Post-Rhinoplasty Acne, Frequency and Role Players

Document Type: Original

Authors

1 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Otorhinolaryngology-Head & Neck Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Professor of Dermatology, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad

4 Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/ijorl.2020.41593.2358

Abstract

Introduction
Acne is a common complain among post rhinoplasty patients. While rhinoplasty is done for aesthetic reasons and acne expressively affects the individual’s appearance, we aimed to study its incidence and role players.
 
Materials and Methods:
A descriptive cross-sectional study was performed on 152 (143 females and 9 males) patients admitted for rhinoplasty during January 2016 to March 2017. Patients were examined by a dermatologist prior to surgery and 7, 30 and 90 days after rhinoplasty using the Global Acne Grading System and responded to a list of questions on the probable risk factors of acne. Psychological status was examined by the perceived stress scale-14 and the Hospital Anxiety and Depression Scale.
 
Results:
The patients' mean age was 28.9±3.82 yrs. Mild and moderate acne were observed in 21.7% (n=33) of the cases in the preoperative visit. The incidence of mild and moderate acne was 36.1%, 42.8% and 23% after 7, 30 and 90 days of surgery, respectively. One week after rhinoplasty, acne manifested in 14.9% of cases with no history of acne. Mean age significantly differed between those with and without post-surgical acne at all post-surgical visits (P> 0.001 and P=0.001 and P=0.015, respectively). Hospital anxiety and depression and perceived stress levels were significantly higher in patients who presented with acne on the first post-surgical visit compared to those with no acne presentations (P=0.04 and P=0.02, respectively).
 
Conclusion:
External psychological stress may be the main role player in post-rhinoplasty acne. Consultation or referral of patients to an experienced psychologist is highly recommended for a better outcome and fewer complications.

Keywords


  1. Rostami Mogaddam M, Safavi Ardabili N, Maleki N, Soflaee M. Correlation between the severity and type of acne lesions with serum zinc levels in patients with acne vulgaris.  Biomed Res Int. 2014;2014:474108.
  2. Liu PF, Hsieh YD, Lin YC, Shu CW, Huang CM. Propionibacterium acnes in the pathogenesis and immunotherapy of acne vulgaris. Curr Drug Metab. 2015;16(4):245-54.
  3. Perera MPN, Peiris WMDM, Pathmanathan D, Mallawaarachchi S, Karunathilake IM. Relationship between acne vulgaris and cosmetic usage in Sri Lankan urban adolescent females. J Cosmet Dermatol. 2018 Jun;17(3):431-436.
  4. Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012;379(9813):361-72.
  5. Jung JY, Kwon HH, Hong JS, Yoon JY, Park MS, Jang MY, et al. Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial. Acta Derm Venereol. 2014; 94(5):521-6.
  6. Ozdarska K, Osucha K, Savitskyi S, Malejczyk J, Galus R. Diet in pathogenesis of acne vulgaris. Pol Merkur Lekarski. 2017 Oct 23;43(256):186-9.
  7. França K, Keri J. Psychosocial impact of acne and postinflammatory hyperpigmentation. An Bras Dermatol. 2017;92(4):505-9.
  8. Vilar GN, Santos LAd, Sobral Filho JF. Quality of life, self-esteem and psychosocial factors in adolescents with acne vulgaris. An Bras Dermatol. 2015; 90(5):622-9.
  9. 2016 Complete Plastic Surgery Statistics Report. American Society of Plastic Surgeons, 2016.
  10. Cosmetic Surgery National Data Bank Statistics. Aesthet Surg J. 2016 Apr;36 Suppl 1:1-29.
  11. Rohrich RJ, Ahmad J. Rhinoplasty. Plast Reconstr Surg. 2011 Aug;128(2):49e-73e.
  12. Sadeghi M, Saedi B, Safavi A, Iri MR. Postrhinoplasty acne formation: a case-control study. B-ENT. 2013;9(2):95-100.
  13. Nemati S, Golchay J, Iranfar K, Alizadeh A. Frequency of acne vulgaris and its exacerbation in facial and periorbital area after septorhinoplasty. Am J Otolaryngol. 2013;34(5):378-81.
  14. Koc EA, Buyuklu F, Koç B, Demirci GT. Skin problems following septorhinoplasty. Laryngoscope. 2015;125(6):1291-5.
  15. Kilkenny M, Merlin K, Plunkett A, Marks R. The prevalence of common skin conditions in Australian school students: 3. acne vulgaris. Br J Dermatol. 1998 Nov;139(5):840-5.
  16. Wu SM, Amtmann D. Psychometric evaluation of the perceived stress scale in multiple sclerosis. ISRN Rehabilitation. 2013; 2013.
  17. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun; 67(6):361-70.
  18. Coban YK. Decreased acne symptoms as a perception of rhinoplasty success. Aesthetic Plast Surg. 2007;31(4):413-4.
  19. Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139(7):897-900.
  20. Yosipovitch G, Tang M, Dawn AG, Chen M, Goh CL, Chan YH, et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-9.
  21. Lugovic-Mihic L, Ljubesic L, Mihic J, Vukovic-Cvetkovic V, Troskot N, Situm M. Psychoneuroimmunologic aspects of skin diseases. Acta Clin Croat. 2013 Sep;52(3):337-45.
  22. Zouboulis CC, Seltmann H, Hiroi N, Chen W, Young M, Oeff M, et al. Corticotropin-releasing hormone: an autocrine hormone that promotes lipogenesis in human sebocytes. Proc Natl Acad Sci U S A. 2002;99(10):7148-53.
  23. Zouboulis CC. Acne and sebaceous gland function. Clin Dermatol. 2004;22(5):360-6.
  24. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013 Mar;168(3):474-85.
  25. Goulden V, Stables G, Cunliffe W. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999; 41(4):577-80.
  26. Bagatin E, Timpano DL, Guadanhim LRdS, Nogueira VMA, Terzian LR, Steiner D, et al. Acne vulgaris: prevalence and clinical forms in adolescents from São Paulo, Brazil. An Bras Dermatol. 2014;89(3):428-35.
  27. Do TT, Zarkhin S, Orringer JS, Nemeth S, Hamilton T, Sachs D, et al. Computer-assisted alignment and tracking of acne lesions indicate that most inflammatory lesions arise from comedones and de novo. J Am Acad Dermatol. 2008;58(4): 603-8.