INTRODUCTION:

Acne vulgaris is an externally visible skin disease; therefore, the most frequently encountered by the health system worldwide. Acne influences 85% of all teenagers to some degree and greatest frequency between ages 15 and 18 years in both genders^1,2. Acne typically begins at puberty usually age of 8-12 years; although the greatest variability in age at onset and resolution occurs. However, all age groups may be affected by its many clinical variants, and have an impact on daily life, particularly in severe cases. It is mainly an inflammatory skin condition that involves the pilosebaceous unit of facial skin. The upper trunk is characterized by comedones, papules, pustule nodules and often potential scarring^3,4. Its etiopathogenesis is multifactorial; however, reported factors include hormonal, genetic, immune, environmental, and psychosocial. The cuti bacterium acnes (formerly known as propionibacterium Acnes) was most frequently isolated among acne cases.^5,6 Acne clinical presentations range from a few comedones to a fulminant systematic condition. Acne fulminant is the most severe form of acne and is characterized by suppurative lesions in association with systematic manifestations including fever, arthralgia, myalgias, hepatosplenomegaly, and severe malaise. It is a skin disorder; the dearth of curable therapy, lack of adherence to the treatment plan, and inescapable outcome of the illness are devasting for sufferers. Its psychological impact can be profound due to flaws in the skin and societal ideals. Post acne scars make them unappealing self-image presentation and low esteem. In Pakistan, acne vulgaris accounts for about one-fifth of all dermatological visits⁴. Failure to meet one’s perception of ideal facial skin image precipitated psychological morbidity in acne patients⁵. The sufferers face problems with self-image, self-esteem, and difficulty in socialization^7,8. Therefore, it can be labeled as a psychosomatic skin disease. Although, the patients with acne had reported being emotional, anxiety, anger, psychological stress, depression, and self-medication tendencies⁹. Self-reported medication is also a most frequent practice among adolescents worldwide. The World Health Organization (WHO) defines self-reported medication as the use of medicinal products by the consumer to treat self-recognized disorders or symptoms intermittent or continued use of medication prescribed by a physician for chronic or recurring diseases or symptoms. Self-medication is also a common practice among medical students worldwide. It is due to their pharmacological information, over-the-counter drug availability, and different sources of information e.g., from pharmaceutical company representatives, hospital pharmacies, clinical wards nursing staff, senior medical students, and postgraduate trainee residents¹⁰. Unfortunately, many acne cases are approached very late by a skin specialist and the majority never consult general practitioners for early management of acne vulgaris¹¹. Acne vulgaris and its effects on quality of life have been well reported in various parts of the world, including the USA, Europe, and Korea. However, studies from Southeast Asian countries, including Pakistan, remain scanty to date. The psychosocial effects of acne vulgaris are often not fully appreciated on quality of life, specifically among undergraduate medical students in Karachi, Pakistan¹². By knowing the information about the magnitude of acne’s psychosocial effects in relation to the quality of life among adult medical college students, stakeholders can propose resource allocation for better post-acne vulgaris management at medical colleges. This study aimed to assess the psychosocial effects of acne and self-medication practice among medical college students.

METHODOLOGY:

A descriptive study from August 2021 to October 2021 was conducted in the Sindh Medical College, Jinnah Sindh Medical University. The sample size was calculated from Open Epi, version 3 open-source calculator-SSPropor, and Hypothesized % frequency of outcome factor in the population (p): 50%+/-5, Confidence limits as % of 100(absolute +/- %) (d): 5%, Design effect (for cluster surveys-DEFF):1 taking 350 medical students per academic year multiply 5 years, the student population size was N=1750 currently enrolled in Sindh Medical College, Karachi. Therefore, the sample size consisted of 316 undergraduate medical students studying at the medical college. Out of a total of 1750 medical students, 316 were self-screened, self-reported acne over the last week. The screened respondents were further self-assessed by DLQI. The medical students with absent acne over last week and not willing to provide informed consent were auto excluded from this digital survey. The screened participants were then asked to fill out the English version of DLQI to assess the psychosocial impact that acne had on their lives over the last week. The non-probability convenience sampling technique was utilized to achieve the required sample size. The response rate was monitored and follow-up emails with reminder were also sent. The medical college was chosen purposively due to its diverse student ethnic background, which enables the inclusion of perspectives and quality of life experiences from a wider range of students. The Dermatology Life Quality Index (DLQI) is a reliable tool that measures how much the acne vulgaris problem has affected your life during the previous week. Due to the COVID-19 pandemic lockdown, data for the study were collected through an online, self-administered questionnaire. A structured Google form, along with informed consent, were developed, consisting of close-ended questions divided into sections. The questionnaire link was distributed via email lists commonly used by medical students. A brief introduction to the study, including its objectives, voluntary nature, and confidentiality assurances, was provided at the beginning of the form. Informed digital consent was obtained before participants could proceed to the survey. Data were collected over a four-week period, and responses were automatically recorded and compiled through Google form in an Excel sheet, later exported for statistical analysis. Only one response per participant was allowed by restricting multiple submissions through email verification. Participation was anonymous and no personal identifiers were collected. Three hundred sixteen questionnaires were returned, used for statistical analysis and the response rate was 100% (n=316). There was no missing data. The DLQI questionnaire consists of 10 self-rated questions about acne disease relevant to respondent life over the last week feelings about acne skin experience, embarrassment, shopping or home activities, clothing, social or leisure activities, sport activities, working or studying, personal or intra personal relationships, and treatment. The questionnaire was categorized into three sections, the first section included items about respondent demographic characteristics, and the second section included items assessing the effect of acne over last week in different domains of dermatological quality of life. The third section comprised items regarding acne’s related self-medication practices. Every item has four options on a four-point likert scale: very much effect 3, a lot effect 2, a little effect 1, not at all or not relevant effect 0. The student had to tick one of four corresponding options in likert scale. Sum the numerical values for each response to an option and divide by the number of respondents to find the average response. The average response score was expressed as a percentage of the maximum possible score of 100 percent and interpreted directly. The acne vulgaris skin disease protocol was approved by the institutional review board of Jinnah Sindh Medical University (JSMU approval/IRB/2021/-523 dated 30 August 2021). Data was collected, compiled, and analyzed by using SPSS software version 20.0 (IBM Corp., Chicago, Illinois, USA). Data were described using proportions for categorical variables, mean and standard deviation for quantitative variable.

RESULTS:

A total of 316 adult medical students were included in this study. Table (1) shows the majority 223 (70.6%) of students were 21 to 23 years old while the minority 1.6%(n=5) of students were 27 to 29 years old. Among the students, 48(15.4%) were males and 268(84.8%) were females. Among the student’s academic year participation, 232(73.7%) belong to fourth-year medical studies, 49(15.5%) third-year medical studies, 13 (4.1%) first-year medical studies, 11 (3.5%) second-year medical studies, 11(3.5%) final year medical studies. Table (2) shows a majority of students shared their acne skin experiences and rated its effects levels as a little 112 (35.4%), 103 (32.6%), not at all effect, 68(21.5%) a lot effect, and 33(10.4%) very much effect rarely. Perception regarding acne and self-conscious embarrassment experiences and rated its effect levels as not at all effect 105(33.2%), 95(30.1%) a little effect,70(22.2%) a lot effect, and 47(14.8%) reported very much effect rarely. Acne vulgaris with indoor and outdoor activities experiences were rated as not at all effect among 174(55.1%) participants, 78(24.7%) reported a little effect, 41(13%) reported a lot effect and 23(7.3%) reported very much effect rarely. Acne vulgaris and the choice of clothes experiences were rated as not at all effect among 164(51.9%), 72(22.8%) a little effect and 23(7.3%) reported its effect very much rarely. Acne during social and leisure activities experiences and its perception was reported as not at all effect among 163(51.6%) participants, 87(27.5%) had a little effect and 24(7.6%) reported its effect very much rarely in participants. Acne during sports activities experiences and its perception reported as not at all effect among 204 (64.6%) participants, 60(19%) as a little effect, 22(7%) as very much effect reported rarely. Acne during studying and working experiences in daily life and its perception was rated, as 230(72.7%) reported not at all effect, 40(12.7%) reported acne has little effect, 31(9.8%) reported a lot effect,15(4.7%) as very much effect rarely. Acne and inter and intrapersonal relationship experiences and its perception as not at all effect among 201(63.6%), 64(20.3%) as a little effect, 35(11.1%) reported a lot effect,16(5.1%) reported very much effect rarely.

Table (3) shows medication habits during acne, the majority of students 169(53.5%) were having self-medication and 147(46.5%) did not do self-medication. The main reason for self-medication was mildness of acne diseases among 50(15.8%) students as 44(13.9%) reported drug easy availability, 23(7.3%) lack of time, and 52(16.5%) used pharmacological information. Regarding the choice of drug therapy, 89(28.2%) reported homemade remedies, 73(23.1%) reported allopathic drugs, 12(3.8%) herbal drugs, 4(1.3%) ayurvedic medications, 101(32%) does not know. Regarding the source of drug information, the majority 136(43%) of participants reported internet, seminars, and lectures while 117(37%) does not know 41(13%) followed prescriptions to other patients, 7(2.2%) drug advertisements, 17(4.7%) books. Regarding drug category over the counter most frequent drug was reported as salicylic acid 48(15.2%), benzoyl peroxide 25(7.9%), 23(7.3%) Safi herbal, 01(0.3%) thuja herbal cream, 06(1.9%) calendula herbal, 174(55.1%) does not use,16(5%) used other drugs. The most frequent form of drug therapy was among 193(61.1%) reported creams, 51(16.1%) tablets/capsules, 16(5.1%) liquid suspension, and 56(17.7%) does not know. Regarding self-medication time frequency, the majority 130(41.1%) reported once in a month, 95(30.1%) no fixed times, 57(18.0%) once in a week, and 34(10.8%) once in a day. Figure (1) shows that the most frequent route of drug administration was topical among 223(70.6%) students while 93(29.4%) reported the oral route.

Table 1: Distribution of Demographic Characteristics of Study Participants (n=316)

Variable	n (%)
Gender
Male	48(15.4%)
Female	268(84.8%)
Age (years)	23.5(18-29)
18 -20	77 (24.4%)
21 -23	223 (70.6%)
24 -26	11 (3.5%)
27 -29	5 (1.5%)
MBBS program level
First-year	13 (4.1%)
Second-year	11 (3.5%)
Third-year	49 (15.5%)
Fourth-year	232 (73.7%)
Final year	11 (3.5%)
Socioeconomic barrier
Yes	16 (05%)
No	300 (95%)

Table 2: Distribution of Acne Effects on Dermatological Quality of Life Index (n=316)

Variable	n (%)
1. Symptoms and feelings (Q1)
not at all effect (not relevant)	103 (32.6%)
a little	112 (35.4%),
a lot effect	68(21.5%)
very much effect	33(10.4%)
2. Self-conscious or embarrassment (Q2)
not at all effect	105 (33.2%)
a little effect	95 (30.0%)
a lot effect	70 (22.1%)
very much effect	47 (14.8%)
3. Indoor or shopping activities (Q3)
not at all effect	174 (55.1%)
a little effect	78 (24.7%)
a lot effect	41 (13%)
very much effect	23 (7.3%)
4. Clothes (Q4)
not at all	164 (51.9%)
a little	72 (22.8%)
a lot and	57 (18%)
very much	23 (7.3%)
5. Social or leisure/sport activities(Q5-Q6)
not at all	204 (64.6%)
a little	60 (19%)
a lot and	30 (9.5%)
very much	22 (7%)
6. Studying or working (Q7)
not at all effect	230 (72.7%)
little effect	40(12.7%)
a lot effect	31(9.8%)
very much effect	15(4.7%)
7. Inter or intrapersonal relationship (Q8-Q9)
not at all effect	201(63.6%)
a little effect	64(20.3%)
a lot effect	35(11.1%)
very much effect	16(5.1%)
8. Treatment (Q10)
not at all	200 (63.2%)
a little	64 (20.2%)
a lot and	36 (11.3%)
very much	16 (5.0%)

Table 3: Distribution of Self-Reported Medication Practices Among Medical Students (n=316)

Variable	n (%)
Self-medication during Acne
Yes	169 (53.5%)
No	147(46.5%)
Reason for self-medication
Pharmaceutical information	52 (16.5%)
Mildness of acne disease	50 (15.8%)
Drug availability	44 (13.9%)
Lack of time	23 (7.3%)
Category of therapy
Home-made remedies	89(28.2%)
Allopathic drug	73(23.1%)
Herbal drug	12(3.8%)
Ayurvedic medications	04(1.3%)
Do nothing	101(32%)
Source of drug information
Internets, seminars, lectures	136 (43%)
Prescriptions to other patients	41(13%)
Does not know	117 (37%)
Drug advertisements	07 (2.2%)
Books	17 (4.7%)
Over the counter drug category
Salicylic acid	48(15.2%)
Benzoyl peroxide	25 (7.9%)
Safi herbal	23(7.3%)
Thuja herbal cream	01(0.3%)
Calendula herbs	06(1.9%)
Don’t use drugs	174(55.1%)
Use other drugs	16(5%)
Self-medication and risk experiences
No adverse drug reaction	113(67.1%)
Yes, adverse drug reaction	56(32.9%)
Grading adverse reaction
Mild drug reaction	50(90.1%)
Moderate drug reaction	05(9.4%)
Severe drug reaction	01(0.5%)

Figure 1: Distribution of Self-Reported Drug Administration Route (n=316)

DISCUSSION:

This study revealed the overall DLQI score was 3.2±2.8 indicating a generally low impact due to acne among medical students. Our study shows that 53.5% of the participants self-medicate for acne. In this study, it was revealed that among 316 young adult participants, the majority of participants were females 84.8% as compared to males 15.2%. The finding was similarly reported in the study by Aryal et al., (2018) in which out of 247 participants 61.9% were females. Regarding tthe psychosocial effect of acne past experiences, 36.9% of students were self-conscious or embarrassed about their acne. It was the least effect reported in this study which is consistent with the earlier findings of the study conducted by Aryal et al., (2018), 38.2% of students were embarrassed or lack of confidence due to acne^13,14. Itchy skin symptom experience was in the second number among the most common complaints related to physical symptoms (31.9%). In our study, it was noted that 25.3% of medical students face difficulty in dressing for clothes due to acne similar to the results found in a study conducted by Tasoula et al., (2012), one out of four acne adolescents face difficulty in dressing for clothes, attributable to acne in the general population¹⁵. It was the least effect experienced for difficulty in dressing common in medical students and adolescent population. In our study, social and leisure experiences of medical students due to acne effect was 35.1%, similar to the results reported by Yarpuz AY et al., (2008) that the degree of social anxiety, social avoidance/withdrawal, general anxiety, depression, and negative automatic thoughts were 25.6%, 32.9%, 27.7%, 36.1%, 30.1% and 50.6% on the scale in acne patients¹⁶. Acne psychosocial effect influence the quality of life to some extent which is shown unimportant and brief among medical college students. This information can be valuable for stakeholders to better understand the psychosocial effect of acne on medical students’ daily life and the allocation of health care resources. Although its impact on quality of life has been significantly associated with severe acne^17,18. The study supports earlier findings that young adult students had mild acne vulgaris effect and experienced negligible size of some considerable unimportant psychosocial impact at college. Self-medication is also an emerging area in the healthcare system worldwide. However, self-medication for acne was also present among medical college students due to pharmacological and diseases information. In our study, the majority of students (53.5%) reported self-medication for acne the observation is similar to a study reported by Jyothi R et al (2013) among Medical and Paramedical students for self-medication (52.5%) for acne vulgaris¹⁹. Pharmacological information (16.5%) was the most frequent reason among 53.5% of participants who reported self-medication, the result was not consistent with the study reported by Banerjee I(2012) that mild acne (47.19%) was the most frequent reason²⁰. This may be because medical students make unsupervised health care decisions, have immature experiences, stress, no socioeconomic barrier and have little information on medical drugs risk without sufficient internship experience. In this study, the self-medication prevalence for homemade remedies was 28.2% while Kumar N et al (2013) reported that allopathic self-medication prevalence was 72.7% contrary to the choice of medications used for self-medication²¹. In our study, the topical route of administration (70.6%) was the most frequent, while Karamata, et al. (2017) also reported that 76.9% preferred the topical administration among medical college students at a tertiary care teaching hospital in India²². There were limitations in this study. A convenient non-probability sampling technique was employed which introduce selection bias, non-representative, potential confounding factors such as stress, preexisting significant dermatological or psychiatric conditions and acne self-reported recall bias in the survey design. There were no socioeconomic barrier experiences among 95% of medical students and it may lead to an underestimation of the acne effect on quality of life at medical college. The study did not examine the relationship between students’ assessment of their overall HRQoL and multi-dimensional DLQI scores, therefore global rating of quality-of-life question scores were missed. Keeping in view of resources limitation, DLQI score taken as a percentage by dividing the respondent's score by the maximum possible score of 30 and then multiplying by 100. It yields a percentage to interpret directly i.e. very much effect, a lot effect, a little effect, not at all effect on quality of life. The DLQI scored in medical students may be helpful to inform the health care provider when taking clinical priority decisions such as the reassurance, initiation of therapy or intensive outpatient therapy in acne vulgaris. Further prospective studies should explore the temporal relationship between acne and its psychosocial effect among all age groups, a diverse population with relatively a larger sample size in a multicenter setting which our study lacked. Acne vulgaris affects to some extent students’ psychological, social and physical activities in terms of embarrassment feelings, self-image, and a considerable disability. Along with accessible mental health professionals’ counseling support services, medical drug regulations implementation should be prioritized.

CONCLUSION:

The present study showed that the psychosocial effects of acne vulgaris in relation to quality of life among different years of medical students were relatively mild. Prospective studies are necessary to reveal whether there is an effect of acne vulgaris over time in medical college students.

ETHICAL PERMISSION:

Jinnah Sindh Medical University, Karachi, Pakistan IRB approval letter No. IRB-2021/JSMU/ Approval/523, dated: 30-08-2021.

CONFLICT OF INTERESTS:

The authors hereby declare that there is no conflict of interest.

REFERENCES:

1. Alajlan A, Al Turki YA, AlHazzani Y, Alhowaish N, AlEid N, Alhozaimi Z, Al Saleh W, Yahya AB, Alkriadees Y,Alsuwaidan S. Prevalence, level of knowledge and lifestyle association with acne vulgaris among medical students. Journal of Dermatology and Dermatologic Surgery. 2017 Jul 1; 21(2): 58-61.

2. Lynn DD, Umari T, Dunnick CA, Dellavalle RP. The epidemiology of acne vulgaris in late adolescence. Adolescent Health, Medicine and Therapeutics. 2016; 7: 13.

3. Safizadeh H, Shamsi-Meymandy S, Naeimi A. Quality of life in Iranian patients with acne. Dermatology Research and Practice. 2012 Feb 15; 2012.

4. Trupti KV, Sneha WS, Darekar AB, Saudagar RB. An Overview: Acne Vulgaris. Research Journal of Pharmaceutical Dosage Forms and Technology. 2015 Apr 1; 7(2): 156.

5. Iinuma K, Noguchi N, Nakaminami H, Sasatsu M, Nishijima S, Tsuboi I. Susceptibility of Propionibacterium acnes isolated from patients with acne vulgaris to zinc ascorbate and antibiotics. Clinical, Cosmetic and Investigational Dermatology. 2011; 4: 161.

6. Kameswararao K, Sujani C, Koteswararao NV, Rajarao A, Satyanarayanamma PN. A brief review on acne vulgaris. Research journal of Pharmacology and Pharmacodynamics. 2019 Jul 1; 11(3): 109-19.

7. Hanisah A, Omar K, Shah SA. Prevalence of acne and its impact on the quality of life in school-agedadolescents in Malaysia. Journal of primary health care. 2009; 1(1): 20-5.

8. Avani H. Sheth, Dhrubo Jyoti Sen,Naman B. Doshi. New Researches on Acne Vulgaris. 2011April; 3(2): 48-57

9. Mulder MM, Sigurdsson V, Van Zuuren EJ, Klaassen EJ, Faber JA, De Wit JB, Van Vloten WA. Psychosocial impact of acne vulgaris. Dermatology. 2001; 203(2): 124-30.

10. Karamata VV, Gandhi AM, Patel PP, Desai MK. Self-medication for acne among undergraduate medical students. Indian Journal of Dermatology. 2017 Mar; 62(2): 178.

11. Uslu G, Şendur N, Uslu M, Şavk E, Karaman G, Eskin M. Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey. Journal of the European Academy of Dermatology and Venereology. 2008 Apr; 22(4): 462-9.

12. Babar O, Mobeen A. Prevalence and psychological impact of acne vulgaris in female undergraduate medical students of Rawalpindi and Islamabad, Pakistan. Cureus. 2019 Sep 22; 11(9).

13. Gonçalves G, Amado JM, Matos ME, Massa A. The prevalence of acne among a group of Portuguese medical students. Journal of the European Academy of Dermatology and Venereology. 2012 Apr; 26(4): 514-7.

14. Aryal E, Shrestha S, Shrestha P, Pokhrel G, Bhattaria SS. Psychological impact of acne vulgaris in basic science medical students in Nepal. Nepal Journal of Dermatology, Venereology and Leprology. 2018 Mar 29; 16(1): 30-

15. Tasoula E, Gregoriou S, Chalikias J, Lazarou D, Danopoulou I, Katsambas A, Rigopoulos D. The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece: results of a population survey. Anais Brasileiros de Dermatologia. 2012; 87: 862-9.

16. Yarpuz AY, Saadet ED, Şanli HE, Özgüven HD. Social Anxiety Level in Acne Vulgaris Patients and its Relationship to Clinincal Variables. Turkish Journal of Psychiatry. 2008 Mar 1; 19(1).

17. Kumar S, Singh R, Kaur S, Mahajan BB. Psychosocial impact of acne on quality of life in North India: A hospital-based cross-sectional study. Journal of Pakistan Association of Dermatologists. 2016 Nov 18; 26(1): 35-9.

18. Chowdary NK, Prabhu SS, Shenoi SD, Nayak SU. Quality of life in acne patients: A clinical and Dermatology Life Quality Index (DLQI) based cross-sectional study. Journal of Pakistan Association of Dermatologists. 2018; 28(4): 415-9.

19. Jyothi R, Deepa R, Pundarikaksha HP, Girish K. A study on the pattern of self-medication for acne vulgaris in medical/paramedical students. Res J Pharm Biol Chem Sci. 2013; 4: 1552-7.

20. Banerjee I, Bhadury T. Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal. Journal of Postgraduate Medicine. 2012 Apr 1; 58(2): 127.

21. Kumar N, Kanchan T, Unnikrishnan B, Rekha T, Mithra P, Kulkarni V, Papanna MK, Holla R, Uppal S. Perceptions and practices of self-medication among medical students in coastal South India. PloS One. 2013 Aug28; 8(8): e72247.

22. Karamata VV, Gandhi AM, Patel PP, Desai MK. Self-medication for acne among undergraduate medical students. Indian Journal of Dermatology. 2017 Mar; 62(2): 178.

Received on 08.10.2025 Revised on 09.12.2025

Accepted on 17.01.2026 Published on 10.04.2026

Available online from April 13, 2026

Asian J. Res. Pharm. Sci. 2026; 16(2):101-106.

DOI: 10.52711/2231-5659.2026.00016

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.