Knowledge and Practice of Community Pharmacists Regarding Acne Vulgaris: A Cross-Sectional Descriptive Survey

Acne Vulgaris (AV) is a common dermatological disorder of adolescents, and patients often seek community pharmacists for professional advice regarding it. This study aimed to assess the knowledge and practice of community pharmacists regarding AV in Bekaa Governorate, a rural area of Lebanon. A cross-sectional survey was conducted in community pharmacies in Bekaa Governorate. A questionnaire was distributed to community pharmacists to assess their knowledge about AV and was composed of four sections addressing demographic data and various aspects of AV practice. Seventy-one community pharmacists responded to the questionnaire, with a mean age of 38 years. Overall, pharmacists displayed good knowledge regarding AV causes, with 68% of respondents aware of its risk factors. The treatment option most commonly used for mild AV was benzoyl peroxide, used by 79% of respondents, followed by topical antibiotics (68%) then facial washes with salicylic acid (66%). The treatment option most commonly used for severe AV was oral antibiotics (73%). The most commonly prescribed antibiotics were topical erythromycin and systemic doxycycline. Surprisingly, 66% of the participants prescribed Isotretinoin. About half of the participants recommended AV management for four weeks. Moreover, about half provided partial treatment and referred patients to dermatologists. The study revealed an overall acceptable knowledge of pharmacists regarding AV management. Still, given the common practice of community treatment of AV, further actions should be made to emphasize their role and keep them updated regarding the latest AV pharmacotherapeutic trends.

1.        Alfarhan KK, Alshammari BT, Abohelaibah FH, Al-Esawi AH, Aldawsari AA, Sulimani SH, et al. An overview of diagnosis and management of acne in primary health care centers. J Biochem Technol. 2020;11(4):98-101.

2.        Alshammari E. Efficacy of Generic vs. branded Isotretinoin for Acne treatment: a case report. J Adv Pharm Educ Res. 2021;11(1):125-7.

3.        Gallitano SM, Berson DS. How acne bumps cause the blues: the influence of acne vulgaris on self-esteem. Int J Womens Dermatol. 2018;4(1):12-7.

4.        Gebauer K. Acne in adolescents. Aust Fam Physician. 2017;46(12):892-5.

5.        Habeshian KA, Cohen BA. Current issues in the treatment of acne vulgaris. Pediatrics. 2020;145(Suppl 2):S225-30. doi:10.1542/peds.2019-2056L

6.        Stamu-O’Brien C, Jafferany M, Carniciu S, Abdelmaksoud A. Psychodermatology of acne: Psychological aspects and effects of acne vulgaris. J Cosmet Dermatol. 2021;20(4):1080-3. doi:10.1111/jocd.13765

7.        Ju Q, Tao T, Hu T, Karadağ AS, Al-Khuzaei S, Chen W. Sex hormones and acne. Clin Dermatol. 2017;35(2):130-7. doi:10.1016/j.clindermatol.2016.10.004

8.        Kurokawa I, Nakase K. Recent advances in understanding and managing acne. F1000Res. 2020;9:F1000 Faculty Rev-792. doi:10.12688/f1000research.25588.1

9.        Omer H, Mcdowell A, Alexeyev OA. Understanding the role of propionibacterium acnes in acne vulgaris: the critical importance of skin sampling methodologies. Clin Dermatol. 2017;35(2):118-29.

10.      Alba MN, Gerenutti M, Yoshida VM, Grotto D. Clinical comparison of salicylic acid peel and LED-Laser phototherapy for the treatment of Acne vulgaris in teenagers. J Cosmet Laser Ther. 2017;19(1):49-53. doi:10.1080/14764172.2016.1247961

11.      Oge' LK, Broussard A, Marshall MD. Acne vulgaris: diagnosis and treatment. Am Fam Physician. 2019;100(8):475-84.

12.      Dreno B, Bagatin E, Blume‐Peytavi U, Rocha M, Gollnick H. Female type of adult acne: Physiological and psychological considerations and management. J Dtsch Dermatol Ges. 2018;16(10):1185-94. doi:10.1111/ddg.13664

13.      Prashar L, Johnfray F, Ngalamika O. Assessment of level of knowledge of management of acne vulgaris among community pharmacists and prescribers in Lusaka urban. Asian J Pharm Nurs Med Sci. 2015;3(5):143-50.

14.      Tucker R, Maclure K, Paudyal V, Layton A, Bewley A, Stewart D. An exploratory study of community pharmacist diagnosis and management of dermatitis and acne. SelfCare. 2017;8(2):1-10.

15.      Tucker R, Duffy J. The role of community pharmacists in the management of skin problems. J Pharma Care Health Sys. 2014;1(1):105-8.

16.       Szepietowski J, Wolkenstein P, Veraldi S, Tennstedt D, Machovcova A, Delarue A. Acne across Europe: an online survey on perceptions and management of acne. J Eur Acad Dermatol Venereol. 2018;32(3):463-6.

17.      Karamata VV, Gandhi AM, Patel PP, Desai MK. Self-medication for acne among undergraduate medical students. Indian J Dermatol. 2017;62(2):178-83. doi:10.4103/ijd.IJD_243_16

18.      Szepietowski JC, Wolkenstein P, Veraldi S, Tennstedt D, Machovcová A, Delarue A. Acne across Europe: an online survey on perceptions and management of acne. J Eur Acad Dermatol Venereol. 2018;32(3):463-6. doi:10.1111/jdv.14719

19.      Dardadi A. Assessment of Knowledge Level and Practice of Management of Acne Vulgaris among Community Pharmacists in Tripoli, Lebanon [dissertation]. Debbiyeh (D): Beirut Arab University; 2016.

20.      Khattar JA, Hamadeh GN, Rahi AC, Musharrafieh UM. Common dermatologic diseases among students at a tertiary care center in Lebanon. J Med Liban. 2010;58(4):195-8.

21.      Bosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN. Progestins and acne vulgaris: a review. Dermatol Online J. 2018;24(5):13030/qt6wm945xf.

22.      Dréno B, Pécastaings S, Corvec S, Veraldi S, Khammari A, Roques C. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol. 2018;32 Suppl 2:5-14. doi:10.1111/jdv.15043

23.      Aghasi M, Golzarand M, Shab-Bidar S, Aminianfar A, Omidian M, Taheri F. Dairy intake and acne development: A meta-analysis of observational studies. Clin Nutr. 2019;38(3):1067-75. doi:10.1016/j.clnu.2018.04.015

24.      Dall'Oglio F, Nasca MR, Fiorentini F, Micali G. Diet and acne: review of the evidence from 2009 to 2020. Int J Dermatol. 2021;60(6):672-85. doi:10.1111/ijd.15390

25.      Baldwin H, Tan J. Effects of diet on acne and its response to treatment. Am J Clin Dermatol. 2021;22(1):55-65. doi:10.1007/s40257-020-00542-y

26.      Zip C. The role of skin care in optimizing treatment of acne and rosacea. Skin Therapy Lett. 2017;22(3):5-7.

27.      Conforti C, Giuffrida R, Fadda S, Fai A, Romita P, Zalaudek I, et al. Topical dermocosmetics and acne vulgaris. Dermatol Ther. 2021;34(1):e14436. doi:10.1111/dth.14436

28.      Subramanyan K. Role of mild cleansing in the management of patient skin. Dermatol Ther. 2004;17Suppl 1:26-34.  

29.      Pontello Junior R, Kondo R. Drug-induced acne and rose pearl: similarities. An Bras Dermatol. 2013;88(6):1039-40.

30.      Lolis M, Bowe W, Shalita A. Acne and systemic disease. Med Clin North Am. 2009;93(6):1161-81.

31.      Bienenfeld A, Nagler AR, Orlow SJ. Oral antibacterial therapy for acne vulgaris: an evidence-based review. Am J Clin Dermatol. 2017;18(4):469-90. doi:10.1007/s40257-017-0267-z

32.      Food and Drug Administration USA. FDA Approves Differin Gel 0.1% gel for Over-the-counter use to treat acne [Internet]. 2016 [updated 2016 July 8; cited 2020 Dec 2020]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-differin-gel-01-over-counter-use-treat-acne.

33.      Fallah H, Rademaker M. Isotretinoin in the management of acne vulgaris: practical prescribing. Int J Dermatol. 2021;60(4):451-60. doi:10.1111/ijd.15089

34.      Xu H, Li H. Acne, the skin microbiome, and antibiotic treatment. Am J Clin Dermatol. 2019;20(3):335-44. doi:10.1007/s40257-018-00417-3

35.      Zhu T, Zhu W, Wang Q, He L, Wu W, Liu J, et al. Antibiotic susceptibility of Propionibacterium acnes isolated from patients with acne in a public hospital in Southwest China: prospective cross-sectional study. BMJ Open. 2019;9(2):e022938.

36.      Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time. J Am Acad Dermatol. 2020;82(1):72-9. doi:10.1016/j.jaad.2019.06.025

37.      Moradi Tuchayi S, Alexander T, Nadkarni A, Feldman S. Interventions to increase adherence to acne treatment. Patient Prefer Adherence. 2016;10:2091-6.

38.      Snyder S, Crandell I, Davis S, Feldman S. Medical Adherence to Acne Therapy: A Systematic Review. Am J Clin Dermatol. 2014;15(2):87-94.