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. 2025 Jun 17:1-15.
doi: 10.1159/000547009. Online ahead of print.

The Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study: An Updated and Detailed Analysis of Acne Vulgaris Severity, Scarring, and Phenotypes and Their Associated Risk Factors among Young Chinese Adults

Zongxun Huang  1 , Jun Jie Lim  2 , Kavita Reginald  2   3 , Yee-How Say  2   3   4 , Fook Tim Chew  2
Affiliations

The Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study: An Updated and Detailed Analysis of Acne Vulgaris Severity, Scarring, and Phenotypes and Their Associated Risk Factors among Young Chinese Adults

Zongxun Huang et al. Dermatology. .

Abstract

Introduction: Despite the high prevalence of acne vulgaris and its impact on affected individuals, few studies have provided a detailed characterization of acne phenotypes and their associated risk factors. This study aimed to comprehensively evaluate the prevalence, severity, scarring, and phenotypes of acne, along with their associated risk factors, in a cohort of young Chinese adults, as part of the Singapore and Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES).

Methods: Participants were randomly and consecutively recruited from universities in Singapore and Malaysia. Data on sociodemographic, familial medical histories of atopic diseases and acne, and lifestyle habits were collected using a validated investigator-administered questionnaire from 6,225 young Chinese adults (mean age = 22.8 ± 5.7 years). A subset of participants underwent clinical assessment for acne severity (n = 2,345), scarring grade (n = 2,345), and phenotypes (n = 1,191) by dermatologically trained personnel.

Results: The prevalence of acne was 56.0%. Among acne cases (n = 3,504), 38.5% had moderate-to-severe acne, 52.8% had scarring, 95.7% presented with blackhead and/or whitehead, and 55.8% had inflammatory phenotypes (e.g., papules, pustules, cysts, and nodules). A parental history of acne emerged as the strongest risk factor associated with all acne phenotypes. Pet ownership (adjusted odds ratio [AOR]: 1.403, 95% confidence interval [CI]: 1.131-1.744, p < 0.05) and occasional alcohol consumption (AOR: 1.328, 95% CI: 1.090-1.617, p < 0.05) were associated with a higher odd for blackhead and/or whitehead. Protective factors included higher parental education levels for acne scarring (AOR: 0.650, 95% CI: 0.459-0.904; p < 0.05), male gender (AOR: 0.365, 95% CI: 0.298-0.446; p < 0.05), and birthplace (AOR: 0.674, 95% CI: 0.555-0.819; p < 0.05) for non-inflammatory phenotypes.

Conclusions: This study, conducted in a well-defined cohort of young Chinese adults from the SMCGES, reinforces familial history as a key risk factor for acne onset, severity, scarring, and phenotype manifestation. The identification of modifiable and environmental factors associated with acne phenotypes offers valuable insights for targeted interventions to improve acne management and control.

Keywords: Acne phenotypes; Acne vulgaris; Epidemiology; Ethnic chinese; Risk factors.

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Conflict of interest statement

F.T.C. reports grants from the National University of Singapore, Singapore Ministry of Education Academic Research Fund, Singapore Immunology Network, National Medical Research Council (NMRC) (Singapore), Biomedical Research Council (BMRC) (Singapore), National Research Foundation (NRF) (Singapore), Singapore Food Agency (SFA), Singapore’s Economic Development Board (EDB), and the Agency for Science Technology and Research (A*STAR) (Singapore), during the conduct of the study; and consulting fees from Sime Darby Technology Centre; First Resources Ltd.; Genting Plantation, Olam International, Musim Mas, and Syngenta Crop Protection, outside the submitted work. The other authors declare no other competing interests. This research is supported by the National Research Foundation Singapore under its Open Fund-Large Collaborative Grant (MOH-001636) (A-8002641-00-00) and administered by the Singapore Ministry of Health’s National Medical Research Council.

Figures

Fig. 1.
Fig. 1.
Flowchart of subject recruitment and acne presentation, severity, scarring, onset, blackhead and/or whitehead and inflammatory phenotypes among the Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES). Scarring grade and acne severity was assessed by dermatologist-trained personnel.
See this image and copyright information in PMC

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