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1.  Sex and sexual health: A survey of Canadian youth and mothers 
Paediatrics & Child Health  2008;13(1):25-30.
INTRODUCTION
Apparent changes in adolescent sexual behaviours have led to debate in recent years. A survey on adolescent sexuality was designed to determine mainstream Canadian adolescents’ current knowledge and sources of sexual health information, to identify their needs, and to understand the perceptions and the role of parents in sexual health education.
METHODOLOGY
In October 2005, on-line interviews were conducted by Ipsos Reid (Ipsos Canada) with 1171 Canadian teenagers (14 to 17 years of age) and 1139 mothers of teenagers.
RESULTS
Twenty-seven per cent of teens were sexually active at a mean age of 15 years, with an average of 2.5 lifetime partners, and had been in their current relationship for longer than eight months. The last time that they had had sex, 76% had used a condom. Teens and mothers overestimated the percentages of teens sexually active at any age. Most valuable sources of information were school, parents, friends and doctors. Sixty-nine per cent of teens could not find the information that they were looking for, and 62% reported obstacles in getting information. Teens lacked knowledge about sexually transmitted infections and their consequences. Seventy-five per cent of mothers believed that their teenagers’ friends were significant role models when it came to sexuality, and 50% mentioned entertainment celebrities at par with them. However, 45% of teenagers regarded their parents as their role models, far ahead of friends (32%) and entertainment celebrities (15%). Despite saying that they had positive relationships with their mothers, 38% of teens had not discussed sexuality with them. Most teens trusted the information given by health professionals (94%) and believed that it was their role to provide sexual health information.
CONCLUSIONS
Most adolescents are responsible when it comes to sexuality, but there are still areas of concern. Adolescents identify barriers to getting information and lack knowledge about sexually transmitted infections. Parents should feel more comfortable when it comes to discussing sexuality, especially the more value-based issues. Health care professionals and teachers have a role to play, and should ensure that teens are getting correct information. It is important to have diverse sources of information. All teens are not ready at the same time to receive the information; thus, it should be repeated. Governments, health, education and public health authorities have an essential role to play to make sexual health information accurate, accessible, inclusive and salient to the reality of Canadian adolescents.
PMCID: PMC2528827  PMID: 19119349
2.  The development of a new measure of quality of life for young people with diabetes mellitus: the ADDQoL-Teen 
Background
This study evaluated the psychometric properties of the ADDQoL-Teen, an innovative individualised, patient-centred questionnaire measuring perceived impact of diabetes mellitus on quality of life (QoL) of teenagers. Respondents rate all 30 life domains for frequency, and personally applicable domains for 'bother'. Two overview items measure present QoL and diabetes-dependent QoL. ADDQoL-Teen design was based on the ADDQoL (for adults with diabetes).
Methods
Interviews and discussion groups were conducted with 23 teenagers aged 13–16 years, during work to design the ADDQoL-Teen. The new questionnaire was then completed by 152 young people, (mean age 16.4 ± 2.4 years), attending diabetes clinics at six UK centres.
Results
Five domains detracted from the measure's reliability and factor structure, four of which were analysed separately and one deleted. The 25-domain ADDQoL-Teen had high internal consistency reliability [Cronbach's alpha = 0.91, (N = 133)] and could be summed into an overall Average Weighted Impact score. There were two subscales: a 10-item Impact-Self subscale (measuring impact of diabetes and its treatment on the individual) and a 15-item Impact-Other subscale (measuring impact on interactions with others and the external world). Both subscales had good internal consistency reliability, [Cronbach's alpha coefficients of 0.82 (N = 142) and 0.88 (N = 138) respectively]. Domains reported as most severely (and negatively) impacted by diabetes were (mean weighted impact ± SD): lie in bed (-3.68 ± 3.41), interrupting activities (-3.5 ± 3.23), worry about the future (-3.45 ± 3.28), career (-3.43 ± 3.15) and sweets (-3.24 ± 3.24), (maximum range -9 to +3). Analysis of the overview items showed that although 72.5% considered that their present QoL was good or brilliant, 61.8% felt that having diabetes had a negative impact on QoL, but 35.6% reported no impact and 2.6% reported a positive impact on QoL.
Conclusions
The ADDQoL-Teen is a new measure of perceived impact of diabetes and its treatment on QoL of teenagers. It will help healthcare professionals and parents consider QoL issues as well as medical outcomes when caring for young people with diabetes. It may be used in clinical trials and for routine clinical monitoring in a context of continuing evaluation.
doi:10.1186/1477-7525-2-61
PMCID: PMC538259  PMID: 15535888
3.  Understanding the Burden of Adult Female Acne 
Objective: Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women. Design: Cross-sectional, web-based survey. Setting: Data were collected from a diverse sample of United States females. Participants: Women ages 25 to 45 years with facial acne (≥25 visible lesions). Measurements: Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity. Results: A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin, and forehead and was characterized by erythema, postinflammatory hyperpigmentation, and scarring. Average age of adult onset was 25±6 years, and one-third (33.7%) were diagnosed with acne as an adult. The majority (80.3%) had 25 to 49 visible facial lesions. Acne was perceived as troublesome and impacted self-confidence. Makeup was frequently used to conceal acne. Facial acne negatively affected health-related quality of life, was associated with mild/moderate symptoms of depression and/or anxiety, and impacted ability to concentrate on work or school. Conclusion: Results highlight the multifaceted impact of acne and provide evidence that adult female acne is under-recognized and burdensome.
PMCID: PMC3935648  PMID: 24578779
4.  Acne Vulgaris and the Epidermal Barrier 
Acne vulgaris is a common dermatological disorder that predominantly affects teenagers, but can also affect preadolescents and post-teen individuals. Despite the fact that acne vulgaris is the most common skin disorder encountered in ambulatory dermatology practice in the United States, there has been limited research on the epidermal permeability barrier in untreated skin of people with acne vulgaris and also after use of acne therapies. This article reviews the research results and discusses the available literature on this subject area. The importance of proper skin care as a component of the management of acne vulgaris is supported by the information that is currently available.
PMCID: PMC3579484  PMID: 23441236
5.  Physical and Psychosocial Impact of Acne in Adult Females 
Indian Journal of Dermatology  2012;57(1):26-29.
Background:
Acne, the most common problem that presents to dermatologists, can persist beyond teen years. Although its physical and psychosocial impact is studied in teen years, it is poorly understood in the Indian adult population.
Aim:
To study the physical and psychosocial impact of acne in adult females.
Settings and Design:
This exploratory study was done in the university setting.
Materials and Methods:
Eleven adult, unmarried females, between the age group of 18 and 25 years, having (mild-to-moderate), acne, for two consecutive years, were interviewed using a semi-structured clinical interview of the Skindex, a quality-of-life measure for patients with skin disease, developed by Chren et al., along with some open-ended questions. Both qualitative and quantitative analysis was done to analyze the data.
Results:
The results indicated a higher level of emotional and social impairment, in terms of the feelings of physical discomfort, anger, and the intermingling impact of these, among the participants.
Conclusions:
Acne is a common problem among adults and appears to have a considerable impact on the mental health, therefore, for the treatment to be successful, a sympathetic approach by doctors and significant others, with the basic psychosomatic treatment, are necessary.
doi:10.4103/0019-5154.92672
PMCID: PMC3312651  PMID: 22470204
Acne; adults; psychosocial impact
6.  Production of Superoxide Anions by Keratinocytes Initiates P. acnes-Induced Inflammation of the Skin 
PLoS Pathogens  2009;5(7):e1000527.
Acne vulgaris is a chronic inflammatory disorder of the sebaceous follicles. Propionibacterium acnes (P. acnes), a gram-positive anareobic bacterium, plays a critical role in the development of these inflammatory lesions. This study aimed at determining whether reactive oxygen species (ROS) are produced by keratinocytes upon P. acnes infection, dissecting the mechanism of this production, and investigating how this phenomenon integrates in the general inflammatory response induced by P. acnes. In our hands, ROS, and especially superoxide anions (O2•−), were rapidly produced by keratinocytes upon stimulation by P. acnes surface proteins. In P. acnes-stimulated keratinocytes, O2•− was produced by NAD(P)H oxidase through activation of the scavenger receptor CD36. O2•− was dismuted by superoxide dismutase to form hydrogen peroxide which was further detoxified into water by the GSH/GPx system. In addition, P. acnes-induced O2•− abrogated P. acnes growth and was involved in keratinocyte lysis through the combination of O2•− with nitric oxide to form peroxynitrites. Finally, retinoic acid derivates, the most efficient anti-acneic drugs, prevent O2•− production, IL-8 release and keratinocyte apoptosis, suggesting the relevance of this pathway in humans.
Author Summary
Acne vulgaris is a chronic inflammatory disorder of the sebaceous follicles. It is the most common skin disease, affecting up to 80% of individuals at some point between the ages of 11 and 30 years. Propionibacterium acnes (P. acnes) plays a role in the development of inflammatory acne lesions, but whether it causes inflammation by itself or through indirect mechanisms is not clear yet. Therefore, by exposing epidermal cells to P. acnes in vitro, we tested whether reactive oxygen species (ROS) production (oxidative burst) was involved in the inflammatory process. We found that one particular ROS, superoxide anion, was generated by epidermal cells following P. acnes stimulation. This phenomenon is associated with the production of a soluble pro inflammatory molecule, IL-8, and epidermal cell death. The abrogation of P. acnes-induced oxidative burst by the most commonly used and most efficient treatments of acne suggests that superoxide anions produced by epidermal cells are critical in the development of acne inflammatory lesions.
doi:10.1371/journal.ppat.1000527
PMCID: PMC2709429  PMID: 19629174
7.  Presentation and management of acne in primary care: a retrospective cohort study. 
BACKGROUND: Acne is the most common skin disorder in young people, affecting up to 80% of teenagers. AIMS: To ascertain the incidence, prevalence, demographic distribution and severity of acne in primary care and to document the management of these patients for a two-year period after presentation. DESIGN OF STUDY: Retrospective cohort study using data from the medical records of 798 patients who had been treated for acne during a one-year identification period. SETTING: Fourteen general practices in a mixed urban area in north-east England. METHOD: Patients aged 13 to 25 years who had acne were identified from computerised practice medical records using diagnostic codes and medication records. The medical records of these patients were then hand-searched for data for two years after presentation. RESULTS: Data were collected for 798 patients from 14 practices. The prevalence of acne in 13- to 25-year-olds was 3.1%, and the incidence was 1.6%. The ratio of male to female patients with acne was 1:1.02. Median age at presentation was 15 years for male subjects and 16 years for female subjects. Recording of site and severity was rare (18.3%). In total, 55% of patients had two or more different prescriptions for acne, 21% of patients had six or more consultations during the two-year follow-up period, and 8.5% were referred to a dermatologist. CONCLUSION: Given previous estimates of community prevalence, it is clear that the majority of young people with acne do not present to primary care. These findings have implications for the provision of effective and appropriate health care for young people with acne.
PMCID: PMC1314642  PMID: 14694664
8.  Pan-Genome and Comparative Genome Analyses of Propionibacterium acnes Reveal Its Genomic Diversity in the Healthy and Diseased Human Skin Microbiome 
mBio  2013;4(3):e00003-13.
ABSTRACT
Propionibacterium acnes constitutes a major part of the skin microbiome and contributes to human health. However, it has also been implicated as a pathogenic factor in several diseases, including acne, one of the most common skin diseases. Its pathogenic role, however, remains elusive. To better understand the genetic landscape and diversity of the organism and its role in human health and disease, we performed a comparative genome analysis of 82 P. acnes strains, 69 of which were sequenced by our group. This collection covers all known P. acnes lineages, including types IA, IB, II, and III. Our analysis demonstrated that although the P. acnes pan-genome is open, it is relatively small and expands slowly. The core regions, shared by all the sequenced genomes, accounted for 88% of the average genome. Comparative genome analysis showed that within each lineage, the strains isolated from the same individuals were more closely related than the ones isolated from different individuals, suggesting that clonal expansions occurred within each individual microbiome. We also identified the genetic elements specific to each lineage. Differences in harboring these elements may explain the phenotypic and functional differences of P. acnes in functioning as a commensal in healthy skin and as a pathogen in diseases. Our findings of the differences among P. acnes strains at the genome level underscore the importance of identifying the human microbiome variations at the strain level in understanding its association with diseases and provide insight into novel and personalized therapeutic approaches for P. acnes-related diseases.
IMPORTANCE
Propionibacterium acnes is a major human skin bacterium. It plays an important role in maintaining skin health. However, it has also been hypothesized to be a pathogenic factor in several diseases, including acne, a common skin disease affecting 85% of teenagers. To understand whether different strains have different virulent properties and thus play different roles in health and diseases, we compared the genomes of 82 P. acnes strains, most of which were isolated from acne or healthy skin. We identified lineage-specific genetic elements that may explain the phenotypic and functional differences of P. acnes as a commensal in health and as a pathogen in diseases. By analyzing a large number of sequenced strains, we provided an improved understanding of the genetic landscape and diversity of the organism at the strain level and at the molecular level that can be further applied in the development of new and personalized therapies.
doi:10.1128/mBio.00003-13
PMCID: PMC3663185  PMID: 23631911
9.  Racial Differences in Clinical Characteristics, Perceptions and Behaviors, and Psychosocial Impact of Adult Female Acne 
Objective: Limited data are available on racial differences in clinical characteristics and burden in adult female acne. The objective was to describe racial differences in clinical characteristics, psychosocial impact, perceptions, behaviors, and treatment satisfaction in facial adult female acne. Design: Cross-sectional, web-based survey. Setting: Diverse sample of United States women. Participants: Women between the ages of 25 and 45 years with facial acne (≥25 visible lesions). Measurements: Outcomes included sociodemographic characteristics, psychosocial impacts, perceptions, behaviors, and treatment satisfaction. Racial differences were evaluated using descriptive statistics and t-test/chi-square analyses. Results: 208 females participated (mean age 35±6 years); 51.4 percent were White/Caucasian and 48.6 percent were non-White/Caucasian women [Black/African American (n=51); Hispanic/Latina (n=23); Asian (n=16); Other (n=ll)]. Age of acne onset (mean 14.8±5 vs. 17.0±8 years, p<0.05) and acne concern occurred earlier (16.6±7 vs. 19.3±9 years, p<0.05) in White/Caucasian than non-White/Caucasian subjects. Facial acne primarily presented on chin (28.0%) and cheeks (30.8%) for White/Caucasian women versus cheeks (58.4%) for non-White/Caucasian women. Non-White/Caucasian women experienced more postinflammatory hyperpigmentation than White/Caucasian women (p<0.0001). Facial acne negatively affected quality of life (QoL) in both groups, and most participants (>70%) reported some depression/anxiety symptoms. More White/Caucasian than non-White/Caucasian women were troubled by facial acne (88.8% vs. 76.2%, p<0.05). Lesion clearance was most important to White/Caucasian women (57.9 vs. non-White/Caucasian 31.7%, p<0.001); non-White/Caucasian females focused on postinflammatory hyperpigmentation clearance (41.6% vs. Caucasian 8.4%, p<0.0001). Conclusion: Results highlight racial differences in participant-reported clinical characteristics, attitudes, behaviors, and treatment satisfaction. These findings may inform clinicians about racial differences in facial adult female acne and guide treatment recommendations toward improving care.
PMCID: PMC4106354  PMID: 25053980
10.  Differential social evaluation of pregnant teens, teen mothers and teen fathers by university students 
Youth may be particularly attuned to social evaluation during the teen years with implications for physical and mental health. Negative attitudes and stereotypes constitute an important type of social evaluative threat. Pregnant and parenting teens not only encounter challenges associated with their early transition to parenthood, but also are confronted with unfavourable attitudes of others. A university sample of 255 men and women responded to surveys targeting their feelings and beliefs about pregnant teens, teen mothers and teen fathers. Teen mothers were generally perceived more positively than pregnant teens who were perceived more positively compared to teen fathers. Social evaluations were generally unrelated to respondents' sex or race, but respondents who had contact with a friend or family member who had experienced a teen pregnancy were selectively more positive, as were freshmen compared to seniors. Risks attributed to early childbearing may be exacerbated by negative social evaluations.
doi:10.1080/02673843.2014.963630
PMCID: PMC4299545  PMID: 25632168
teen pregnancy and parenting; teen fathers; social evaluation; attitudes; stereotypes
11.  Acne vulgaris 
Clinical Evidence  2008;2008:1714.
Introduction
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 67 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin (alone or plus zinc), isotretinoin, tetracycline, tretinoin), and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline).
Key Points
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne, and can cause scarring and psychological distress.
Topical benzoyl peroxide should be considered as first-line treatment in mild acne. Topical benzoyl peroxide and topical azelaic acid reduce inflammatory and non-inflammatory lesions compared with placebo, but can cause itching, burning, stinging, and redness of the skin.
Topical antibiotics such as clindamycin and erythromycin (alone or with zinc) reduce inflammatory lesions compared with placebo, but have not been shown to reduce non-inflammatory lesions. Tetracycline may reduce overall acne severity. Antimicrobial resistance can develop with use of topical or oral antibiotics, and their efficacy may decrease over time.Tetracyclines may cause skin discoloration, and should be avoided in pregnant or breastfeeding women.Topical preparations of tretinoin, adapalene, and isotretinoin may reduce inflammatory and non-inflammatory lesions, but can also cause redness, burning, dryness, and soreness of the skin.
Oral antibiotics (doxycycline, erythromycin, lymecycline, minocycline, oxytetracycline, and tetracycline) are considered useful for people with more severe acne, although we don't know for sure whether they are effective. Oral antibiotics can cause adverse effects such as contraceptive failure.Minocycline has been associated with an increased risk of systemic lupus erythematosus, and of liver disorders.Oral isotretinoin has been associated with skin problems, change in liver function, teratogenesis, and psychiatric disorders.
PMCID: PMC2907987  PMID: 19450306
12.  Acne vulgaris 
Clinical Evidence  2011;2011:1714.
Introduction
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 69 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin [alone or plus zinc]; isotretinoin, tetracycline, tretinoin); and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline).
Key Points
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne, and can cause scarring and psychological distress.
Topical benzoyl peroxide should be considered as first-line treatment in mild acne. Topical benzoyl peroxide and topical azelaic acid reduce inflammatory and non-inflammatory lesions compared with placebo, but can cause itching, burning, stinging, and redness of the skin.
Topical antibiotics such as clindamycin and erythromycin (alone or with zinc) reduce inflammatory lesions compared with placebo, but have not been shown to reduce non-inflammatory lesions. Tetracycline may reduce overall acne severity. Antimicrobial resistance can develop with use of topical or oral antibiotics, and their efficacy may decrease over time.Tetracyclines may cause skin discoloration, and should be avoided in pregnant or breastfeeding women.Topical preparations of tretinoin, adapalene, and isotretinoin may reduce inflammatory and non-inflammatory lesions, but can also cause redness, burning, dryness, and soreness of the skin.
Oral antibiotics (doxycycline, erythromycin, lymecycline, minocycline, oxytetracycline, and tetracycline) are considered useful for people with more severe acne, although we don't know for sure whether they are effective. Oral antibiotics can cause adverse effects such as contraceptive failure.Minocycline has been associated with an increased risk of systemic lupus erythematosus and liver disorders.Oral isotretinoin has been associated with skin problems, change in liver function, teratogenesis, and psychiatric disorders.
PMCID: PMC3275168  PMID: 21477388
13.  “Being in a Funk”: Teens’ Efforts to Understand Their Depressive Experiences 
Qualitative health research  2004;14(9):1227-1238.
Although there is literature about adults’ experiences of depression, little research has focused on teenagers’ experiences. In this article, the authors describe how a sample of adolescents makes sense of depression and responds to a depression diagnosis. Twenty-two adolescents participated in in-depth individual or focus group interviews. Teens discussed their experiences with depression and getting health care for depression, and described a trajectory similar to that found among adults: a slow growth of distress, a time of being in a funk, and a time of consideration of whether they are depressed. Teens who received a diagnosis from a medical provider then sought to make sense of their depression. Teens understood a depression diagnosis as a helpful label, a chronic medical problem, or a significant part of their identity. Understanding the subjective experience of adolescents who are depressed might increase health care providers’ empathy and improve their communication with teens.
doi:10.1177/1049732304268657
PMCID: PMC3575523  PMID: 15448297
depression; adolescents; treatment; attitudes; primary care; meaning
14.  Perimenstrual Flare of Adult Acne 
Background: Acne is typically regarded as an adolescent disease. A significant body of literature suggests a post-adolescent or adult form of acne. Female patients are known to experience perimenstrual acne flares, the exact prevalence of which is unknown. Objective: To establish a pattern of perimenstrual acne flare in adult women in order to better characterize the disorder. Methods: Subjects aged 18 and over were recruited during previously scheduled visits with their dermatologist at Mount Sinai Hospital in New York. An anonymous survey was distributed to women who reported their first menses at least six months earlier and had a complaint of acne within the last 30 days. Women <18 years of age and postmenopausal women were excluded from the study population. Results: Participants included women 18- to 29-years old (67%) and women 30- to 49-years old (33%). The ethnicity of respondents was Caucasian (50%), African American (20%), Latino (19%), Asian (5%), and Other (6%). The majority of participants with perimenstrual acne reported the onset of acne between the ages of 12 and 18 years. Sixty-five percent of participants reported that their acne symptoms were worse with their menses. Of those who reported perimenstrual acne symptoms, 56 percent reported worsening symptoms in the week preceding their menses, 17 percent reported worsening symptoms during their menses, three percent reported worsening symptoms after their menses, and 24 percent reported worsening symptoms throughout their cycle. Thirty-five percent of patients with perimenstrual acne reported oral contraceptive pill use. Conclusion: A significant number of adult women have perimenstrual acne symptoms. This study has proven to be useful in characterizing perimenstrual acne flare and is one of the first qualitative documentations of the presence and degree of this disorder.
PMCID: PMC4142818  PMID: 25161758
15.  Parental and peer influences on teen smoking: Are White and Black families different? 
Nicotine & Tobacco Research  2009;11(5):558-563.
Introduction:
The health risks associated with smoking disproportionately burden Blacks, and Black adults are more likely to smoke than are White adults. Most adult smokers have their first smoking experience as teenagers; however, rates of smoking initiation during adolescence remain lower among Black compared with White youth.
Methods:
The level and impact of family and peer risk and protective factors on adolescent smoking across both groups were modeled prospectively from 8th to 10th grade in a sample of 331 (Black n = 162, White n = 168) families using data from self-administered computer-assisted questionnaires. Predictors included parent smoking, guidelines against substance use, monitoring, consistent discipline, attachment to parents, and association with deviant peers.
Results:
Mean-level differences indicated greater risk for Black teens in some cases and higher protection in others. Multiple-group structural equation modeling indicated no race differences. Several factors affected both groups: (a) parenting factors reduced association with deviant peers, (b) association with deviant peers increased the risk of smoking in the 10th grade, and (c) teens were more likely to smoke if their parents smoked.
Discussion:
Reduced smoking among Black teens compared with White teens may be due to the protection of clear parental guidelines about substance use and clearly stated consequences for failure to observe those guidelines.
doi:10.1093/ntr/ntp034
PMCID: PMC2671462  PMID: 19351778
16.  Severity and impact of acne vulgaris on the quality of life of adolescents in Nigeria 
Background
Acne vulgaris is a common skin condition, which affects most adolescents at some point in their lives. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicide ideation. Many studies have assessed the impact of acne vulgaris on the quality of life (QoL) in different population subgroups around the world, but there is a dearth of reports from the African subcontinent. This study thus seeks to assess the severity of acne vulgaris and determine its effect on the QoL of adolescents in Lagos, Nigeria.
Methods
In a cross-sectional survey employing a two-stage sampling method, the severity of acne vulgaris and its impact on the QoL of adolescents attending a senior secondary school in Lagos, Nigeria was assessed using the Global Acne Grading Scale (GAGS) and the Cardiff Acne Disability Index (CADI), respectively. The correlation between the results of the GAGS and CADI was also determined.
Results
One hundred and sixty adolescent students with acne were recruited, with males accounting for 51.9% and females 48.1%. The mean and standard deviation of the GAGS severity scores were 11.3±5.4 for males and 11.9±5.4 for females. Only one student had severe acne vulgaris (GAGS, 31–38), 10% moderate (GAGS, 19–30), and 89.4% mild (GAGS, 1–18). The overall CADI score was 3.4±3.0, which suggests mild impairment in QoL; however, the solitary student with severe acne had severe QoL impairment. There was a weak positive correlation between the GAGS and the CADI score.
Conclusion
Most adolescents in our study had mild acne vulgaris, and the overall impact on their QoL was mild. However, the correlation between the psychosocial impact and acne severity was weak. There is a need for similar studies in other parts of the country and for further studies to determine the adequacy of the existing instruments in assessing the impact of acne vulgaris in Nigerian adolescents.
doi:10.2147/CCID.S73302
PMCID: PMC4266243  PMID: 25525376
CADI; GAGS; skin disease; teenage dermatosis; psychosocial impact
17.  Acne: more than skin deep 
Postgraduate Medical Journal  2006;82(970):500-506.
Acne is one of the most prevalent skin conditions affecting teenagers. It is a disease of the pilosebaceous unit. Blockage of sebaceous glands and colonisation with Proionobacterium acnes leads to acne. Grading the severity of acne helps to determine the appropriate treatment. Treatment of acne should be started as early as possible to minimise the risk of scarring and adverse psychological effects. It should be tailored to the individual patient, the type of acne, its severity, the patient's ability to use the treatment, and the psychological state. Topical agents are the mainstay for treatment of mild acne. Moderate acne is treated with oral antibiotics. Resistance to antibiotics may be reduced by subsequent use of non‐antibiotic topical medications. Severe acne is treated with isotretinoin, and this can lead to permanent remission. With better education and care given by medical profession, acne treatment could be significantly improved.
doi:10.1136/pgmj.2006.045377
PMCID: PMC2585707  PMID: 16891439
acne vulgaris; propionobacterium acnes; acne grading; acne treatment; acne psychological effects
18.  Inducible Siphoviruses in superficial and deep tissue isolates of Propionibacterium acnes 
BMC Microbiology  2008;8:139.
Background
Propionibacterium acnes is a commensal of human skin but is also known to be involved in certain diseases, such as acne vulgaris and infections of orthopaedic implants. Treatment of these conditions is complicated by increased resistance to antibiotics and/or biofilm formation of P. acnes bacteria. P. acnes can be infected by bacteriophages, but until recently little has been known about these viruses. The aim of this study was to identify and characterize inducible phages from P. acnes on a genetic and morphological basis.
Results
More than 70% (65/92) of P. acnes isolates investigated have inducible phages, classified morphologically as Siphoviruses. The phages have a head of 55 nm in diameter and a tail of 145–155 nm in length and 9–10 nm in width. There was no difference in carriage rate of phages between P. acnes isolates from deep infections and isolates from skin. However, there was a significant lower carriage rate of phages in P. acnes biotype IB, mostly attributed to the low carriage rate of inducible phages in biotype IB isolated from deep tissue. Most phages have a strong lytic activity against all P. acnes isolates with inducible phages, but have less lytic activity against isolates that have no prophages. Phages only infected and lysed P. acnes and not other closely related propionibacteria. All phages could infect and lyse their non-induced parental host, indicating that these prophages do not confer superinfection immunity. The phages have identical protein pattern as observed on SDS-PAGE. Finally, sequencing of two phage genes encoding a putative major head protein and an amidase and showed that the phages could be divided into different groups on a genetic basis.
Conclusion
Our findings indicate that temperate phages are common in P. acnes, and that they are a genetically and functionally homogeneous group of Siphoviruses. The phages are specific for P. acnes and do not seem to confer superinfection immunity.
doi:10.1186/1471-2180-8-139
PMCID: PMC2533672  PMID: 18702830
19.  College-Bound Teens’ Decisions about the Transition to Sex: Negotiating Competing Norms 
The normative influence of parents, close friends, and other peers on teens’ sexual behavior has been well documented. Yet, we still know little about the processes through which these oftentimes competing norms impact teens’ own sexual norms and behaviors. Drawing on qualitative data from 47 interviews conducted with college-bound teens, we investigate the processes through which perceived parental, close friend, and other peer norms about sex influenced teens’ decisions about whether and when to have sex. Although virtually all teens perceived that most of their peers were having sex and that parents were almost universally against teen sex, some teens had sex and others did not. Our findings demonstrate that teens who remained virgins and those who were sexually active during high school often negotiated different sets of competing norms. Differences in understandings of age norms, in close friends’ sexual norms and behaviors, and in communication about sex with parents, close friends and other peers were related to different levels of sexual behavior for teens who otherwise shared many similarities in social location (e.g.. class, race, and educational status). While virgins reported an individualized process of deciding whether they were ready for sex, we find that their behavior fits within a traditional understanding of an age norm because of the emphasis on avoiding negative sanctions. Sexually experienced teens, on the other hand, explicitly reported abiding by a group age norm that prescribed sex as normal during high school. Finally, parents’ normative objections to teen sex – either moral or practical – and the ways they communicated with their teen about sex had important influence on teens’ own sexual norms and behaviors during high school.
doi:10.1016/j.alcr.2011.05.001
PMCID: PMC3306840  PMID: 22439133
Age norms; sexual behavior; teenage sex; adolescence; communication; parental and peer influences
20.  Over-the-counter Acne Treatments 
Acne is a common dermatological disorder that most frequently affects adolescents; however, individuals may be affected at all ages. Many people who suffer from acne seek treatment from both prescription and over-the-counter acne medications. Due to convenience, lower cost, and difficulty getting an appointment with a dermatologist, the use of over-the-counter acne treatments is on the rise. As the plethora of over-the-counter acne treatment options can be overwhelming, it is important that dermatologists are well-versed on this subject to provide appropriate information about treatment regimens and potential drug interactions and that their patients see them as well-informed. This article reviews the efficacy of various over-the-counter acne treatments based on the current literature. A thorough literature review revealed there are many types of over-the-counter acne treatments and each are designed to target at least one of the pathogenic pathways that are reported to be involved in the development of acne lesions. Many of the key over-the-counter ingredients are incorporated in different formulations to broaden the spectrum and consumer appeal of available products. Unfortunately, many over-the-counter products are not well-supported by clinical studies, with a conspicuous absence of double-blind or investigator-blind, randomized, vehicle-controlled studies. Most studies that do exist on over-the-counter acne products are often funded by the manufacturer. Use of over-the-counter acne treatments is a mainstay in our society and it is important that dermatologists are knowledgeable about the different options, including potential benefits and limitations. Overall, over-the-counter acne therapies can be classified into the following five major groups: cleansers, leave-on products, mechanical treatments, essential oils, and vitamins.
PMCID: PMC3366450  PMID: 22808307
21.  Childhood exposure to ultraviolet radiation and harmful skin effects: Epidemiological evidence 
We review the general amount and patterns of exposure to solar ultraviolet (UV) radiation that children and teenagers experience and the spectrum of UV-related skin damage that can occur as a result. Data about the amount of solar UV received by children and teenagers are relatively few but suggest that around 40–50% of total UV to age 60 occurs before age 20. Among white children, those with the palest complexions suffer the most damage. Comparisons of prevalence and incidence of outcomes in children and teenagers sharing common ancestry, but living at different latitudes, show that prevalence rates of photoaging and melanocytic naevi are higher in Australian compared with British children, and similarly for melanoma. Genetic risk for the majority of the melanomas in teens is a function of genes controlling naevus propensity and pigmentation in the skin. High numbers of naevi and freckles, red hair, blue eyes, inability to tan, as well as a family history are the primary determinants of melanoma among adolescents. Beyond the signs of skin damage seen in children are the latent effects observed later in adulthood. Childhood is believed to be a susceptible window for long-term harmful effects of UV, as evidenced by clear differences in skin cancer risk between child and adult migrants from high to low latitudes. Effective UV radiation protection from childhood is necessary to control both immediate and long-term harmful effects on children’s skin.
doi:10.1016/j.pbiomolbio.2011.08.010
PMCID: PMC3409870  PMID: 21907230
Childhood; Ultraviolet radiation; Melanoma; Skin cancer
22.  Acne Vulgaris and Quality of Life Among Young Adults in South India 
Indian Journal of Dermatology  2015;60(1):33-40.
Acne vulgaris is a chronic condition affecting more than 85% of adolescents and young adults. It is one of the most common diseases affecting humanity and its impact on quality of life (QoL) is important. The impact of acne on QoL in Indian patients remains undocumented. The study was undertaken to detect the impact of acne vulgaris and related factors that may influence the QoL.
Materials and Methods:
This was a hospital-based, prospective, cross-sectional, prestructured, questionnaire-based study done on 140 consenting individuals, who attended the Dermatology outpatient department. Acne vulgaris was graded using simple grading system. QoL was measured using a combination of skin disease-specific (Dermatological Life Quality Index (DLQI)) and acne-specific (Cardiff Acne Disability Index (CADI)) questionnaires.
Results:
Majority of our study population were students (103, 73.6%). Face (139, 99.3%) was the commonest site of acne and comedones 133, 95% were the commonest type of lesion. Most of the individuals 66, 47.1% were observed to have grade 1 acne. The mean DLQI score was 6.91 and the mean CADI score was 5.2. Association between the scores was statistically significant. Age, occupation, marital status, family, and treatment history played a role in affecting the QoL. Diet, smoking, and alcohol did not influence the QoL.
Conclusion:
Though acne had impact on patient's QoL, it was less severe in our study. It is important for health professionals to incorporate QoL measurements when managing acne patients to provide better and appropriate care.
doi:10.4103/0019-5154.147784
PMCID: PMC4318060  PMID: 25657394
Acne; influencing factors; quality of life; young adults
23.  Moisturizers for Acne 
Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers. Different treatments offer different modes of action, but aim to target acne pathology. Topical therapies, such as benzoyl peroxide, retinoids, antibiotics with alcohol-based preparations, and salicylic acid, can cause skin irritation resulting in a lack of patient adherence. Some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical benzoyl peroxide or a retinoid is prescribed. Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne. Moisturizers contain three main properties, which are occlusive, humectant, and emollient effects. Currently, many moisturizers claim to be suitable for acne treatment. This article aims to provide a review of the active ingredients and properties of those moisturizers. Fifty-two moisturizers for acne were included for analysis. Most of the products (92%) have anti-inflammatory properties apart from occlusive, humectant, and emollient effects. Anti-acne medications, including salicylic acid, benzoyl peroxide, and retinol, were found respectively in 35, 10, and 8 percent of the moisturizer products containing anti-inflammatory properties. More than half of the products contain dimethicone and/or glycerin for its moisturizer property. Aloe vera and witch hazel are botanical anti-inflammatories that were commonly found in this study. Scientific data regarding some ingredients are discussed to provide a guide for physicians in selecting moisturizers for acne patients.
PMCID: PMC4025519  PMID: 24847408
24.  Novice Drivers' Exposure to Known Risk Factors During the First 18 Months of Licensure: The Effect of Vehicle Ownership 
Traffic injury prevention  2011;12(2):159-168.
Objective
Though there is ample research indicating that nighttime, teen passengers, and speeding increase the risk of crash involvement, there is little research about teen drivers' exposure to these known risk factors. Three research questions were assessed in this article: (1) Does exposure to known risk factors change over time? (2) Do teenage drivers experience higher rates of exposure to known risk factors than adult drivers? (3) Do teenage drivers who own a vehicle experience higher rates of exposure to risk factors than those who share a family vehicle?
Methods
Forty-one newly licensed teenage drivers and at least one parent (adult) were recruited at licensure. Driving data were recorded for 18 months.
Results
Average vehicle miles traveled (VMT) or average nighttime VMT for teens did not increase over time. Teenagers consistently drove 24 percent of VMT at night, compared with 18 percent for adults. Teenagers drove 62 percent of VMT with no passengers, 29 percent of VMT with one passenger, and less than 10 percent of VMT with multiple passengers. Driving with no passengers increased with driving experience for these teens. Teenage drivers who owned their vehicles, relative to those who shared a vehicle, sped 4 times more frequently overall and more frequently at night and with multiple teen passengers.
Conclusion
These findings are among the first objective data documenting the nature of teenage driving exposure to known risk factors. The findings provide evidence that vehicle access is related to risk and suggest the potential safety benefit of parental management of novice teenage driving exposure.
doi:10.1080/15389588.2010.549531
PMCID: PMC4138606  PMID: 21469023
Teenage drivers; Risk factors; Exposure; Nighttime driving; Speeding; Teenage passengers
25.  Body Dysmorphic Disorder: Treating an Underrecognized Disorder 
The American journal of psychiatry  2008;165(9):1111-1118.
“Mr. H,” a 33-year-old single white male, presented with preoccupations focused on his “thinning” hair, facial “acne,” and “short” fingers. He began to worry excessively about his appearance at age 15, focusing at that time on his “pale” skin and “uneven” cheekbones. Mr. H described his appearance preoccupations as “severely upsetting,” but he was too embarrassed to reveal them to family or friends. Even though he looked normal to others, Mr. H was “100% convinced” that these body areas appeared “abnormal and deformed,” although in the past he had sometimes thought that “maybe I don't look so bad.” He believed that other people took special notice of him and “laugh at me behind my back because I look so ugly.” Mr. H spent 5 to 6 hours a day thinking about his perceived appearance flaws. He also performed compulsive behaviors for 4 to 5 hours a day, which included excessive mirror checking, comparing his appearance with that of other people, wearing and frequently adjusting a baseball cap to cover his hair, picking his skin to remove tiny blemishes, and searching the Internet for acne and hair loss treatments.
Mr. H's appearance preoccupations and compulsive behaviors made it difficult to concentrate on his job as a store clerk and often made him late for work. In the past few weeks, he had missed work several times because he thought his skin looked particularly bad on those days. Mr. H avoided many social events with family and friends as well as sexual intimacy with his girlfriend because of shame over how he looked. In addition, he reported depressed mood, anhedonia, feelings of worthlessness, and passive suicidal ideation, and he had attempted suicide 5 years ago. He attributed his depressive symptoms and suicidal thinking to his appearance concerns, stating, “If I didn't look like such a freak, I wouldn't feel so hopeless and depressed.” Mr. H had received treatment from a dermatologist for his acne concerns, which did not diminish his preoccupations. He had never received psychiatric treatment and was ambivalent about trying it because, as he stated, “my appearance problems are real.”
doi:10.1176/appi.ajp.2008.08040500
PMCID: PMC2716131  PMID: 18765493

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