Introduction: Acne vulgaris is not only associated with physical morbidity, but also associated with significant psychosocial disturbances, such as depression and suicide. The objective of this study was to examine the functional
disability and psychological impact of acne vulgaris. Methods: A cross-sectional study of 55 acne patients, aged
more than 12, was conducted in the dermatology clinic of Serdang Hospital from January to March 2017. Data on
demographics, clinical features, current treatment modalities were collected. Acne severity was graded using Comprehensive Acne Severity Scale (CASS), Cardiff Acne Disability Index (CADI) was used to assess functional disability,
while DASS-21 was used to assess three related states of depression, anxiety and stress. Statistical analysis was done
using SPSS software. A p value ≤ 0.05 considered significant. Results: The mean age was 23.2 (14-46), majority were
females (39, 70.9%), Malays (44, 80%) and students (34, 61.8%). 53 (96.4%) subjects had almost clear (CASS = 1) to
moderate (CASS = 3) acne severity. Majority had facial acne with or without truncal involvement, 53 (96.3%). The
average age of disease onset was 17.8 (9-45). 45 (81.8%) patients found their acne mild to moderately disabling.
69.1%, 45.8% and 41.8% reported feeling anxious, depressed and stressed out. CADI was found to be significantly
related with depression (p=0.012), anxiety (p= 0.015) and stress (p=0.001). Relationship between CASS with CADI
(p=0.07), stress (p=0.09), anxiety (p=0.13) and depression (p=0.12) were insignificant. Conclusion: Although acne
vulgaris is not hazardous, it is associated with psychosocial disturbances. Early and effective treatments are necessary, especially when dealing with facial lesions.
Kojic acid (KA), a fungal secondary metabolite, is commonly used in the cosmetic industry as a skin-whitening agent because of its ability to inhibit tyrosinase, the enzyme involved in melanin production. However, KA has shown poor depigmenting effects and becomes unstable after prolonged storage. Its use in cosmetics products has also been restricted due to its hydrophilic nature. To overcome these limitations, the structure of KA can be altered to form KA derivatives, such as KA ester (KAE), with improved chemical and biological properties. For instance, multiple studies have shown that KAE is more effective at inhibiting tyrosinase, is less toxic and more stable than KA, thus making it more beneficial. Aside from structural modification, nanotechnology applications such as nanoemulsion, and others have shown the ability to strengthen the efficacy of both KA and KAE by increasing skin permeability and delivering the drug more precisely to the targeted site with better controlled release rate. Therefore, the aim of this review article is to discuss the importance of modifying KA's chemical structure as well as the role of nanoemulsion, solid lipid nanoparticles (SLN), nanostructured lipid carrier (NLC), liposomes and ethosomes in improving topical delivery of KA and KAE for cosmetic and pharmaceutical applications.