The Epidemiology of Acne in the Current Era: Trends and Clinical Implications

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

Your manuscript presents an important review of acne epidemiology, highlighting its global burden, risk factors, and emerging research areas. The study is well-structured and covers key aspects, including the psychosocial impact and potential applications of artificial intelligence in dermatology. However, several areas could be improved to enhance clarity, methodological transparency, and consistency in reporting.

The writing is generally clear, but some sentences are overly complex. For example, in the introduction, “Acne vulgaris is one of the most common dermatologic conditions reported in the dermatologist’s office, and the prevalence of this disease is increasing both worldwide and in Europe” could be revised to “Acne vulgaris is among the most frequently encountered dermatologic conditions, with its prevalence rising globally, including in Europe.” Streamlining sentences throughout the manuscript would improve readability.

The epidemiological data should be presented more consistently. The manuscript cites a global prevalence of 9.4% but later references estimates as high as 35–100% in adolescents. It would be beneficial to clarify the sources for each figure and reconcile discrepancies. Additionally, specifying which Global Burden of Disease (GBD) datasets were used (e.g., GBD 2010, 2019, 2021) would strengthen the credibility of the reported trends.

The discussion of risk factors is comprehensive but lacks methodological details on how these factors were assessed in prior studies. Clarifying whether findings are based on meta-analyses, cohort studies, or cross-sectional surveys would improve the rigor of the review. Additionally, the manuscript mentions geographical differences in acne prevalence but does not address socioeconomic disparities in access to dermatological care. Expanding on this aspect would add depth to the discussion.

Certain terms should be used consistently throughout the manuscript. Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and prevalence are mentioned interchangeably, but each term should be clearly defined and consistently applied. Additionally, replacing “psychological burden” with “psychosocial burden” or “mental health impact” would provide a more precise description of acne’s effects. Standardizing the use of quality-of-life measures such as the Dermatology Life Quality Index (DLQI) and Cardiff Acne Disability Index (CADI) would also enhance clarity.

The manuscript reports prevalence rates and statistical significance but does not consistently provide confidence intervals (CIs). Including 95% CIs for key epidemiological estimates would improve statistical rigor. For example, instead of stating “The global prevalence of acne is estimated at 9.4%,” it would be preferable to write “The global prevalence of acne is estimated at 9.4% (95% CI: X.X - X.X), based on GBD data.”

Figures and tables are well-organized but could be labeled more effectively. Table 1 should specify whether prevalence estimates apply to adolescents, adults, or all age groups. Figure 1 should clarify whether percentage changes represent absolute or relative differences, and the color scheme should be adjusted to improve readability, especially for colorblind readers. If available, error bars or confidence intervals should be included in graphical representations.

The discussion section effectively summarizes key points but could be more structured. The section on artificial intelligence applications in dermatology is scattered throughout the manuscript and would be better presented as a standalone section. Additionally, highlighting unresolved research gaps, such as the impact of pollution, dietary factors, and genetic predisposition, would strengthen the discussion.

Overall, this review provides valuable insights into the epidemiology of acne and its broader implications. Addressing the suggested revisions—particularly methodological transparency, epidemiological consistency, and statistical reporting—will significantly enhance the manuscript. I appreciate the opportunity to review your work and look forward to the revised version.

Author Response

Dear Reviewer,

Thank you for taking the time to review my manuscript. I appreciate your suggestions and will use them to improve the paper and I find your feedback extremely valuable.

I have simplified long and overly complex sentences with more accessible and easier to understand sentences.

Unfortunately, I could not find CIs for this statement: ”The global prevalence of acne is estimated at approximately 9.4%, based on GBD data.”

I have also introduced 2 graphical representations regarding the environmental, biological and socio-economic factors involved in acne.

Socioeconomic discrepancies were introduced into the paper by citing a study conducted in Canada.

I have clearly defined the terms DALY and YDL and clarified the psychosocial impact of acne through the DLQI and CADI questionnaires.

The confidence intervals are found in the paragraph of the 2019 study: “The same global epidemiologic study, conducted in 2019, demonstrated that acne vulgaris was responsible for 4.96 million (95% CI 2.98-7.85) DALYs. Of these, 3.52 million (95% CI 2.11-5.64) DALYs occurred in 15-49 year olds. In the 10-24 year age group, acne was the 27th most common cause of DALY increase in 1990 (DALY %: 1.1), rising to 19th in 2019 (DALY %: 1.6)”.

I have adjusted the data in table 1. According to your recommendations, I have also added an easy-to-view color scheme.

I have introduced several studies on the impact of pollution, but also aspects regarding genetic predisposition.

Furthermore, the discussion section has been organized in a more concise manner and now includes the current research gaps mentioned in your review.

I am at your disposal for any further suggestions and recommendations.

Kind regards,

Dumitrita Gugulus

 

 

Reviewer 2 Report

Comments and Suggestions for Authors

Many thanks for submitting this manuscript.

The overall aim and scope of the manuscript is unclear. It shifts between a narrative review, a meta-analysis and is lacks focus. Is this a manuscript centering on epidemiology, quality of life, pathogenesis or treatment. 

This needs to be addressed and is meant as a constructive criticism. 

There are many statements and assertions without references. 

The language used often does not sit well within a scientific journal.

"Last but not least, we believe that in today's times, patients' mental health is as important as their physical health, so paying attention to this aspect can totally change the quality of life of the dermatologic patient and of course contribute to increased confidence in the medical act."

 

Comments on the Quality of English Language

Needs to be improved. At times the style is journalistic. 

Author Response

Dear Reviewer,

Thank you for taking the time to review my manuscript. I greatly appreciate the suggestions provided and will use them to improve the paper. Your feedback is extremely valuable to me.

My work is intended to look like a review of the dermatoepidemiology of acne in the current era, with a strong focus on epidemiology, but also relevant contemporary aspects. More precisely, the psychosocial impact, data on the implications of internal or even external factors (cytokines, microbiome, environmental factors, diet), the applicability of AI in the field of dermatology (with a focus on its use in diagnosis, treatment and prognosis in acne) are all essential parts of my review.

I have revised the paper and added references to the paragraphs that I omitted.

I have also revised the English language, modified the expressions that did not fit in a reputable scientific journal.

I remain at your disposal for any further suggestions and recommendations.

Kind regards,

Dumitrita Gugulus

Reviewer 3 Report

Comments and Suggestions for Authors

This review highlights epidemiology, pathophysiology, and psychosocial impacts of acne and the application of artificial intelligence in the field of acne diagnosis and treatment. This paper is well-written, but I have some concerns.

 

1. The description of artificial intelligence (AI) is abundant, but the association between AI and acne seemed to be scarcely mentioned. The paragraph of AI should be more focused on acne.

 

2. Graphical images are lacked. The addition of some impressive graphical figures is recommended.

 

3. IL-6 is an important cytokine in the pathophysiology of acne, but there are several other cytokines associated with acne. Why did the authors include only IL-6?

Author Response

Dear Reviewer,

Thank you for taking the time to review my manuscript. I greatly appreciate the suggestions offered and will use them to improve the paper. I find your feedback extremely valuable.

1. I have reviewed your requirements, therefore I have added the applicability in acne in the AI ​​paragraph.

2. I have added 2 suggestive graphic figures, regarding the factors involved in acne.

3. Indeed, I initially placed more emphasis on IL-6, but taking your advice I have also introduced other cytokines with an important role in the physiopathology of acne.

I remain at your disposal for any further suggestions and recommendations.

Kind regards,

Dumitrita Gugulus

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Many thanks for reviewing the manuscript. 

I still think that the manuscript is too broadly focussed. 

 

The manuscript still reads poorly, often containing lists.

Is the manuscript attempting to focus on the epidemiology, pathogenesis, or psychosocial burden of acne? This is not clear from the title or abstract.

I would remove the entire AI section. This is poorly referenced an adds little and what relevance does this have to epidemiology? Is the term “dermato-epidemiology of acne” scientific?

This discussion comprises only 9 lines!

I would combine the QoL discussion 2.1.1. und 3.0.

Author Response

Dear reviewer,

Thank you for your valuable comments and helpful suggestions which contributed to the improvement of my manuscript.

1. I have replaced the lists in the article by narrative writing.
2. I have modified the abstract, the title and I have introduced a new paragraph in the introduction to place the paper’s focus on epidemiology.
3. I have completely removed the AI ​​section from the manuscript.
4. I have replaced the term “dermato-epidemiology of acne” with “epidemiology of acne”.
5. I have added new paragraphs to the discussion section.
6. I have also merged section 3.0 with 2.1.1 in 2.1. section.

I hope that the changes I have made are appropriate and meet your requirements.

Yours sincerely,

Dumitrita Gugulus

Reviewer 3 Report

Comments and Suggestions for Authors

The authors revised the manuscript well and I have no more concerns.

Author Response

Dear reviewer,

Thank you for your valuable comments and helpful suggestions which contributed to the improvement of my manuscript.

Yours sincerely,

Dumitrita Gugulus

 

Round 3

Reviewer 2 Report

Comments and Suggestions for Authors

Many thanks for improving the manuscript. Good luck with the resubmission.