
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

MD-D-24-01080
00069
10.1097/MD.0000000000039577
3
3800
Research Article
Observational Study
The assessment of complementary and alternative medicine use in acne vulgaris patients in Turkey: A cross-sectional study
https://orcid.org/0000-0001-5433-168X
Ürün Ünal Bahar MD a*
Demirbaş Abdullah MD b
Marakoğlu Kamile MD a
Gök Erdoğan Burcu MD a
a Department of Family Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey
b Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
* Correspondence: Bahar Ürün Ünal, Selçuk University Faculty of Medicine, Department of Family Medicine, Alaeddin Keykubat Campus, Akademi Mah. Yeni İstanbul Cad. No:369, Selçuklu, Konya 42130, Turkey (e-mail: urunbahar@gmail.com).
13 9 2024
13 9 2024
103 37 e3957729 1 2024
12 8 2024
15 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Because acne vulgaris has a chronic course, can cause cosmetic problems, and negatively affects the psychosocial functionality and quality of life of patients, patients with acne vulgaris can frequently resort to complementary medicine practices. This study aimed to examine the frequency of complementary medicine use in patients diagnosed with acne vulgaris, the methods they used, the reasons for practicing these methods, and the factors affecting these practices. In this descriptive cross-sectional study, 400 (81.4%) of 491 patients aged ≥13 years who were diagnosed with acne vulgaris and treated at the dermatology outpatient clinic at Konya Numune Hospital between February and October 2020 were enrolled. A survey consisting of 37 questions was administered to patients in face-to-face interviews. Permission to conduct the study was obtained from the Faculty of Medicine Local Ethics Committee. The mean age of the patients was 20.0 ± 5.17, and 60% of the patients were women. It was stated by 87% of the patients that they used complementary medicine methods for the treatment of acne vulgaris. The first 3 methods used, in order of frequency, were topical herbal remedies at a rate of 61%, herbal medicines at 23.5%, and cupping/leeches at 2.5%. Complementary medicine use was significantly higher among the patients aged 19 to 25 and among the single patients. While practicing complementary medicine treatments, 33.5% also used the treatment given by their doctor simultaneously. It was determined that the physicians of 73.5% of the patients did not question their use of complementary medicine when prescribing treatment. In our study, it was determined that 87% of patients with acne vulgaris used complementary and alternative medicine (CAM) methods, and the majority of these patients were young. These treatment methods may affect the treatments that their physicians will recommend. Therefore, to prevent ill-advised practices, patients should be informed about the CAM methods they use when planning their treatment. Considering the possible side effects of CAM practices, physicians need to be aware that acne vulgaris patients frequently use CAM methods and improve themselves in raising the desired awareness on this issue.

acne vulgaris
alternative medicine
attitude
complementary medicine
education
OPEN-ACCESSTRUE
SDCT
==== Body
pmc1. Introduction

Traditional, alternative, and complementary medicine is the entirety of knowledge, skills and practices that can be explained or not, based on beliefs and experiences, used to protect people from physical and mental diseases, diagnose and treat them, and maintain their health, nourished from different cultures in different geographies for centuries. They are complementary and supportive methods to modern medical practices.[1]

Nowadays, many individuals in society resort to complementary and alternative medicine (CAM) methods for both treatment, preventive, and cultural purposes. Studies also indicate that CAM practices are being used at increasing rates. In many countries, conventional and alternative medicine methods have been used simultaneously for years.[2] CAM has become significantly popular in healthcare in Turkey. In a study conducted in Turkey, it was determined that 60% of healthy individuals used CAM methods.[3] CAM methods are frequently used in diseases that are chronic, resistant to treatment, and can have negative psychological and physical effects.[4]

Acne vulgaris (AV; or simply “acne”) is a chronic obstructive and inflammatory disease caused by the excessive secretion of facial sebaceous glands. Patients with AV may frequently resort to CAM treatments because the disease has a chronic course, can cause cosmetic problems, and negatively affects the psychosocial functionality and quality of life of patients. Acne severity can be assessed according to the global acne grading system (GAGS). In this rating system, AV lesions are divided into 6 regions: forehead, right cheek, left cheek, nose, chin, and chest – upper back, and the lesions receive a score of 0 to 4 (no lesion: 0, comedo: 1, papule: 2, pustule: 3, nodule: 4). The total score obtained in this system reflects the severity of AV. A total score between 1 and 18 is considered mild, a score between 19 and 30 is considered moderate, a score between 31 and 38 is considered severe, and a score above 39 is considered very severe.

Although there are many effective topical and systemic agents used in acne treatment today, the search for more effective and reliable treatment options continues due to the chronic course of acne. Therefore, in addition to medical treatments, many CAM methods are specified and/or supported in acne treatment.[1] Acne has a complex pathogenesis. It is suggested that CAM methods are effective in acne treatment by affecting androgenicity, increased sebum activity, infection, inflammation, and hyperkeratinization.[1] AV has the highest prevalence in adolescents and affects approximately 9.4% of the world’s population.

The disease burden associated with AV is globally distributed, and its prevalence continues to increase over time in this population. Approximately 80% of patients reported improvement in their skin with the CAM methods they chose.[3] Seventy-eight percent of patients stated that dermatologists should recommend CAM methods.[4] However, since there is insufficient evidence for the use of CAM, dermatologists are hesitant in this matter.

This study aimed to examine the frequency of CAM use in patients diagnosed with AV, the specific methods they used, their reasons for practicing these methods, and the factors affecting these practices.

2. Material and methods

This study is a single-center descriptive cross-sectional study conducted at the Dermatology Clinic of Konya Numune Hospital between February and October 2020. Patients who presented to the dermatology clinic with complaints of acne, were diagnosed with AV and agreed to participate in the study were included in the study after the purpose of the study was explained to them. Before their participation, a consent form was signed by the patients aged 18 or older, while this form was signed by both those aged under 18 and their guardians (Informed Volunteer Consent Form, Supplemental Digital Content 1, http://links.lww.com/MD/N512). Among the 491 patients diagnosed with AV in the specified period, 400 (81.4%) agreed to participate in the study. The criteria for inclusion in the study were consent for participation in the study, having experienced AV for >1 month, and being over 13 years of age. A survey form consisting of 37 questions was administered to these patients using the face-to-face interview technique (Survey Form, Supplemental Digital Content 2, http://links.lww.com/MD/N511). The participation process was completely voluntary and free of charge. No payment was made to the patients in exchange for their participation. There were 3 patients on a gluten-free diet. Due to the small number of patients, the data of 2 questions related to the gluten diet were not used in the study. The survey form used as a data source was created by the researchers by reviewing the literature on the subject.[5]

The sociodemographic characteristics of the patients, their disease duration, the CAM practices they used, why they used CAM practices, from what sources did they learn about CAM methods, their thoughts about the effects and side effects of CAM methods, their preferences about modern medicine and CAM practices, and whether they informed their doctors about their use of these practices were questioned. Each lasted approximately 20 minutes (min–max: 15–25 minutes).

CAM is defined as a variety of health systems, practices, and products outside of standard medical treatments.[3] CAM falls into 5 main categories: alternative medical systems (e.g. acupuncture), mind-body therapies (e.g. meditation), biological therapies (e.g. herbal therapy), manipulative and body-based practices (e.g. massage), and energy-focused therapies (e.g. Reiki).[5]

The analyses of the data were carried out using frequencies, percentages, chi-squared tests, and binary logistic regression analysis (with Backward Stepwise: Likelihood Ratio method). CAM use was the dependent variable, and gender (female), age (19–25 years), education (primary education), marital status (single), and smoking status (constant users) were the independent variables. The categories of independent variables given in parentheses were determined as the reference categories. In the logistic regression model, the probability of P < .05 for entering the model and P > .10 for exiting the model was determined as the threshold value. The data were analyzed in the SPSS 21.0 package program.

The research protocol was approved by the Selçuk University Faculty of Medicine Ethics Committee on 18.03.2020 (Decision No. 2020/134).

3. Results

Four hundred patients with AV were included in the study. While 240 (60%) of the patients were female, 160 (40%) were male. The mean age of the patients was 20.0 ± 5.17. Forty-two percent (n = 168) of the patients were 13 to 18 years old, 42% (n = 168) were 19 to 25 years old, and 13% (n = 52) were 26 years old or older. While 295 (73.7%) of the patients were single, 105 (26.3%) were married. Forty-two percent of the patients were elementary-middle school graduates, 37% were high school graduates, and 21% were university graduates. It was found that 51.5% of the patients were students, 10.5% were homemakers, 18% were laborers, 18% were civil servants, and 2% were unemployed. It was determined that 33% (n = 132) of the patients were current smokers, 48% (n = 192) were nonsmokers, 14.5% (n = 58) were occasional smokers, and 4.5% (n = 18) were former smokers. It was stated by 96.5% (n = 386) of the patients that they did not consume alcohol, whereas 3.5% (n = 14) consumed alcohol. Thirty-nine percent (n = 156) of the patients did not exercise, 46.5% (n = 186) went on walks, 6.5% (n = 26) went on jogging, and 8% (n = 32) performed other exercise activities.

It was determined that 348 (87%) patients used at least 1 CAM method, 61% of all patients used topical herbal methods, 23.5% used herbal medicines, and 2.5% used cupping and/or leeches (Fig. 1).

Figure 1. Complementary medicine treatments used by patients.

As conventional acne treatments, the rate of patients receiving only topical agents was 60%, the rate of those using isotretinoin was 5%, and the rate of those using topical treatments with antibiotics was 35%. Patients diagnosed within the first 2 years of their condition constituted 35.5% of the sample, while 31.5% were diagnosed within 2 to 4 years, and 33% were diagnosed within 4 to 6 years. Of these patients, 75.5% had received acne treatment before, and 24.5% had not received acne treatment before. Among the patients who received acne treatment, 80.5% had a family history of acne, and 19.5% had no family history of acne (Table 1).

Table 1 Disease characteristics of AV patients (n = 400).

Characteristics		n	%	
Treatment type	Topical	240	60.0	
Isotretinoin	20	5.0	
Antibiotic and topical	140	35.0	
Diagnosis time	Within the first 2 yr	142	35.5	
Within 2–4 yr	126	31.5	
Within 4–6 yr	132	33.0	
Previous acne treatment	Yes	302	75.5	
No	98	24.5	
Location	Face	280	70.0	
Body	22	5.5	
Face and body	98	24.5	
Acne severity by global acne rating score	Mild	218	54.5	
Moderate	152	38.0	
Severe	14	3.5	
Very severe	16	4.0	
Family history of acne	Yes	322	80.5	
No	78	19.5	
Status of receiving traditional and complementary treatment	Herbal topicals	244	61.0	
Herbal medicines	94	23.5	
Cupping and/or leech	10	2.5	
Non	52	13.0	
AV = acne vulgaris, Non = do not use any ''CAM'' methods.

It was determined that 70% of the patients had acne only on their faces, 5.5% had it only on their bodies, and 24.5% had it on both their faces and bodies (Fig. 2).

Figure 2. Acne localization.

According to the GAGS, it was determined that 54.5% of the patients had mild cases, 38% had moderate cases, 3.5% had severe cases, and 4% had very severe cases (Fig. 3).

Figure 3. Acne severity by global acne grading system.

Among the patients who used CAM methods, 48.2% stated that they used CAM methods before consulting a doctor, 25.9% used them immediately after diagnosis, and 25.9% used them within the first 5 years of the disease. It was stated by 21.3% of the patients that they used these methods when their acne was mild, 10.3% used them when it became severe, 12.7% used them when their itching increased, 5.2% used them when acne appeared on their bodies, 28.7% used them when acne appeared on their faces, and 21.8% used them when their acne recurred. According to their statements, 28.2% of the patients had used CAM for 0 to 1 month, 30.4% had used it for 1 to 6 months, 16.7% had used it for 6 to 12 months, and 24.7% had used it for >12 months. The rate of the patients who used the treatment prescribed by their doctor along with CAM regularly was 38.5%, the rate of those who sometimes used it was 28.7%, and the rate of those who never used the treatment prescribed by their doctor was 32.8%. It was determined that the most common way of being informed about CAM was the advice of a relative/friend/acquaintance at a rate of 49.4%, and the second most frequently observe source was the internet/social media at a rate of 29.3%. This was followed by advice from someone with acne at 24.1%, TV/radio/newspaper at 10.9%, and pharmacist advice at 8.6%. The doctors of 15.5% of the patients questioned their use of CAM methods, and 84.5% of the patients stated that their doctors did not question this factor. While 60.9% of the patients told their doctor that they used CAM methods, 39.1% stated that they did not tell their doctor about this practice. Of the 212 patients who shared their use of CAM methods with their doctor, 15.6% stated that their doctor strongly recommended that they quit using them, 50% stated that their doctor did not recommend them but left the decision to them, 11.3% reported that their doctor told them could use CAM methods, and 23.1% stated that their doctor was indifferent to their usage of CAM methods. It was reported by 45.4% of the patients that they preferred using CAM because they found it natural and safe, and 33.9% said they preferred it because they were bored and were looking for another, non-pharmaceutical method. It was thought by 18.4% of the patients that using CAM methods would provide additional benefits to their treatment, 12.1% thought it would be safer and more effective, 11.5% thought their acne would not recur, 8% thought it was easy and cheap to supply, and 3.4% thought it would cause side effects of the treatment. While 31.6% of the patients stated that they benefited greatly from CAM methods, 19% stated that they received an average benefit, 40.8% stated that it had no effect, and 8.6% stated that this treatment made their acne worse. Among the patients who used CAM methods, 35.6% stated that they would recommend the method they used to someone else, 8.6% stated that they would not recommend this method to someone else, and 55.8% stated that they were undecided about recommending the method they used to someone else (Table 2).

Table 2 Disease characteristics of AV patients using CAM treatment (n = 348).

Characteristics		n	%	
In what year of your illness did you use CAM?	Before applying for a doctor	168	48.2	
As soon as the diagnosis is made	90	25.9	
In the first 5 yr of my illness	90	25.9	
In which state of your disease did you apply?	When it is mild	74	21.3	
When it gets heavy	36	10.3	
When my itch increases	44	12.7	
When the lesions appear on my body	18	5.2	
When the lesions appear on my face	100	28.7	
When the disease recurs	76	21.8	
How long did you use?	0–1 mo	98	28.2	
1–6 mo	106	30.4	
6–12 mo	58	16.7	
Longer than 12 mo	86	24.7	
Did you also use the treatment given by your doctor while using CAM?	Yes, I used it regularly	134	38.5	
Yes, I used it sometimes	100	28.7	
No, I didn’t use	114	32.8	
How did you hear about this form of treatment?	I saw it on the internet/social media	102	29.3	
Recommended by a relative/ friend/acquaintance	172	49.4	
My pharmacist suggested	30	8.6	
Saw it on TV/radio/newspaper	38	10.9	
Suggested by someone with acne	84	24.1	
Did your doctor question your use of CAM while treating you?	Yes	54	15.5	
No	294	84.5	
Did you inform your doctor about the your using CAM?	Yes, I said	212	60.9	
No, I didn’t say	136	39.1	
If you shared it with your doctor, what was his reaction?	The doctor definitely suggested that I quit	33	15.6	
The doctor didn’t suggest it but left the decision to me	106	50.0	
The doctor said I could use	24	11.3	
The doctor didn’t care	49	23.1	
Why did you want to use this technique?*	I thought it wouldn’t make acne come back	40	11.5	
I got bored and looked for another method	118	33.9	
I found it natural and safe	158	45.4	
I found it more reliable and effective	42	12.1	
I thought it would be of additional benefit to my treatment	64	18.4	
Easier and/or cheaper to reach	28	8.0	
I thought it would reduce the side effects of my treatment	12	3.4	
Did you benefit from the treatment?	Yes, I have benefited a lot	110	31.6	
There was an average benefit	66	19.0	
No effect	142	40.8	
Made my acne worse	30	8.6	
Which features of your acne has improved?	My acne has decreased	70	20.1	
My itching has decreased	60	17.3	
My pain has decreased	36	10.3	
Other effects	182	52.3	
Would you recommend this technique to other acne sufferers?	Yes	124	35.6	
I don’t know/I’m undecided/maybe	194	55.8	
No	30	8.6	
AV = acne vulgaris, CAM = complementary and alternative medicine.

* More than one option is marked.

Among the patients who did not use CAM methods, 65.4% stated that they did not use this treatment because they did not find it safe/healthy, 53.8% said they did not use it because they thought it would not work, 30.8% reported that they did not use it because they thought their doctor would object, and 30.8% did not use it because they were afraid of the side effects of the treatment. When the patients were asked whether they would consider using CAM for their acne in the future, 25% of them stated that they did not intend to use it, and 75% stated that they might use it. CAM methods were not considered safe and useful by 34.6% of the patients, whereas 42.3% stated they had no medical basis, and 23.1% thought the use of CAM methods was uncontrolled (Table 3).

Table 3 Characteristics of AV patients who do not use CAM (n = 52).

Characteristics		n	%	
Why didn’t you use these methods?a	I don’t find it safe/healthy	34	65.4	
I didn’t think it would work	28	53.8	
I thought my doctor would object	16	30.8	
I was afraid of the side effects	16	30.8	
I never thought of it	4	7.7	
Would you consider using it for your acne in the future?	No	13	25.0	
Maybe	39	75.0	
What do you think about these methods?	Not reliable and useful	18	34.6	
There is no medical basis	22	42.3	
It is done without control	12	23.1	
AV = acne vulgaris, CAM = complementary and alternative medicine.

a More than one option is marked.

As stated in Table 4, 59.2% of the patients using CAM methods were female, and 40.8% were male. There was no significant relationship between the gender of the patients and their use of CAM methods. It was found that 38.8% of the patients using CAM were 13 to 18 years old, 48.9% were 19 to 25 years old, and 12.3% were 26 years old or older. CAM use was significantly more frequent among the patients who were 19 to 25 years old (P < .001). It was seen that 22.7% of the patients using CAM were married, and 77.3% were single. CAM use was significantly more frequent among the single patients (P < .001). Of the patients using CAM methods, 39.4% were elementary-middle school graduates, 39.9% were high school graduates, and 20.7% were university graduates. The lowest usage rate of CAM methods was found in the university graduate group. The difference among the CAM usage rates of these groups was statistically significant (P = .004). Of the patients using CAM methods, 49.4% were students, 11.2% were homemakers, 18.7% were laborers, 18.4% were civil servants, and 2.3% were unemployed. No significant difference was detected in the CAM usage statuses of the patients in terms of their professions. It was found that 47.4% of the patients were nonsmokers, 36.2% were current smokers, 12.1% smoked occasionally, and 4.3% had quit smoking. Nonsmokers used CAM methods the most frequently, the patients who had quit smoking use CAM methods the least frequently, with a statistically significant difference among the groups based on their smoking status (P < .001). No significant relationship was identified between the alcohol consumption statuses of the patients and their CAM use statuses. There was also statistically significant relationships between their CAM usage statuses and their vitamin use, number of meals per day, or nighttime eating habits.

Table 4 Comparison of CAM users and nonusers (n = 348).

Characteristics	CAM usage	All participants	
Yes, n	%	No, n	%	Total, n	%	χ 2	P	
Gender	
 Female	206	59.2	34	65.4	240	60.0	0.722	.395	
 Male	142	40.8	18	34.6	160	40.0	
Age	
 13–18 yr old	135	38.8	33	63.5	168	42.0	16.228	.000	
 19–25 yr old	170	48.9	10	19.2	180	45.0	
 26 yr and above	43	12.3	9	17.3	52	13.0	
Marital status	
 Married	79	22.7	26	50.0	105	26.2	17.415	.000	
 Single	269	77.3	26	50.0	295	73.8	
Educational status	
 Elementary school	137	39.4	31	59.6	168	42.0	10.983	.004	
 High school graduate	139	39.9	9	17.3	148	37.0	
 University graduate	72	20.7	12	23.1	84	21.0	
Profession	
 Student	172	49.4	34	65.3	206	51.5	5.618	.230	
 Housewife	39	11.2	3	5.8	42	10.5	
 Laborer	65	18.7	7	13.5	72	18.0	
 Civil servant	64	18.4	8	15.4	72	18.0	
 Unemployed	8	2.3	0	0.0	8	2.0	
Smoking status	
 Constantly smoker	126	36.2	6	11.5	132	33.0	19.659	.000	
 None	165	47.4	27	51.9	192	48.0	
 Occasional user	42	12.1	16	30.8	58	14.5	
 Quitter	15	4.3	3	5.8	18	4.5	
Alcohol status	
 None	338	97.1	48	92.3	386	96.5	3.110	.094	
 Occasional user	10	2.9	4	7.7	14	3.5	
Exercise status	
 No	146	41.9	10	19.2	156	39.0	13.564	.004	
 Walking	153	44.0	33	63.5	186	46.5	
 Jogging	24	6.9	2	3.8	26	6.5	
 Other sports (pilates, zumba, etc)	25	7.2	7	13.5	32	8.0	
Vitamin usage	
 Yes	70	20.1	16	30.8	86	21.5	3.043	.081	
 No	278	79.9	36	69.2	314	78.5	
Number of meals per day	
 1	242	69.5	34	65.4	276	69.0	0.771	.680	
 2	78	22.4	12	23.1	90	22.5	
 3 and above	28	8.1	6	11.5	34	8.5	
Night eating habit	
 Yes	51	14.7	3	5.8	54	13.5	3.059	.080	
 No	297	85.3	49	94.2	346	86.5	
CAM = complementary and alternative medicine.

P < 0.05.

A logistic regression analysis, in which CAM use was the dependent variable, and gender, age, education, marital status, and smoking status were the independent variables, was performed. The established logistic regression model was successfully completed to classify CAM use with 99.1% accuracy. The logistic regression model was found to be significant (χ2 = 78.482; P < .001), had a high level of fit (χ2 = 2.196; P = .901 [Hosmer and Lemeshow]), and was adequate (R2 = 0.179 [Cox & Snell], R2 = 0.179 [Nagelkerke], −2LL = 230.627 [−2Log Likelihood]). The results of the logistic regression analysis are shown in Table 5. According to these results, gender, one of the independent variables thought to be a risk factor for CAM use, was not associated with a significant increase or decrease in risk, while the other independent variables caused a change in the risk (increase or decrease) of CAM use. The patients aged 19 to 25 used CAM methods 21.7 times more frequently than those aged 13 to 18 (P = .005), while the patients aged 26 or older did not have a significant increase in risk compared to the patients in the 19 to 25 age group (OR = 0.400; P = .156) was determined. Primary school graduates were OR = 90.9 times (P = .007) as likely to use CAM as university graduates. Singles were 9.3 times more likely to use CAM than married patients (P < .001). Regular smokers were 6.9 times (P = .001) more likely to use CAM than occasional smokers (Table 5).

Table 5 Effects of risk factors on CAM use.

Variables	B	SE	Wald	P	OR	95% CI for OR	
Lower	Upper	
19–25 yr old*			9.507	.009				
13–18 yr old	−3.082	1.087	8.042	.005	0.046	0.005	0.386	
26 yr and above	−0.915	0.646	2.008	.156	0.400	0.113	1.420	
Elelmentary-middle school*			9.787	.007				
High school graduate	0.443	0.547	0.655	.418	1.557	0.533	4.552	
University graduate	−4.498	1.662	7.324	.007	0.011	0.000	0.289	
Single*	−2.237	0.506	19.554	<0.001	0.107	0.040	0.288	
Constantly smoker*			15.119	.002				
None	−0.295	0.588	0.251	.616	0.745	0.235	2.358	
Occasional user	−0.658	0.969	0.461	.497	0.518	0.078	3.458	
Quitter	−1.929	0.596	10.459	.001	0.145	0.045	0.468	
Constant	4.832	0.840	33.101	<.001	125.512			
CAM = complementary and alternative medicine.

*Variable(s) entered on step 1: age, educational status, marital status, smoking status.

P < 0.05.

4. Discussion

CAM methods are generally used in diseases that are chronic, resistant to treatment, and negatively affect people’s physical and psychological health.[6] AV is a common, multifactorial, and inflammatory disease of the pilosebaceous unit. AV can cause psychosocial problems in patients because it can last for years despite treatment and leave permanent scars on the skin.[7–10]

CAM methods are practices that are increasingly preferred in the preventive and therapeutic field. In our study, it was determined that 83.7% of patients with AV used CAM treatments. Similar to our findings, a study conducted in 2017 revealed that 77% of patients with AV had a history of CAM use.

It was shown that CAM was used more frequently in chronic skin diseases (such as acne and eczema) rather than acute skin diseases. Herbal treatments were the most commonly used CAM methods and may reflect the fact that CAM treatments are typically based on herbal treatments.[11] Demirci et al similarly found that the most frequently used CAM method was herbal treatments in dermatological diseases (59.1%), and the disease for which CAM methods were the most frequently used was AV (31.8%).[12] Durusoy et al found that 57.4% of patients with AV used CAM methods, and all of these patients preferred herbal products.[3] In a study conducted by Mullaaziz et al, it was found that herbal topical treatments were used frequently among AV patients at a rate of 62% to 100%.[13] In our study, this rate was found to be 61%. This shows that patients mostly resort to treatments derived from plants.

In our study, no statistically significant difference was found between the rates of male and female patients using CAM methods (P = .395). While some publications in the literature reported high rates of CAM use in women, some publications have not found a relationship between CAM use and gender.[13,14] The results of a study conducted by Oral et al supported our results, and Kaur et al determined that women preferred to use complementary treatments more than men did.[15,16] Among all patients in our study, no statistically significant difference was detected between the groups using and not using CAM in terms of sociodemographic characteristics, other than their education levels. However, the rate of CAM use was found to be higher in the younger age group, female gender, single patients, and patients who were students. Patients who were 19 to 25 years old were 21.7 times more likely to use CAM methods than patients who were 13 to 18 years old, primary school graduates were 89.9 times more likely to use CAM methods than university graduates, and single patients were 9.3 times more likely to use CAM than married patients. The reason for this situation may be the desire of young people, single people, and those who are students to get results in a short time, as well as being more influenced by one’s environment, the internet, and other factors. This may be due to greater media influence, that is, the possibility that CAM use is higher in women with AV than in men may be related to the possibility that women are more concerned with their appearance. In many other studies, consistent with our study, it has been reported that CAM use is higher in younger patients, women, and single patients.[17–19] As found in our study, the significantly higher rate of AV patients using CAM may be related to the young age of AV patients, the finding that their lesions were located especially on the face, the disease being seen in an age group where physical characteristics are at the forefront, and the desire for a quick recovery.

In a study conducted in Korea, in 90% of AV cases, patients stated that they resorted to CAM treatments when their lesions increased, and their disease worsened,[20] while in our study, 28.7% of the patients stated that they resorted to CAM treatments when acne appeared on their faces. The use of CAM in patients with only facial involvement (90.7%) was significantly higher than that in patients with only trunk involvement (4.9%) or those with both face and trunk involvement (22.1%; P = .003). Similarly, in a meta-analysis study conducted in Turkey, the use of CAM in patients with cheek and chest involvement was significantly higher.[5]

In the literature, consistent with our study, it was stated that CAM users use these methods the most frequently with the recommendations of close relatives and friends.[4,21] The means and rates of access to CAM methods for patients in Turkey have been reported as follows: the environment of the person (family, friends, other patients, 53.9–75.9%), the media (e.g. internet, television, newspaper/magazine, 24.5–26.9%), herbalist (2.8–7.93%), health-related professionals (doctors and pharmacists, 5.5–11.3%), and barbers (5.5%).[3,16,22] It is observed that the rate of patients using healthcare professionals as a source of information about the CAM methods they utilize for AV treatment is low compared to other methods. In our study, it was determined that the most common way of obtaining information about CAM was from one’s environment (relative/friend/acquaintance; 49.4%).

Studies on the use of CAM in dermatological diseases have demonstrated that CAM use increases significantly along with the duration of one’s disease.[18,23,24] In our study, there was no statistically significant relationship between disease duration and CAM use.

Studies have shown that patients do not willingly give information about CAM use to their doctors.[25] This suggests that doctors should be responsible for asking questions about CAM use. In our study, the rate of patients using CAM methods and not informing their doctors about the method they used was found to be consistent with the literature (60.9%).

It should not be forgotten that the CAM methods used by their patients may affect the treatments that physicians will prescribe to their patients. Therefore, patients should be informed about the CAM methods they use when planning their treatment. It was reported that Italian dermatologists generally had a positive perspective on CAM methods, and patients frequently asked for advice from doctors on these issues (88.3%).[26]

Situations that may result in unfavorable outcomes in the context of the use of CAM methods include factors such as the lack of experts on the subject, the lack of sufficient scientific evidence regarding these methods, and the need for a long period of time for treatment methods to be used.[27] It is important that healthcare professionals have the necessary knowledge to prevent ill-advised practices in this field. The widespread use of these practices among the public necessitates that their effects be examined scientifically.

5. Limitations

The sample of this study included patients with AV presenting to the dermatology outpatient clinic of a hospital in Turkey. Since it was a single-center study, it is not possible to generalize the results to the whole population. The study identified certain relationships but could not determine causation due to the limitations imposed by its cross-sectional design. We also did not ask patients for additional details about the CAM methods they used. In future endeavors, conducting multicenter studies that include larger samples regarding the use of CAM in AV patients and ask more detailed questions about the CAM methods used by these patients will provide more generalizable results.

Author contributions

Conceptualization: Bahar Ürün Ünal , Abdullah Demirbaş, Kamile Marakoğlu, Burcu Gök Erdoğan.

Data curation: Bahar Ürün Ünal, Abdullah Demirbaş, Burcu Gök Erdoğan.

Formal analysis: Bahar Ürün Ünal.

Investigation: Bahar Ürün Ünal.

Methodology: Bahar Ürün Ünal, Kamile Marakoğlu, Burcu Gök Erdoğan.

Project administration: Bahar Ürün Ünal, Abdullah Demirbaş.

Software: Bahar Ürün Ünal.

Supervision: Bahar Ürün Ünal, Burcu Gök Erdoğan.

Validation: Bahar Ürün Ünal.

Writing – original draft: Bahar Ürün Ünal, Burcu Gök Erdoğan.

Writing – review & editing: Bahar Ürün Ünal, Burcu Gök Erdoğan.

Supplementary Material

Abbreviations:

AV acne vulgaris

CAM complementary and alternative medicine,

GAGS global acne grading system.

The authors have no funding and conflicts of interest to disclose.

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Supplemental Digital Content is available for this article.

How to cite this article: Ürün Ünal B, Demirbaş A, Marakoğlu K, Gök Erdoğan B. The assessment of complementary and alternative medicine use in acne vulgaris patients in Turkey: A cross-sectional study. Medicine 2024;103:37(e39577).
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