Systematic review of the epidemiology of acne vulgaris

Anna Hwee Sing Heng, Fook Tim Chew, Anna Hwee Sing Heng, Fook Tim Chew

Abstract

A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong association was observed between several risk factors - family history, age, BMI and skin type - and acne presentation or severity in multiple studies. The pooled odds ratio of 2.36 (95% CI 1.97-2.83) for overweight/obese BMI with reference to normal/underweight BMI and the pooled odds ratio of 2.91 (95% CI 2.58-3.28) for family history in parents with reference to no family history in parents demonstrate this strong association. In addition, a pooled odds ratio of 1.07 (95% CI 0.42-2.71) was obtained for sex (males with reference to females). However, the association between other factors, such as dietary factors and smoking, and acne presentation or severity was less clear, with inconsistent results between studies. Thus, further research is required to understand how these factors may influence the development and severity of acne. This study summarizes the potential factors that may affect the risk of acne presentation or severe acne and can help researchers and clinicians to understand the epidemiology of acne and severe acne. Furthermore, the findings can direct future acne research, with the hope of gaining insight into the pathophysiology of acne so as to develop effective acne treatments.

Conflict of interest statement

Professor Fook Tim CHEW reports grants from Singapore Ministry of Education Academic Research Fund, Singapore Immunology Network, National Medical Research Council (NMRC) (Singapore) and the Agency for Science Technology and Research (A*STAR) (Singapore), during the conduct of the study; consultancy fees from Sime Darby Technology Centre; First Resources Ltd; Genting Plantation, and Olam International, outside the submitted work. Apart from these authors declare no other competing interests.

Figures

Figure 1
Figure 1
Individual and pooled odds ratio and 95% confidence intervals for acne presentation in association with male or female sex. Two studies were excluded from meta-analysis due to a lack of data, such as the odds ratio and/or 95% confidence interval.
Figure 2
Figure 2
Individual and pooled odds ratio and 95% confidence intervals for acne presentation in association with family history (parents) or no family history (parents). Four studies were excluded from meta-analysis due to a lack of data, such as the odds ratio and/or 95% confidence interval. Five additional studies were excluded from meta-analysis due to study design or because the comparison and reference groups used were different from the other studies. Two entries are used for Wolkenstein et al. as the odds ratios for maternal family history and paternal family history were presented separately.
Figure 3
Figure 3
Individual and pooled odds ratio and 95% confidence intervals for acne presentation in association with overweight/obese individuals or normal/underweight individuals. One study was removed from the meta-analysis due to study design. Two entries are used for Aksu et al. as the odds ratio for normal BMI and overweight BMI were presented separately.
Figure 4
Figure 4
Flowchart of the process used to select studies for meta-analysis.

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