الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 119 |  |  |
| | | from | 119 | | |
Abstract
Acne vulgaris is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules, nodules, pimples and possibly scarring.
Acne develops as a result of blockages in the follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen dehydroepiandrosterone (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedo. Comedones are the direct result of sebaceous glands that clogged with sebum and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acne can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.
The severity of acne vulgaris can be classified as mild, moderate or severe as this helps to determine an appropriate treatment regimen. Mild acne is classically defined by the presence of comedones limited to the face with occasional inflammatory lesions. Moderate severity acne is said to occur when high number of inflammatory papules and pustules occur on the face compared to mild cases of acne and are found on the trunk of the body. Severe acne is said to occur when nodules are the characteristic facial lesions and involvement of the trunk is extensive. Acne occurs most commonly during adolescence caused by an increase in androgens such as testosterone. Acne affects an estimated
Summary
77
80-90% of teenagers in the Western world. Lower rates are reported in some rural societies.
Pre-pubertal acne is the appearance of acne before true puberty that is due to maturation of ovary and testis. During adrenarche, there is an increase in secretion of DHEA and DHEAS by adrenal glands leading to activation of sebaceous glands. Age of adrenarche is 10-14 years in females and 12-16 years in males.
DHEA and other adrenal androgens such as androstenedione, although relatively weak androgens, are responsible for the androgenic effects of adrenarche, such as early pubic and axillary hair growth, adult-type body odor, increased oiliness of hair and skin and mild acne. DHEA is potentiated locally via conversion into testosterone and dihydrotestosterone (DHT) in the skin and hair follicles.
The aim of this study was to study some risk factors related to pre-pubertal acne with special emphasis on Dehydroepiandrosterone level.
Type of study: A cross – sectional analytic study.
Time and place of study:
This study was carried out from the beginning of October, 2019 through the end of March, 2021 in some primary and preparatory schools in both rural and urban areas at Shebin El-Kom district, Menoufia governorate.
Setting of the study:
Shebin El-Kom is a randomly chosen district out of the nine districts at Menoufia governorate by simple random sample method. This study was conducted in randomly chosen seven urban and three rural primary and preparatory schools.
Summary
78
The study participants:
A randomly chosen one thousand (1000) pre-pubertal students were recruited from primary and preparatory schools. The sample size was calculated according to number of students in Menoufia governorate. The study included 520 female and 480 male and their age ranged between 10-16 years with mean ± SD of (11.98 ±1.408).
Methods:
Each participant was subjected to the following:-
1. Personal interview and filling a pre-designed questionnaire which included an inquiry about:
Personal data (age, sex, residence and socioeconomic standard according to the scoring system. The score of family income was modified to be as; 3 for more than sufficient, 2 for sufficient and 1 for less than sufficient. Scores of all parameters were added and the scoring system was based on 3 socioeconomic levels:
a) High = 9 to 12
b) Middle = 5 to < 9
c) Low = less than 5
Food intake habits (oily food, nuts, spicy food, chocolate and sweets). Drug history: Steroid therapy (oral/ inhalation), lithium therapy and vitamins intake.
Reproductive history including appearance of puberty signs and menstruation for females.
Family history.
2. Medical examination:
Summary
79
a. General examination including measurement of weight (Kg), height (cm) and body mass index ”BMI= weight (Kg)/ height(m)2”.
b. Local examination: Skin examination for acne:
Acne was classified into mild, moderate and severe according to the global acne scale (6). Mild acne is characterized by the presence of few to several papules and pustules mixed with comedones, but no nodules. Moderate acne has several papules and pustules along with few nodules. Severe acne has numerous or extensive papules, pustules as well as many nodules.
Another classification was used in which the acne was classified into comedonal, inflammatory or both.
3. Dehydroepiandrosterone (DHEA) blood level measurement for randomly chosen 100 acne-positive students and 100 acne-negative students:
The results of our present study can be summarized as follows:
This study showed that prevalence of acne among the studied group was 47%.
The current study showed that type of acne among acne-positive students, 48.9% was comedonal, 21.3% were inflammatory and 29.8% were both Comedonal & Inflammatory.
This work showed that site of acne among acne-positive students, 14.9% was cheek, 27.7% were chain, 42.6% were forehead and 14.9% were nose.
The current study showed insignificant relation between acne and age.
Summary
80
This study showed that the percentage of male that had positive Acne was the most predominant (57.4%).
This study showed that the percentage of rural cases that had Acne positive was the most predominant (63.8%).
The present work showed that the percentage of family history of acne was statistically significant higher among Acne-positive than Acne-negative.
This study showed insignificant relation between food consumption and acne.
The current study showed that the percentage of present in appearance of puberty signs was statistically significant lower among Acne-positive than Acne-negative. The percentage of started in menstruation was statistically significant lower among Acne-positive than Acne-negative.
The present study showed that the percentage of Corticosteroids in drug intake was statistically significant higher among Acne-positive than Acne-negative.
This study showed that there was statistical significance increase in DHEA level among Acne-positive compared to Acne-negative.