الفهرس 
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Abstract
Appearance is important in our community and influences the way in which we are perceived by others. The skin is the most visible organ of the body and determines, to a large extent, our appearance; with a wide function in social communication. Conditions which affect the skin may, therefore, affect an individual’s quality of life. Overall quality of life is an all-inclusive concept incorporating all factors that impact upon an individual life. The concept can be divided into several components, includ¬ing psychological, social and physical domains.
Acne vulgaris is one such condition, primarily seen in adolescents and often with a definite and limited course. Its onset coincides with the period of identity formation and the development of the secondary sexual characteristics, that frequently marked by lack of self-confidence and changes in social dynamics. The presence of acne lesions therefore, may add to the emotional and psychological challenges experienced during this period.
Acne is the most frequent visible skin disease in adolescents, unlike most other dermatologic diseases that may be limited to areas covered by clothing. Therefore, it is not surprising that a susceptible individual with facial acne may develop significant psychosocial disability and have a great potential for jeopardizing quality of life.
Acne is not a trivial disease; the levels of social, psychological and emotional impairments in acne may be compared with chronic diseases such as asthma, epilepsy, diabetes and arthritis. Because of that, it is imperative to evaluate both the prevalence of acne and its repercussion on the quality of life among secondary school students. Such investigations may attract the attention of adolescents to the topic. Even this may have a contribution as a first step for seeking help for acne.
The aim of the present study was to estimate the prevalence of acne, its severity and determine self-esteem among secondary school students in Alexandria.In addition, impact of acne on self-esteem, quality of life and scholastic achievement was determined.
To fulfill this aim, a cross sectional study design was carried out in 12 public and private secondary schools in Alexandria. Three educational districts (the most crowded) were chosen from the eight educational districts in Alexandria Governorate.from each of the selected educational district; two public schools and two private schools (i.e. one school for girls and one school for boys) were chosen at random. The sample of the students was determined according to proportional allocation method based on the total number of students in the selected educational districts. Nearly equal number from each of the selected schools was chosen at random (i.e. from 1st and 2nd secondary grades of each school).
For the execution of this work, the students were subjected to:
I) The following techniques and tools were used to collect data from the sampled students:
1. A pre-designed structured self-administered questionnaire was used to collect the following data from the sampled students:
a. Socio-demographic data: age, sex, family size, father and mother education and occupation, income and socioeconomic level.
b. Scholastic history: absenteeism days per year and causes of absenteeism.
c. Personal history: Personal hygiene, eating habits, physical activity and smoking.
d. Family data: living conditions and inter-parental relationship.
e. Presence of acne at the time of the study or in the previous year.
2. The Arabic version of the Cooper-Smith Self-Esteem inventory was used to measure self-esteem.
3. Review of school records for the student scholastic achievement.
II) The following techniques and tools were used to collect data from the sampled students with clinically-confirmed acne:
1. A pre-designed structured self-administered questionnaire was used to collect the following data from the sampled students with clinically-confirmed acne:
a. Duration of acne and health seeking behavior.
b. Students’ opinion concerning aggravating factors of their acne.
c. Family history of acne.
2. The Arabic version of Cardiff Acne Disability Index (CADI) was used to measure disability induced by acne.
3. Global Acne Grading System (GAGS) was used to grade facial acne.
The results of the present study revealed the following:
• The present study was carried out among 787 students from public and private secondary schools in Alexandria. Both males and females were nearly equally represented (50.3% and 49.7% respectively).
• The age of the students enrolled in the study, ranged from 15-18 years with a mean of 16.31 ± 0.725 years.
• The prevalence of self-reported acne among the sampled students was 34.7%; meanwhile the prevalence of clinically confirmed acne was 24.4%.
• Regarding sex difference, females reported acne more frequently than males did (39.1% vs. 30.3%) and the difference was statistically significant (p=0.009). Moreover, prevalence of clinically-confirmed acne was higher among females (28.6%) than males (20.2%) and the result was statistically significant (p=0.006).
• A significantly higher proportion of students in private schools compared with those in public schools had acne (p=0.001).
• According to the severity of acne, it was found that 75.5% of students with clinically-confirmed acne had mild acne, 22.9% had moderate acne and only 1.6% had severe acne. There was no significant difference between males and females regarding severity of acne (p=0.586).
• Overall self-esteem scale showed that more than half of the sampled students (54.3%) had low self-esteem compared to 8.8% of them who had high self-esteem. The female students had a lower self-esteem when compared with the male students and the difference was statistically significant (p=0.000).
• As regards impact of acne on self-esteem, no association was found between self-esteem and acne, nor with the severity of acne (p=0.188 & 0.960 respectively). There was a statistical significant difference among males and females with clinically-confirmed acne regarding self-esteem (p=0.004).
• Concerning quality of life impairment, 49.0% of the sampled students with clinically-confirmed acne experienced mild level of disability, 39.6% of them had moderate level of disability while only 11.4% of the sampled students with acne experienced severe level of disability.
• There was a significant medium posi¬tive correlation between acne severity and degree of impairment of quality of life (r=0.338, p=0.00).
• There was no statistically significant difference in quality of life impairment based on duration of acne and sex (p=0.929 & 0.103 respectively).
• Regarding scholastic achievement, there was no statistically significant difference between students with clinically-confirmed acne and those without acne regarding midterm results and absenteeism days (p= 0.697 & 0.140 respectively).
• Prevalence of clinically-confirmed acne was significantly higher among students consuming dairy products compared to those who did not consume dairy products at all (p=0.006).
• There was no significant association between acne and intake of nuts, chocolate and spicy food.
• Concerning the health seeking behavior of the sampled students with clinically-confirmed acne, two thirds of them (66.7%) had visited a health facility or pharmacy concerning their acne. Doctors were more consulted than pharmacists.
• About 37.5% of students sought medical advice within 3 months after developing acne, while 28.1% waited for more than one year until seeking medical advice.
• Facial cleansers were the most frequently usedself-administered treatments before a health facility or pharmacist was visited followed by medicated soap, masks, scrubs and home remedies.
• Reviewing opinion concerning aggravating factors revealed that poor hygiene, eating too much fat, sweets and chocolate was reported as frequent aggravating factors by 41.3%, 35% and 30% of male sampled students with clinically-confirmed acne, respectively.
• The female sampled students with clinically confirmed acne claimed that menses and eating sweets and chocolate as the most frequent aggravating factor for acne (52.7%) followed by eating too much fat (49.1%). Cosmetics were thought to be responsible for making acne worse by 23.2% of the female students.
• Nearly half of the students with acne (53.6%) reported family history for their acne. The history of acne in the siblings of the students was higher than that for the parents.
• According to binary logistic regression analysis of significant variables related to acne, the possible variable proved to be significant predictors were: being a female (OR=1.662), being from private school (OR=1.658), consuming dairy products 3 times or less per week (OR=3.467) and consuming dairy products more than 3 times per week (OR=2.801).