Risk factors and epidemiology of acne severity and acne scar development: A comprehensive clinical study
Dr. Keshava M
M.B.B.S, D.V.D, D.N.B, P.D.C.R, Skin & Hair Specialist
DR. KESHAV’S SKIN HAIR & AESTHETICS HOSPITAL
Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit, presenting with comedones, papules, pustules, and cysts. Several factors have been linked to increased acne severity, including female sex, older adolescent age, parental education, family history, oily skin type, and higher BMI. By contrast, the roles of diet and smoking are less clearly understood and require further investigation. Acne scarring can develop in the vast majority of individuals with acne, even when the acne is only mild to moderate. Because lesions often occur on visible areas, scarring can contribute significantly to psychosocial distress. There is currently no universal agreement on the optimal treatment approach for acne scars, and many patients present with more than one scar type, adding to the complexity of management. For these reasons, early identification of patients at high risk of scarring is crucial for timely and effective intervention.
The study by Etgu F, et al., aimed to identify risk factors associated with acne severity, the development of acne scars, and the severity of scarring in patients with acne vulgaris. A cross-sectional study was conducted over six months in a dermatology outpatient clinic, where demographic characteristics, acne lesion features, treatment histories, and various potential risk factors were documented. Acne severity and scar severity were assessed using standardized grading systems.
A six-month cross-sectional study was conducted in a dermatology outpatient clinic, where demographic characteristics, acne lesion features, treatment history, and potential risk factors for acne and scarring were documented. Acne severity and scar severity were assessed using standardized grading systems.
The study included 269 patients: 175 (65.1%) females and 94 (34.9%) males. The mean age was 25±6.6 years, with an average acne onset at 19.5±6.2 years and a mean disease duration of 5.7±5.6 years. The average stress level score was 6.2±2.7, and the mean GAGS score was 23.4±7.9.
Patients with severe acne were significantly younger (23±5.5 vs. 25±9; p=0.000) and experienced earlier acne onset (16.5±6 vs. 19±10; p=0.001). A history of adolescent acne increased the likelihood of developing severe acne, with 1.87-fold higher odds. Lesions on the forehead were also strongly associated with higher acne severity.
Previous treatments influenced scar risk: patients who had used topical therapies showed a higher likelihood of scarring (OR=2.02), and those treated with oral antibiotics had an even greater risk (OR=4.11). In contrast, oral isotretinoin was associated with a markedly reduced risk of scarring (OR=0.16), suggesting a protective effect.
Male sex and severe acne were additional predictors of both the presence and severity of scars. Higher emotional stress levels were reported among patients with scarring. Post-lesional hyperpigmentation and erythema were also strong indicators of more severe scar formation. Overall, the findings emphasize the importance of early and appropriate acne management to reduce long-term scarring risk.
Early recognition of risk factors and timely intervention can lessen the burden of acne scarring and enhance patients’ quality-of-life. Identifying predictors of acne severity and scarring supports clinicians in adopting preventive approaches and improving long-term outcomes.
Reference: Etgu F, Sekerlisoy Tatar G. Risk factors and epidemiology of acne severity and acne scar development: A comprehensive clinical study. Dermatol Pract Concept. 2025;15(4):e20256108.
