Study On The Relationship Between The Clinical Classifications And Related Risk Factors With Patients In Post Adolescent Acne

Objective: To investigate the relationship between clinical classifications and related risk factors in patients with post adolescent acne,provide evidence for the diagnosis and treatment of post adolescent acne.Methods: Patients with post adolescent acne in our department from January 2016 to January 2017,were conducted with questionnaire and doctors' observation to estimate the skin lesions,clinical classifications and related risk factors.Selected the female patients who agreed to be test for sex hormones.Taking fast cubital vein blood on day 2-4 of menstruation for serum sex hormones testing.SPSS21.0 was used for statistical analysis,the comparison between normal distribution groups was made by T test or ANOVA,the comparison between non normal distribution groups was made by U test and KruskalWalllis test.The difference was statistically significant with P<0.05.Result: Total 550 patients recruited.Among them,479(87.1%)cases were female,with mostly mild to moderate(I,II)acne(68.7%);71(12.9%)cases were male,with mostly moderate to severe(III,IV)acne(64.8%).According to the skin lesions classify into papulopustular type(426 cases,77.5%)and comedonal type(124 cases,22.5%).According to the onset time classify into persistent type(349 cases,63.5%),late-onset type(148 cases,26.9%)and recurrence type(53 cases,9.6%).Study on the related risk factors found that male had higher BMI(body mass index)and overweight rate than female(P<0.001).221(40.2%)cases with seasonal factors,378(68.7%)cases with diet factors,312(56.7%)cases with chemical exposures,320(58.2%)cases with psychological problems,338(65.0%)cases with lack of sleep,165(30.0%)cases with constipation,were complained by patients.The first degree relatives of 134 patients(24.4%)had a history of post adolescent acne or a history of severe acne vulgaris.In female patients,304(63.5%)cases had premenstrual exacerbation.Furthermore,season(spring),diet(spicy food,coffee,wine,seafood),constipation were found to be more associated with papulopustular type(P<0.05)compared to comedonal type.Season(summer)and family history were found to be more associated with persistent type and recurrence type(P<0.05)compared to late-onset type.While exogenous chemicals exposures(cosmetic)were more highly associated with comedonal type and late-onset type(P<0.05)compared to papulopustular type and persistent type.Male affected more obvious by season(summer),diet(spicy food,wine)compared with female.In the external factors,male patients were associated with smoking,and female patients were related to the cosmetic,especially the oil and powder(all P<0.05).In female patients,premenstrual aggravation was more associated with persistent type and papulopustular type(P<0.05)compared to late-onset type and comedonal type.In addition,46(9.6%)cases of female patients suffered from endocrine system disease,such as polycystic ovary syndrome,thyroid disease and so on;10(14.1%)cases of male patients were accompanied by inverse acne or diagnosed with acne associated syndrome99 patients were included.Among them,28.3% patients had at least one clinical symptom of hyperandrogenism.20.2% patients had androgen increased,11.2% patients had prolactin increased,8.1% patient had LH/FSH ratio increased.In addition,P,DHEAS in papulopustular type were higher than comedonal type,but E2 was lower than comedonal type.T,T/E2 ratio,PRL,LH,FSH in recurrence type were higher than lateonset type.T,FSH in recurrence type were higher than persistent type(P<0.05).And all sex hormone was no difference between persistent type and late-onset type(P >0.05).Conclusion: Papulopustular type and persistent type are the main clinical classification of post adolescent acne.In female patients,majority of them had mild to moderate acne,often accompanied with premenstrual exacerbation,papulopustular type and recurrence type are closely related with the elevated androgen or the drop in estrogen.Majority male patients with moderate to severe acne,and a higher proportion had inverse acne or acne associated syndrome.The etiology of post adolescent acne is more complex than acne vulgaris,different clinical classifications of post adolescent acne may associate with different related risk factors and sex hormone index.Therefore,clinical classifications should be considered in diagnosis of post adolescent acne to guide clinical treatment better.