0/74 (0.0) | 0.062 |
Table 6.
Postadolescent males to postadolescent females
| Postadolescent male, n (%) | Postadolescent female, n (%) | p value | |
|---|---|---|---|
| Positive family history | 13/22 (59.1) | 56/94 (59.6) | 0.299 |
| Severity of acne | 0.442 | ||
| Mild | 12/22 (54.5) | 37/94 (39.4) | |
| Moderate | 8/22 (36.4) | 46/94 (48.9) | |
| Severe | 2/22 (9.1) | 11/94 (11.7) | |
| Type of acne | 0.099 | ||
| Noninflammatory | 17/22 (77.3) | 57/94 (60.6) | |
| Inflammatory | 0/22 (0.0) | 15/94 (16.0) | |
| Mixed | 5/22 (22.7) | 22/94 (23.4) | |
| BMI band | 0.025* | ||
| <18.5 | 1/18 (5.6) | 2/88 (2.3) | |
| 18.5–<25 | 13/18 (72.2) | 40/88 (45.5) | |
| 25–30 | 4/18 (22.2) | 24/88 (27.3) | |
| >30 | 0/18 (0.0) | 22/88 (25.0) | |
| Mean BMI kg/m2 (SD) | 23.4 (4.2) | 26.1 (5.8) | <0.002* |
| Lesions of acne | |||
| Total noninflammatory | 22/22 (100.0) | 84/94 (89.4) | 0.205 |
| Pustules | 12/22 (54.5) | 62/94 (66.0) | 0.450 |
| Nodules | 1/22 (4.5) | 17/94 (18.1) | 0.189 |
| Cysts | 1/22 (4.5) | 12/94 (12.8) | 0.457 |
| Category of acne | 0.117 | ||
| Persistent | 17/22 (77.3) | 57/94 (60.6) | |
| Late onset | 0 (0) | 15/94 (16.0) | |
| Recurring acne | 5 (22.7) | 22/94 (23.4) | |
Discussion
Facial acne vulgaris in adolescents is commonly documented but not PAA despite an increasing prevalence of PAA [6, 8, 13]. Even fewer are documentations of differences between AA and PAA. Our study highlights the differences in epidemiological and clinical characteristics between AA and PAA. In addition, the study shows gender-based differences of acne.
Acne accounted for 17.2% of the dermatological consultation over the study period reflecting the commonness of acne. The common presentation of acne to our clinics is similar to what has been documented in other studies. Acne was more prevalent in adolescents compared to PAA. This finding is not unlike what has been reported: acne being more of an adolescent problem than an adult one [5, 7]. Our study revealed an acne prevalence of 5.5% in male and 14.8% in female PAA. Although, these figures are not as high as what is documented in adolescents, they do confirm the occurrence of acne in adults and are similar to what was reported by Goulden et al. [13] and Cunnlife and Gollnick [18] in their initial studies of adult acne.
The female gender was predominantly affected irrespective of age. Epidemiological studies of acne show the female gender to be disproportionately affected by acne, and this has been attributed to hormonal influences, use of cosmetics, and females being more likely to seek medical help than males [5, 16, 19, 20]. The mean age at consultation of the patients was 24 years and acne was found to be more prevalent in the age 21–30 years. Acne was also found to decrease with age, as acne was only diagnosed in 8% of those aged 40 years and older compared to patients aged 30 years and below. Furthermore, the mean age at onset of acne was 18 years and most of the patients had an onset of acne at age 11–20 years. These findings are in keeping with acne being a disease of adolescents and young adults. Similar to our study, other researchers found acne to have an onset in the second decade of life and to be rare in those aged 40 years and older [9, 21, 22].
A family history of acne was reported in half of the patients and within what has been reported in other studies [7, 9, 16, 21]. A family history of acne especially in first-degree relations is not uncommon in acne patients and it is reported to be associated with early onset, increased severity, and relapse of acne in adulthood [16, 21, 23]. Body mass index was not contributory to acne occurrence in this study, as 60% of the patients had a normal BMI. The influence of BMI on acne is variable. Studies show BMI to be important in adolescent and not in adult acne [4, 21, 24]. The study population was more adult than adolescents; this may be responsible for this noncontributory influence of BMI. Premenstrual flare was recorded in most of the females. Premenstrual flare is thought to have a hormone-dependent effect in females: to be caused by increased water content of the pilosebaceous unit and blockage of the sebaceous duct opening [19, 23]. Premenstrual flares especially in PAA is frequently reported [6, 7, 14, 16, 22].
In keeping with the increasing observance and documentation of acne no longer being a disease of just adolescents, this study had a lot of postadolescents in it [5, 6, 16]. In the PAA group, persistent acne followed by late-onset and the returning acne was found. The finding of persistent acne is not surprising, as the duration of acne was over 5 years in the majority of the population studied. Our study does not differ from other studies of PAA with persistent acne reported more frequently than other categories of acne [7, 16, 21].
Clinically, acne was noninflammatory with comedonal lesions found in the majority of the patients. Comedonal acne was followed by pustules, cysts, and nodules in a few patients. Acne is frequently polymorphic and so this combination of lesions is not unlikely. The severity of acne was mild for almost half of the patients. Acne is frequently graded based on the type of lesions observed on the patients. Comedonal lesions which are noninflammatory tend to be classed in the mild grade of acne [17]. Our study population was one-third adolescent, and in this population, acne is frequently noninflammatory and mild [3, 5]. The total lesion count showed comedones to be more than inflammatory lesions. Also, most patients did not have a lot of acne lesions. This is in keeping with mild acne being the predominant severity of acne in the study. Also, in most clinical studies of acne in adults, a mild form of acne is reported [5, 16].
The whole face was affected by acne, irrespective of whether it was inflammatory or noninflammatory acne. The reported site of acne occurrence varies in literature with whole face affected in some studies and the cheeks and chin in others [6, 9, 12, 14, 15]. In their review of acne, Preneau and Dreno [8] in their review article on acne concluded that irrespective of AA or PAA, the whole face is affected by acne [12]. Acne sequelae were present in a large proportion of the patients and this was mostly AIH. Acne is frequently documented to be associated with a sequelae irrespective of severity especially in PAA which made up the majority of the patients in the study [7, 9, 14]. This study was conducted in skin type V and VI individuals in whom inflammatory diseases frequently lead to post-inflammatory hyperpigmentation and a poor quality of life [25–27]. In these skin types, apart from treating acne, AIH has to be addressed as this becomes the main worry of the patients [6, 25, 26].
On comparing PAA to AA, there were significant differences in the type of acne, BMI, type of acne lesions, and acne scarring. AA was mostly comedonal, while PAA was more inflammatory. PAA were more overweight and obese compared to adolescents. Acne scars were more frequent in PAA compared to AA being present in 42.4% of AA compared to its presence in 79% of PAA. Acne scars although independent of severity depend on the duration of acne [14, 23]. PAA have a longer duration of acne: this accounts for the more scarring in PAA. There was no difference in the severity of acne, gender affectation, family history of acne, premenstrual flare, and the anatomical location of acne. Acne occurred on the whole face irrespective of age. Our study compares favorably with similar comparative studies of acne in some aspects but differs in some features. In consonance with our study, the whole face is affected, including female gender in both AA and PAA. The occurrence of acne on the whole face is similar to what is documented by some researchers [8, 9, 15]. But it is different from that documented by Dhaher et al. [14], who found acne more on the lower face in PAA, and on the forehead and cheek in AA. Like Skroza et al. [16], we found the female gender to be affected in both AA and PAA. However, the male gender was found to be more affected by AA in other studies [5, 21–23]. Similar comparative studies found PAA to have more of inflammatory acne and to be associated with more scarring [5, 14, 15, 21, 23].
We did not find any difference in the family history of acne and premenstrual flare. Dhaher like us did not find a difference in premenstrual flare but found a family history more in AA [14]. This is unlike Kutlu et al. [23], who found premenstrual flare more in PAA. Dhaher et al. [14] like us recorded a difference in BMI with higher BMI PAA. The lack of difference in acne severity in our study is like that reported by Dreno et al. [9] and Uwajeni et al. [7], but unlike that by Dhaher et al. [14] who reported more severe acne in PAA. Our study shows that PAA is not exactly the same as AA and should be treated differently.
Differences were also observed when the genders were compared. The mean BMI in females significantly differed from that of males: overweight and obesity was more in the females. We do not know if hormonal influences accounted for this difference. Other gender-based comparative studies of acne did not compare BMI making it difficult to compare our study with that of others [3, 4, 14]. Pustular acne was more in males, although the severity and type of acne lesions did not significantly differ. Skroza et al. [16] like us, were unable to demonstrate any gender-based difference in the severity of acne.
On comparing adolescent males to adolescent females, acne was significantly more severe in males. Males had more inflammatory lesions and pustules. This is not unlike what has been documented in studies of AA. We did not find any significant difference in BMI unlike the study by Anaba et al. [4], where there was a significant difference in BMI between adolescent males and females. The study by Anaba et al. [4] had over a thousand adolescents unlike this study. We opine that, this difference in number studied may have influenced the difference in BMI.
When PAA males and females were compared, mean BMI and type of acne significantly differed. The mean BMI was higher in females similar to what we observed in the adolescents. Like we have previously alluded to, we think this may be a hormone-related effect, as this difference was found in both AA and PAA. Inflammatory lesions were found more in females unlike what we saw in adolescents. We are unable to say why this difference exists but this makes the case for PAA being different from AA. Skroza et al. [16] in consonance with our study did not find any gender-based difference in severity.
In conclusion, there is an increasing prevalence of PAA. Acne is mostly comedonal and mild in severity. A family history of acne is frequent and acne is associated with premenstrual flare. AIH is frequent in acne and should be taken into cognizance in treatment. Persistent acne is the most common category of acne in PAA. There are significant differences between adolescent and PAA: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and PAA.
Statement of Ethics
The study was conducted following ethical approval by the Lagos State University Teaching Hospital Ethical Committee (LREC/06/10/1530). In addition, verbal and written consents were obtained from the participants. In addition, written informed consent was obtained from parents/guardians of all participants aged under 18 years.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
No funding was received for this study.
Author Contributions
E.L.A.: conceptualization, literature review, patient examination and recruitment, and drafting and review of manuscript. H.S.: conceptualization, patient examination and recruitment, and drafting and review of manuscript. B.A.: data analysis and drafting and review of manuscript.
Funding Statement
No funding was received for this study.
Data Availability Statement
All data generated during this study are included in this article. Further inquiries can be directed to the corresponding author.
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Associated Data
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Data Availability Statement
All data generated during this study are included in this article. Further inquiries can be directed to the corresponding author.