Acne is a common problem, but often considered only a minor problem in Asian countries. The prevalence of acne in Asia ranges between 50% and 90%, with most sufferers only having a mild form. Issues surrounding quality of life (QoL) for acne sufferers are well-known in Western countries, but there is a scarcity of data on this issue in Asia. QoL impairment in this region is mild and based on the Dermatology Life Quality Index (DLQI), a dermatology-specific tool. This is in comparison with moderate impairment among European nations. When the acne-specific tool of Cardiff Acne Disability Index (CADI) is used, the impairment increased to moderate among Asian patients; not dissimilar to that of Europeans. This discrepancy between Index scales, particularly with regard to the DLQI, might be owing to the irrelevance of a few questions for Asian-specific populations. QoL impairment in Asia is not correlated with the severity of acne, but more likely related to acceptance and coping mechanisms of patients with regard to their condition. Impairment is worsened with acne scarring. In addition, acne causes poor self-image, depression, stress, interpersonal relationship problems, and difficulty in daily activities. Therefore, acne should be regarded as a potentially life-altering condition, which warrants better treatment and resource allocation.
Acne is a widespread problem, with an estimated lifetime prevalence of more than 80%1. It is a multifactorial disorder of the pilosebaceous units affecting mainly adolescents and young adults1. It is caused by hyperkeratinisation of the pilosebaceous units, excessive sebum production, Propionibacterium acnes hypercolonisation, and infiltration of inflammatory cells around the pilosebaceous units2.
Studies that focus on acne in Asian countries are scarce, and the true prevalence of the condition in this region is still unknown. The majority of studies are carried out in countries with higher socioeconomic status, or focus on school children in East and South East Asia. In developed Asian countries, the prevalence ranges between 79% and 88%: in Singapore, the prevalence is approximately 88%, Hong Kong 81.5%, and South Korea 78.9%3–5. In developing countries, the prevalence is lower, at between 52% and 68%: in Malaysia, the prevalence is 67.5%, and in China 51.3%6, 7. In the Philippines, acne vulgaris is the main dermatologic condition seen in the general population8.
In community studies, the majority of adolescents and young adults have mild acne, constituting between 52% and 69% of those with acne3, 4, 9. Severe acne only constitutes between 6% and 9%3. However, in the dermatology clinic setting, the proportion of patients with severe acne increased to between 13% and 30%10–12. Great variations in the prevalence of acne based on severity are seen within the country, and between different countries, owing to the different acne severity gradings used.
In clinical practice, the majority of patients have moderate-to-severe acne. These patients typically failed treatment with over-the-counter (OTC) anti-acne products and treatment prescribed by general practitioners (GPs). Those with mild acne usually improved when using these products and usually do not present to dermatology and aesthetic clinics. In Asia, patients not only purchase medical products, but also try complementary products such as traditional Chinese medications and ayurvedic medications.
[pull_quote align=”right” ]Most communities regard acne as part of growing up and mostly resort to over-the-counter products and traditional medication.[/pull_quote]
Most communities regard acne as part of growing up and mostly resort to OTC products and traditional medication. Parents in Third World and developing countries across Asia do not put great emphasis on the treatment of acne. Similarly, health authorities do not regard acne as a significant dermatological problem, with allocation of resources for the treatment of acne being poor in most Asian countries. Furthermore, developing countries like Malaysia still do not allocate insurance coverage for the treatment of acne. Insurance allocation in Malaysia is only limited to medical illnesses; there is no coverage for cosmetic problems. Unfortunately, in many developing countries acne is considered a cosmetic problem and thus devoid of insurance coverage.
From Western studies, acne poses a significant impact on the QoL of its sufferers. The social, psychological, and emotional impairments caused are not dissimilar to those reported among patients with chronic disabling asthma, diabetes, epilepsy, back pain or arthritis, for example13. The impairments in QoL affect all sufferers regardless of gender and age14. Anxiety, depression and suicidal thoughts were commonly seen among patients with acne and some have actually attempted suicide15, 16. There is also a higher rate of unemployment among those with acne17, many of whom are also more prone to embarrassment, stigmatisation, social withdrawal, lower self-esteem, eating disorders, and body dysmorphic disorder (BDD)18.