A Clinical Appraisal of Endogenous and Exogenous Factors of Acne Vulgaris in Adolescents and Adults from a Tertiary Care Teaching Hospital in Central Kerala

Acne vulgaris a common cosmetic problem especially in the adolescent age is caused and perpetuated by various endogenous and exogenous factors. Identification of these factors would improve the treatment outcome and prevent recurrences.

To identify various etiological factors in acne vulgaris among out patients attending the Dermatology department of a tertiary care teaching hospital.

200 registered patients who presented with acne vulgaris and on regular follow up for a period not less than 6 months were classified into three groups, mild, moderate and severe. Detailed history was elicited and clinical examination were done in all cases with hormonal evaluation in clinically relevant cases.

110 females and 90 males participated in the study. 118 (59%) had mild acne, 68 (34%) moderately severe and 14 (7%) severe form of acne. Main endogenous factors observed were genetic predisposition in 64/200 subjects (32%), seborrhoeic dermatitis in 102/200 (51%) and acanthosis nigricans was present in 9/200 (4.5%). Of the 110 females premenstrual exacerbation of acne was observed in 48 (43.6%) and polycystic ovaries in 16 females (14.5%). Main exogenous factors identified were usage of topical comedogenic agents in 102 (51%) subjects, dietary factors in 64 (32%) subjects, emotional stress in 17(8.5%) subjects.

A proper evaluation of endogenous and exogenous factors is necessary to prevent persistence or recurrence of acne and long term consequences like scarring, pigmentation and psychological distress. The most common exogenous etiological factor identified in the present study was usage of comedogenic substances and the most prevalent coexistent dermatoses was seborrhoeic dermatitis. Hence these factors need to be addressed in all cases of acne to prevent its recurrence or perpetuation.