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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 Hayashi1,*, Mizuho Imori2, Midori Yanagisawa3, Yoko Seto3, Osamu Nagata4, Makoto Kawashima1
Department 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
1

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

et al. The results of GHQ 30 at the beginning of this study stressed the importance of mental care for acne patients.5).3 to 46. They were originally designed for sensitive skin patients and later modified for acne patients. mental status. The patients’ mental health must be of concern to dermatologists.0 (P < 0. We also used the revised Leeds grading system [8] that classifies acne patients on the basis of clinical appearance. All data was statistically analyzed by the paired t-test. The cosmetics used in this study met these criteria. The average score of WHO QOL-26 showed slight improvement (P < 0.3 to 3. and the VAS score at the end of this trial was 69. namely Japanese versions of Skindex-16 [9].5 and of emotions from 78. WHO QOL-26 (World Health Organization Quality of Life-26). Estimation of QOL and mental status By the measure of Skindex-16.05).01). 140: 672-6. embarrassment (from 79. They should never be comedogenic. Pediatr Dermatol 1991. J Dermatol 2004. but decreased to 5 after continuous make-up (P < 0. being annoyed (from 89.7 to 51. Make-up application methods are also important. but they are not enough to guarantee clinical safety. cosmetic lessons improve the score to a normal level.01). STAI revealed that cosmetic lessons clearly improved anxiety state and their effects continued at least until the end of this study. The Leeds grading of global acne appearance also decreased from 4. including acne.8 to 82. and QOL of acne patients without aggravating eruptions. but these two questionnaires were less sensitive in detecting the status of acne patients than the other measurements we used.7 for one month with regular treatments. 8: 332-8.1 (P < 0. Newton JN. The improvements of VAS score for satisfaction of camouflage demonstrated that these concepts for acne camouflage were well accepted by most of our patients. et al.e. VAS increased from 33.6 to 63. The VAS score was slightly decreased at the end of this study when we compared with the results immediately after lessons.6 (P < 0. Klassen A.4 to 52. 2 Hayashi N. Depression-dejection (from 56. cheeks and lips to make eruptions inconspicuous.6 to 14. Based on these results. and non-inflammatory eruptions decreased from 15. the emotional impediments are greater than we expected.counted the numbers of inflammatory and non-inflammatory acne eruptions on each patient’s face. et al.2 to 61.01) during this trial. and emotions from 80. It is recommended that people who have a score higher than 7 in GHQ 30 get mental health care services. Several items of WHO QOL-26 and POMS were also improved by cosmetic 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. 31: 971-6. and scale scores of symptoms changed to 24.5 (P < 0.4 to 50. Cosmetic camouflage rapidly improves patients’ mental status and quality of life. Indices such as persistence/reoccurrence (from 74.7) of POMS showed improvements as well (P < 0. Higaki Y. Br J Dermatol 1999. Lower score of WHO QOL-26 means better quality of life. requiring mental health care services). The psychosocial effects of acne on adolescents. Acne patients should not put on layers of foundation to conceal eruptions. acnegenic. A cross-sectional analysis of quality of life in Japanese acne patients using the Japanese version of Skindex-16. the average scale score of symptoms was decreased from 30. 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. non-comedogenic tests are performed for many commercially available cosmetics.01) ( (figure 6) ). GHQ 30 was originally designed to screen people for psychological or mental health care services.01). The quality of life in acne: a comparison with general medical conditions using generic questionnaire. indicating that acne was camouflaged successfully (P < 0.7). Our study demonstrated that treatments reduce acne eruptions even if patients wear cosmetic camouflage if they use well-designed cosmetics properly. irritating. GHQ 30 (General Health Questionnaire 30).9). or allergic [12]. Our results revealed that although the total GHQ 30 score of acne patients was above 9 before the lessons (i. Anxiety state depends on the conditions where the examinee is situated. The total GHQ 30 score was more than 9 before the make-up lessons.01).3). Our formally performed transversal study using Skindex-16 revealed the scale score improvement of symptoms from 29. Our data confirmed their assertions and showed that cosmetic camouflage immediately improved appearance.1 which is still statistically significant. We recommend powder foundation of complimentary colors and rouge for eyes. Boehncke et al. .0).05).9 and of emotions to 53.01) ( (figure 2) ).1) showed significant improvement (P < 0. Keskinen R.3 to 24. On the other hand. indicating the successful camouflage of acne. we suggest that dermatologists’ help improves the quality of life of acne patients by encouraging them to wear make-up.01) ( (figure 1) ). frustration (from 83.2 to 63. appearance (from 89. Anxiety traits depend on the personal characteristic of the examinee and are not affected by the situation.5). the satisfaction of camouflage was assessed using a visual analogue scale (VAS). Anxiety traits also improved slightly (P < 0. Discussion Although acne is a non-fatal and usually transient disease.05) ( (figure 4) ). At this point.1 immediately after cosmetic lessons. anger-hostility (from 54. Cosmetics suitable for acne patients must meet strict criteria. STAI can detect anxiety state and anxiety traits. Results Acne severity The number of inflammatory acne eruptions decreased from 10.8 to 51.3 (P < 0. POMS (Profile of Mood States) and STAI (State-Trait Anxiety Inventory) [10].3 to 49.0 to 32. Visual analogue scale showed satisfactory levels for make-up and moved in a similar way as anxiety state.0 to 6. 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. Most dermatologists therefore discourage patients from using cosmetic materials. Functional scores did not change significantly ( (figure 3) ).01) ( (figure 5) ). 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].6 for 6 months (unpublished data).1 to 10. VAS as well as STAI was additionally conducted immediately after make-up lessons. The QOL and mental/emotional state were evaluated using several authorized questionnaires.5) and fatigue (from 56. and feeling depressed (from 79. 3 Mallon E. Stancin T. References 1 Kriwchuk DP. [4] have already reported the beneficial role of decorative cosmetics for the purpose of disfiguring skin diseases. Kawamoto K. In addition.0 to 51. many adult female acne patients refuse to give up cover-up preparations [11].

Semin Cutan Med Surg 2001. 5 Plewig G. 69: 611-7. Aube I. Cunliffe WJ. Fulton JE. 10 Nakazato K. 6 Barer RL. 29: 694-8. et al. Pomade acne. Kamo T. Eur J Dermatol 2003. Allaert FA. 9 Higaki Y. Cosmetics in acne and rosacea. The Japanese State-Trait Anxiety Inventory: age and sex differences. 11 Samuel B Frank: Cosmetics in Acne vulgaris. Arch Dermatol 1970. Kligman AM. 12: 577-80. Decorative cosmetics improve the quality of life in patients with disfiguring skin diseases. Ochsendorf F. Lewis JB. 12 Draelos ZD. .4 Boehncke WH. Daniel F. Eur J Dermatol 2002. Charles C Thomas publisher Springfield. USA: p. 13: 166-70. Illinois. Shimonaka Y. J Dermatol 2002. Percept Mot Skills 1989. Year Book Publishers 1959. 8 O’Brien SC. The Japanese version of Skindex-16: a brief quality of life measure for patients with skin diseases. Witten VH. 101: 580-4. The Leeds revised acne grading system. [Chapter 8 Other considerations]. Paeslack I. 155. J Dermatol Treat 1998. et al. Chicago. 20: 209-14. 9: 215-20. Kawamoto K. Acne: evolution of the clinical practice and therapeutic management of acne between 1996 and 2000. 1960: 7-32. 7 Dreno B. 60-Year Book of Dermatology.