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Make-up improves the quality of life of acne patients without aggravating acne eruptions during treatments

European Journal of Dermatology. Volume 15, Number 4, 284-7, July-August 2005, Clinical report

Summary

Author(s) : Nobukazu Hayashi, Mizuho Imori, Midori Yanagisawa, Yoko Seto, Osamu Nagata, Makoto Kawashima , Department of Dermatology, Tokyo Women’s Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan., Pias Corporation, Toyosaki 3-19-3, Kita-ku, Osaka, 531-0072, Japan, Acseine Corporation, Toyosaki 3-19-3, Kita-ku, Osaka, 531-0072, Japan, Department of Anesthesiology, Tokyo Women’s Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan.

Summary : Boehncke et al. suggested that decorative cosmetics can improve the quality of life (QOL) of skin diseases. But dermatologists sometimes discourage female acne patients from applying make-up since decorative cosmetics are considered one of the aggravating factors for acne eruptions. The purpose of this study is to assess whether make-up application interferes with acne treatments and how QOL changes when the make-up items are designed for acne patients and used in order to disguise acne eruptions. Eighteen female acne patients were trained by a make-up artist and advised to apply acne-designed basic and decorative cosmetics for 2 to 4 weeks while their acne was appropriately treated. The acne-severity and QOL of patients were assessed before and after the study. The results revealed that the number of acne eruptions decreased even though patients were applying make-up. The QOL scores of Skindex-16, GHQ30 and anxiety state index greatly improved. Our results suggest that dermatologists should encourage acne patients to utilize appropriate make-up to improve their QOL.

Keywords : acne, cosmetics, make-up, quality of life, Skindex-16, STAI

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ARTICLE

Auteur(s) :, Nobukazu Hayashi^1,*, Mizuho Imori², Midori Yanagisawa³, Yoko Seto³, Osamu Nagata⁴, Makoto Kawashima¹

¹Department of Dermatology, Tokyo Women’s Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan.
²Pias Corporation, Toyosaki 3-19-3, Kita-ku, Osaka, 531-0072, Japan
³Acseine Corporation, Toyosaki 3-19-3, Kita-ku, Osaka, 531-0072, Japan
⁴Department of Anesthesiology, Tokyo Women’s Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan

accepté le 5 Avril 2005

Acne can cruelly impair self-image and psychological well-being because it affects the appearance, specifically of young patients. Dissatisfaction with facial appearance is correlated with feelings of embarrassment and social inhibition [1], and emotional QOL of acne patients is severely affected by their acne [2]. Acne patients report levels of social, psychological and emotional problems that are as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain or arthritis [3]. It is easy to understand that decorative cosmetics can improve the quality of life by hiding skin diseases [4]. However, the existence of cosmetic acne was reported in 1970 as pomade acne [5] and cosmetic preparations that contain oils or waxes can convert a “plug-ready” follicular opening into an actually plugged one [6]. Dermatologists usually discourage acne patients from applying cosmetic make-up since it was thought that make-up was one of the aggravating factors for acne eruptions.The benefits of decorative cosmetics for acne have already been reported by Boehncke et al. [4], but the combinational effects of acne treatments and make-up have never been scientifically demonstrated. In this study, we investigated the combinational effects of acne treatments and make-up both on acne eruptions as well as on quality of life of acne patients.

Materials and methods

Eighteen female acne patients, with written informed consent, were enrolled. The average age was 25.3 ± 6.0 (from 13 to 38).

Patients received lectures about basic cosmetics including cleansing, moisturizing and UV protection of the skin. A professional make-up artist then gave private make-up lessons. The acne patients were trained to accomplish two goals by applying make-up: one was not to conceal eruptions but to make them inconspicuous by using powder foundation of a complimentary color. For example, red eruptions can be camouflaged by applying a green color foundation. The blending of the red eruptions and green foundation results in a brown tone, which is inconspicuous compared with the original red eruptions. The other was to create a focal point such as eyes, cheeks and lips by applying make-up so that the acne is made less obvious. Patients continued the recommended make-up for 2 to 4 weeks at least until the end of this study. Acseine Corporation (Osaka, Japan) provided the cosmetic products that were designed for people who have acne problems. Each patient was simultaneously treated for acne using the best method which is available in Japan. Authorities in Japan have not yet approved topical or oral retinoids that are commonly used in other countries [7] and we mainly used oral and/or topical antibiotics and chemical peeling.

The severity of acne and QOL of acne patients were evaluated before the make-up lessons and at the end point of this investigation, more than two weeks after the lessons. For the assessment of acne severity, we counted the numbers of inflammatory and non-inflammatory acne eruptions on each patient’s face. We also used the revised Leeds grading system [8] that classifies acne patients on the basis of clinical appearance. The QOL and mental/emotional state were evaluated using several authorized questionnaires, namely Japanese versions of Skindex-16 [9], GHQ 30 (General Health Questionnaire 30), WHO QOL-26 (World Health Organization Quality of Life-26), POMS (Profile of Mood States) and STAI (State-Trait Anxiety Inventory) [10]. In addition, the satisfaction of camouflage was assessed using a visual analogue scale (VAS). VAS as well as STAI was additionally conducted immediately after make-up lessons. All data was statistically analyzed by the paired t-test.

Results

Acne severity

The number of inflammatory acne eruptions decreased from 10.0 to 6.5 (P < 0.01) during this trial, and non-inflammatory eruptions decreased from 15.1 to 10.1 (P < 0.01) ( (figure 1) ). The Leeds grading of global acne appearance also decreased from 4.3 to 3.3 (P < 0.01) ( (figure 2) ).

Estimation of QOL and mental status

By the measure of Skindex-16, the average scale score of symptoms was decreased from 30.6 to 14.6 (P < 0.01), and emotions from 80.0 to 51.0 (P < 0.01). Functional scores did not change significantly ( (figure 3) ). Indices such as persistence/reoccurrence (from 74.0 to 32.3), appearance (from 89.2 to 63.5), frustration (from 83.3 to 46.9), embarrassment (from 79.4 to 50.0), being annoyed (from 89.6 to 63.5), and feeling depressed (from 79.4 to 52.1) showed significant improvement (P < 0.01).

The total GHQ 30 score was more than 9 before the make-up lessons, but decreased to 5 after continuous make-up (P < 0.01). Lower score of WHO QOL-26 means better quality of life. The average score of WHO QOL-26 showed slight improvement (P < 0.05) ( (figure 4) ). Depression-dejection (from 56.7 to 51.7), anger-hostility (from 54.3 to 49.5) and fatigue (from 56.8 to 51.7) of POMS showed improvements as well (P < 0.05).

STAI can detect anxiety state and anxiety traits. Anxiety state depends on the conditions where the examinee is situated. Anxiety traits depend on the personal characteristic of the examinee and are not affected by the situation. The results of the STAI questionnaire revealed a prompt change of anxiety state after make-up lessons and that change remained until the end of this trial (P < 0.01) ( (figure 5) ). Anxiety traits also improved slightly (P < 0.05). VAS increased from 33.8 to 82.1 immediately after cosmetic lessons, indicating the successful camouflage of acne, and the VAS score at the end of this trial was 69.1 which is still statistically significant, indicating that acne was camouflaged successfully (P < 0.01) ( (figure 6) ).

Discussion

Although acne is a non-fatal and usually transient disease, the emotional impediments are greater than we expected. We found that the emotional QOL of acne patients was as impaired as that of patients suffering from chronic inflammatory skin diseases such as atopic dermatitis [2]. Cosmetic camouflage rapidly improves patients’ mental status and quality of life. Our formally performed transversal study using Skindex-16 revealed the scale score improvement of symptoms from 29.3 to 24.5 and of emotions from 78.2 to 61.7 for one month with regular treatments, and scale scores of symptoms changed to 24.9 and of emotions to 53.6 for 6 months (unpublished data). A simple comparison reveals that cosmetic camouflage rapidly improved symptomatic and emotional QOL scale scores when cosmetic materials were used in combination with appropriated acne treatment.

GHQ 30 was originally designed to screen people for psychological or mental health care services. It is recommended that people who have a score higher than 7 in GHQ 30 get mental health care services. Our results revealed that although the total GHQ 30 score of acne patients was above 9 before the lessons (i.e. requiring mental health care services), cosmetic lessons improve the score to a normal level. The results of GHQ 30 at the beginning of this study stressed the importance of mental care for acne patients. The patients’ mental health must be of concern to dermatologists.

Several items of WHO QOL-26 and POMS were also improved by cosmetic lessons, but these two questionnaires were less sensitive in detecting the status of acne patients than the other measurements we used.

STAI revealed that cosmetic lessons clearly improved anxiety state and their effects continued at least until the end of this study. Visual analogue scale showed satisfactory levels for make-up and moved in a similar way as anxiety state.

At this point, non-comedogenic tests are performed for many commercially available cosmetics, but they are not enough to guarantee clinical safety. Most dermatologists therefore discourage patients from using cosmetic materials. On the other hand, many adult female acne patients refuse to give up cover-up preparations [11]. Our study demonstrated that treatments reduce acne eruptions even if patients wear cosmetic camouflage if they use well-designed cosmetics properly. Cosmetics suitable for acne patients must meet strict criteria. They should never be comedogenic, acnegenic, irritating, or allergic [12]. The cosmetics used in this study met these criteria. They were originally designed for sensitive skin patients and later modified for acne patients. Make-up application methods are also important. Acne patients should not put on layers of foundation to conceal eruptions. We recommend powder foundation of complimentary colors and rouge for eyes, cheeks and lips to make eruptions inconspicuous. The improvements of VAS score for satisfaction of camouflage demonstrated that these concepts for acne camouflage were well accepted by most of our patients. The VAS score was slightly decreased at the end of this study when we compared with the results immediately after lessons. It is not easy to apply make-up in the manner of a professional artist and we considered that continuous training in make-up application might be required.

Boehncke et al. [4] have already reported the beneficial role of decorative cosmetics for the purpose of disfiguring skin diseases, including acne. Our data confirmed their assertions and showed that cosmetic camouflage immediately improved appearance, mental status, and QOL of acne patients without aggravating eruptions. Based on these results, we suggest that dermatologists’ help improves the quality of life of acne patients by encouraging them to wear make-up.

References

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