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Medical Skin Care significantly improves Quality of Life
in Subjects with mild Acne Vulgaris
Scherdin U1, Treder-Conrad C1, Berger B2, Micic S2, Rippke F1
1Beierdorf AG, Hamburg, Germany; 2Beiersdorf Ges mbH, Vienna, Austria
68 subjects (48 females, 20 males; mean age: 21.5 years) with mild
Assessment at baseline
forms of acne vulgaris were enrolled in this open, dermatologically
The study population was predominantely female (70.6%). 58.8% of the sub-
controlled clinical study. For skin cleansing the subjects were supplied
jects were younger than 21 years; 26.5% were between 21 and 30 years of age.
with Impure Skin Cleansing Gel and Facial Tonic, for purposes of special
34 patients received pharmacological acne medication at baseline; benzoyl
face care Impure Skin Cream Gel was used. Efficacy of medical skin
peroxide (in 14.7% of the cases), erythromycin (13.2%), minocyclin (13.2%)
care, product tolerability and quality of life, determined by the Acne
and adapalene (8.8%) were the drugs used most frequently. Due to the severity
Disability Index (ADI), were evaluated. According to the physicians´
of the disease 44.1% of the patients had to use acne medication continuously
Acne Disability Index (ADI)
assessment 88.2% of the patients demonstrated normalized or
improved skin conditions after the 6 week study period. Tolerability of
the products was predominantly assessed to be “very good“ or “good“
Efficacy of products
regardless of whether or not concomitant acne medication was used. In
Acne-related symptoms markedly decreased during the study period (Fig. 1).
cases of mild acne vulgaris the exclusive use of Impure Skin products
These changes were highly significant for all symptoms (p<0.0001; two-sided
Reduction of Acne Disability Index after 6-weeks of using
not only proved to reduce comedones and inflammatory lesions but
t-test) except for itch/burning. After 6 weeks of treatment 83.4% of patients
also significantly increased quality of life. Determination of the ADI
using Eucerin® Impure Skin in addition to pharmacological medication present-
demonstrated a 45% increase of the patients´ well-being. As a result,
ed with normalised or improved skin conditions (Fig. 2). Improvement of the
patient´s satisfaction with the products was extremely high and the
skin conditions observed in patients using the skin care regimen only were also
further use of the products was recommended by their dermatologist in
more than 95% of cases. Our data clearly demonstrate that medical skin
care has marked beneficial effects for acne sufferers also in terms of
quality of life. We conclude that this Impure Skin product range is
a valuable tool in the management of patients with mild acne vulgaris.
Acne vulgaris is one of the most common dermatoses in Western countries.
Relative improvement [%]
Although most frequently seen in adolescents, acne is not restricted to this peri-
quest. 1 quest. 2 quest. 3 quest. 4 quest. 5
od of life (1). In the United States acne affects 8% of all Americans between 25
Question 1: psychological impact of acne in general
and 34 years and 3% of those 35 to 44 years of age (2). In Germany approx.
11% of the female population aged 20-29 suffer from acne vulgaris (3).
Question 3: Impact on social/outdoor activities (acne of chest or back)Question 4: Psychological state
Over the last years the number of affected adults has clearly increased (4).
Question 5: Subjective assessment of acne severity
Topical treatment with benzoyl peroxide, tretinoin and salicylic acid especially
Improvement of acne symptoms (physicians` assessment)
Mean scores of ADI questions at baseline and relative
in sensitive skin can lead to irritation and dry skin problems (5). This is even
improvement in quality of life after 6 weeks
more pronounced in elderly subjects since skin ageing is physiologically corre-
lated with a decrease in skin moisture (6). Lactic acid, an alpha-hydroxy acid, is
Discussion and Conclusion
well known for its keratolytic properties and its high water-binding capacity (7).
Furthermore, antibacterial properties have been described (8). Therefore, lactic
Acne vulgaris has a considerable impact on the quality of life of patients
acid seems perfectly suited for therapy related application even in combination
regardless of its severity (12, 13, 14). However, although this disease has a
with skin irritating sebosuppressive preparations.
profound effect on patient´s emotional well-being, non-compliance with acne
treatment is quite frequent (15). It has been found that besides the physicians´
It was demonstrated that psychosocial effects of acne are more influenced by
interpersonal skills (16) appropriate skin care may enhance patients compliance
the patients´ self-perception than by the objective severity of the disease (9,
(17, 18). We published recently that treatment of patients suffering from
10). Lasek et al. (11) reported that, regardless of its severity, the impact of acne
mild acne with medical skin care products (Eucerin® Impure Skin) resulted in a
on quality of life is higher in older patients than in adolescents. Thus, besides
Improvement of acne symptoms (physicians` assessment)
profound reduction of the Acne Disability Index (12) which correlates with an
assessing objective clinical parameters of improvement, measuring quality of
increase in life quality (19). These results were substantiated by the current
patients´ life is of profound importance in assessing the outcomes of acne
Skin tolerability of Eucerin® Impure Skin products was predominantely rated to
investigation as a significant improvement in quality of life of acne sufferers
treatment. We performed a clinical study to evaluate the efficacy of lactic acid
be “good“ or better, irrespective of whether concomitant acne medication was
was demonstrated by using Eucerin® Impure Skin products. Gain in quality of
preparations in mild forms of acne and its effect on the quality of life of acne
used or not (Tab. 2). Only 10.3% of patients, reported some kind of slight side
life also correlated with a marked improvement of the clinical acne skin status.
effects; mainly burning and tension were reported. 2 patients - both receiving
The products proved to be highly effective in subjects with mild acne vulgaris
concomitant acne medication - discontinued the study prematurely; one missed
even without pharmaceutical acne medication. 92.1% of the patients presented
Materials and Methods
the final examination due to being on vacation, a second patient terminated
with a normalized or improved skin condition after using the products for 6
the study after the second visit due to exacerbations with confluencing pustules
weeks. This observation underlines the importance of not only treating acne
which could not be controlled despite high dosed antibiotics.
patients effectively with drugs but also taking into account their emotional
Gaining further experience regarding tolerability, efficacy, and effects on quali-
needs of using appropriate and effective skin care products.
ty of life of Eucerin® Impure Skin cleansing and care products (Beiersdorf AG,
without acne medication with acne medication
Hamburg, Germany) in subjets with acne vulgaris and in patients in need of
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68 patients of all ages (average of 21.5 ± 8.6 years) with mild or treatment
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requiring acne vulgaris were eligible for analysis.
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Preparations and application
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adults: results of a survey conducted in France. J. Europ. Acad. Dermatol.
5. Berson D S. Treatment of acne in patients with sensitive skin. Cosm. Derma-
The dermatologists recommended which of the above preparations should be
6. McCallion R, Li Wan Po A. Dry and photoaged skin: manifestations and man-
used. Test products were applied onto the face and affected areas of the body.
agement. J. Clin. Pharm. Ther. 18, 15-32 (1993).
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Assessment of skin compatibility after 6 weeks
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Efficacy of treatment of the cleansed facial skin was assessed with respect to
eight different solicited symptoms (open and closed comedones, papules, pus-
9. Kellett S C , Gawkrodger D J. The psychological and emotional impact of acne
tules, seborrhea, erythema, tension, and itch/burning). The severity of symptoms
and the effect of treatment with isotretinoin. Br. J. Dermatol. 140, 273-282
was evaluated by symptom scores (0 = no lesions/none, 1 = <10 lesions/slight,
2 = 10-15 lesions/moderate, and 3 = >15 lesions/severe). Skin compatibility
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of the products was assessed according to a 4 point scale (very good, good,
C, Waldstreicher J. Evaluating health-related quality of life measure for
moderate, poor). All parameters were taken at baseline, after 2 and after 6
patients with facial acne: development of a self-administered questionnaire
weeks of treatment. The assessment of disability due to acne was measured by
for clinical trials. Qual. Life Res. 5, 481-490 (1996).
a standardized patients‘ questionnaire (Acne Disability Index (ADI), Table 1).
11. Lasek R J, Chren M-M. Acne vulgaris and the quality of life of adult derma-
The response to each question was scored from 0 to 3 and the ADI (min. 0, max.
tology patients. Arch. Dermatol. 134, 454-458 (1998).
15) was calculated at baseline and after 6 weeks of treatment. At the end of the
12. Motley R J, Finlay A Y. Practical use of a disability index in the routine man-
study selected product characteristics were assessed with the help of a stan-
agement of acne. Clin. Exp. Dermatol. 17, 1-3 (1992).
Wish of further use
13. Lasek R B, Chren M-M. Acne vulgaris and the quality of life of adult derma-
1. As a result of having acne, during the last month have you been
aggressive, frustrated or embarrassed?
14. Yazici K, Baz K, Yazici A E, Köktürk A, Tot S, Demirseren D, Buturab V, Disease-
a) very much indeed b) a lot c) a little d) not at all
specific quality of life is associated with anxiety and depression in patients
with acne. J. Europ. Acad. Dermatol. Venereol. 18, 435-439 (2004).
2. Do you think that having acne during the last month interfered with your daily
15. Heyer G. Problemfelder der Aknetherapie – Non-Compliance. DERMAforum
social life, social events or relationships with members of the opposite sex?
Intention of recommendation by physicians (A) and further use by
16. Renzi C, Abeni D, Picardi A, Agostini E, Melchi C F, Pasquini P, Puddu P, Braga
c) occasionally or in only some activities
M. Factors associated with patient satisfaction with care among dermato-
Quality of Life
3. During the last month have you avoided public changing facilities or wearing
logical outpatients. Br. J. Dermatol. 145, 617-623 (2001).
Life quality clearly improved during the study period. At baseline the Acne
swimming suits because of acne?
17. Bergfeld W F. Optimizing the approach to acne therapy. Cosm. Dermatol.
Disability Index (ADI) was 3.8 for patients applying medical skin care products
a) all of the time b) most of the time c) occasionally d) not at all
only and 6.0 for patients receiving pharmaceutical acne medication. Reduction
18. Draelos Z K. Patient compliance: enhancing clinician abilities and strategies.
4. How would you describe your feeling about the appearance of your skin over
of the Acne Disability Index was 45% in subjects without drug treatment and
J. Am. Acad. Dermatol. 32, S42-48 (1995).
the last month?
17% in patients receiving concomitant acne medication (relative change,
19. Scherdin U, Presto S, Rippke F, Nielsen J, Strassner M, Imadojemun A, Gärt-
Fig. 3). These results were reflected by differences in relative improvement rates
ner E, Herpens A, Korting H C, Bielfeldt S. In vivo assessment of the efficacy
which were approx. twice as high for patients without acne medication (Fig. 4).
of an innovative face care system in subjects with mild acne vulgaris Int. J.
5. Please indicate how bad you think your acne is now:
Patients´ satisfaction with the performance of the products was very high. Mostof the patients were in favour of using these products after finishing the study.
The Acne Disability Questionnaire according to Motley and Finley 
In 95.6% of all cases the dermatologists decided to recommend the products.
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