Displaying publications 1 - 20 of 38 in total

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  1. Goh CL, Noppakun N, Micali G, Azizan NZ, Boonchai W, Chan Y, et al.
    J Cutan Aesthet Surg, 2016;9(2):85-92.
    PMID: 27398008 DOI: 10.4103/0974-2077.184043
    Conventional acne treatment presents several challenges such as intolerable side effects and antibiotic resistance. Dermocosmetic products may be used to reduce these unwanted effects. Dermocosmetics include skin cleansers, topical sebum-controllers, skin antimicrobial/anti-inflammatory agents, moisturizers, sunscreens, and camouflage products. Appropriate use of these products may help augment the benefit of acne treatment, minimize side effects, and reduce the need for topical antibiotics. In Asia, there is currently limited scientific data on the application and recommendations for dermocosmetic use in acne vulgaris (AV). This article reviews the evidence on dermocosmetics for AV and provides practice recommendations as discussed during the 4(th) Asia-Pacific Acne Leaders' Summit held in Bangkok, Thailand, on 7 and 8 February 2015. Through a premeeting survey, a series of plenary lectures, a stepwise program of discussion sessions, and Medline article review, the Expert Panel set forth relevant recommendations on the role of dermocosmetics as adjunct for treating AV in Asian patients.
    Matched MeSH terms: Acne Vulgaris*
  2. Chew SS
    Family Practitioner, 1982;5:27-30.
    Matched MeSH terms: Acne Vulgaris
  3. Goh CL, Abad-Casintahan F, Aw DC, Baba R, Chan LC, Hung NT, et al.
    J Dermatol, 2015 Oct;42(10):945-53.
    PMID: 26211507 DOI: 10.1111/1346-8138.12993
    The management of acne in South-East Asia is unique, as Asian skin and local variables require a clinical approach unlike that utilized in other parts of the world. There are different treatment guidelines per country in the region, and a group of leading dermatologists from these countries convened to review these guidelines, discuss current practices and recent advances, and formulate consensus guidelines to harmonize the management of acne vulgaris in the region. Emphasis has been placed on formulating recommendations to impede the development of antibiotic resistance in Propionibacterium acnes. The group adopted the Acne Consensus Conference system for grading acne severity. The group recommends that patients may be treated with topical medications including retinoids, benzoyl peroxide (BPO), salicylic acid, a combination of retinoid and BPO, or a combination of retinoids and BPO with or without antibiotics for mild acne; topical retinoid with topical BPO and a oral antibiotic for moderate acne; and oral isotretinoin if the patient fails first-line treatment (a 6- or 8-week trial of combined oral antibiotics and topical retinoids with BPO) for severe acne. Maintenance acne treatment using topical retinoids with or without BPO is recommended. To prevent the development of antibiotic resistance, topical antibiotics should not be used as monotherapy or used simultaneously with oral antibiotics. Skin care, comprised of cleansing, moisturizing and sun protection, is likewise recommended. Patient education and good communication is recommended to improve adherence, and advice should be given about the characteristics of the skin care products patients should use.
    Matched MeSH terms: Acne Vulgaris*
  4. Abad-Casintahan F, Chow SK, Goh CL, Kubba R, Hayashi N, Noppakun N, et al.
    J Dermatol, 2016 Jul;43(7):826-8.
    PMID: 26813513 DOI: 10.1111/1346-8138.13263
    In patients with darker skin types (Fitzpatrick phototypes III-VI), acne is often accompanied by post-inflammatory hyperpigmentation (PIH). Further, acne-related pigmentation can pose a greater concern for the patient than the acne lesions. There has been little formal study of this acne-related PIH. Recently, the Asian Acne Board - an international group of dermatologists with interest in acne research - made a preliminary evaluation of the frequency and characteristics of PIH in seven Asian countries. A total of 324 sequential acne subjects were evaluated for the presence of PIH. The majority (80.2%) of subjects had mild to moderate acne and there were more females than males (63.0% vs 37.0%). In this population of patients consulting a dermatologist for acne, 58.2% (188/324) had PIH. The results also showed that pigmentation problems are often long lasting: at least 1 year for more than half of subjects and 5 years or longer in 22.3%. In accordance with our clinical experience, patients reported that PIH is quite bothersome, often as bothersome or more so than the acne itself and sometimes more problematic. Excoriation was commonly reported by patients, and may represent a modifiable risk factor that could potentially be improved by patient education.
    Matched MeSH terms: Acne Vulgaris/complications*; Acne Vulgaris/epidemiology
  5. Muthupalaniappen L, Tan HC, Puah JW, Apipi M, Sohaimi AE, Mahat NF, et al.
    Clin Ter, 2014;165(4):187-92.
    PMID: 25203331 DOI: 10.7417/CT.2014.1731
    BACKGROUND AND AIMS: Acne is a common skin disorder which can cause physical scaring and impact the quality of life. The aim of this study is to determine the prevalence, severity and the risk factors for developing acne among medical students in Universiti Kebangsaan Malaysia (UKM).
    MATERIALS AND METHODS: A cross sectional study among UKM medical students from academic year 1 to 5 was conducted from July 2011 to May 2012. A total of 361 students were selected by stratified cluster sampling method. Baseline data of the students, risk factors, height and weight were recorded. Acne severity was graded using the Comprehensive Acne Severity Scale (CASS).
    RESULTS: The prevalence of acne among medical students is 68.1% (n=246). Males and females were almost equally affected (1:1.1). Majority students with acne were graded as almost clear (55.7%, n=137), mild (35.0%, n=86), moderate (7.7%, n=19), and severe (1.6%, n=4). More than half of them had developed acne scars (59.0%, n= 213). Males were found to be at higher risk of developing acne compared to females (p<0.05, OR=4.734; 95%CL=2.726-8.222). They are also at higher risk of developing moderate and severe grades of acne compared to females (p=0.001). The odds for developing acne was higher when mother (p=0.029; OR=1.752; 95%CL=1.058-2.902) or father (p=0.027; OR=1.852; 95%CL=1.072-3.201) had acne. When both parents were affected by acne the odds of developing acne was 3 times. (p=0.025; OR=3.056; 95%CL=1.153-8.094).
    CONCLUSIONS: This study shows that the prevalence of acne among medical students is high. Hence, it is important to identify those at risk and provide optimal treatment to prevent scarring and possible low self esteem among these future doctors.
    KEYWORDS: acne vulgaris; medical; prevalence; risk factors; severity; students
    Matched MeSH terms: Acne Vulgaris*
  6. Mohd Nor NH, Aziz Z
    J Dermatolog Treat, 2013 Oct;24(5):377-86.
    PMID: 22658322 DOI: 10.3109/09546634.2012.699179
    OBJECTIVE: Comparative trials of benzoyl peroxide (BPO) have yielded contradictory results on its effectiveness for acne vulgaris. The aim of the study was to synthesise the evidence for the effectiveness of BPO-containing topical products for facial acne vulgaris.
    DESIGN: Systematic review.
    METHODS: The Cochrane Central Register of Controlled trials, Cochrane Library, MEDLINE and other relevant databases were searched without publication date or language restriction.
    RESULTS: We identified 22 trials involving 2212 participants; 12 trials compared BPO as single agent while the other 10 trials compared BPO in combination products. All trials reported lesion count as the outcome measure but only five trials provided numerical data. However, pooling of data from these trials was inappropriate due to variations between trials in terms of acne severity, comparator used and trial duration. Overall the study quality was fair but most studies had some bias particularly in method of random generation and allocation concealment. Although the results provide some evidence that BPO reduces acne-lesion count, the available evidence is not robust enough for firm conclusions.
    CONCLUSIONS: There is no high quality evidence that topical BPO improves facial acne vulgaris, and further research is needed.
    Matched MeSH terms: Acne Vulgaris/drug therapy*
  7. Yap FBB
    Ann Dermatol, 2012 May;24(2):158-61.
    PMID: 22577265 DOI: 10.5021/ad.2012.24.2.158
    BACKGROUND: Acne is considered a cosmetic nuisance in Malaysia since no insurance coverage is provided for its treatment. Its psychological impact is unknown.
    OBJECTIVE: The aim of this study is to determine the impact of acne on quality of life and its relationship with severity.
    METHODS: A cross-sectional study using the Cardiff acne disability index (CADI) and Global Acne Grading System for acne severity grading was done in three government-run dermatology clinics in Sarawak, Malaysia.
    RESULTS: The study cohort of 200 patients had a mean CADI score of 5.1. Most of the patients (59.5%) had mild CADI impairment, with the domain of feelings most affected. Patients with a family income <1,000 United States Dollor/month had a higher mean CADI (mean 5.5 vs. 4.4; p=0.04). Females, indigenous groups, and patients with tertiary education tended to have more severe CADI impairment (p>0.05). The correlation between CADI and mild acne severity was low (Pearson correlation coefficient=0.35; p<0.001) but became insignificant for moderate and severe acne.
    CONCLUSION:
    Acne impairment in Sarawak was moderate and must be addressed. It should be viewed as a psychologically disabling disease requiring optimal management and resource allocation.
    KEYWORDS: Acne vulgaris; Disability; Quality of life

    Study site: Dermatology Departments of Sarawak General Hospital
    Matched MeSH terms: Acne Vulgaris*
  8. Loh KC, Chan LC, Phang LF
    Med J Malaysia, 2020 01;75(1):18-23.
    PMID: 32008014
    INTRODUCTION: People often judge others and make decisions based on the physical appearance of an individual. This study assesses the perception and psychosocial judgment on patients with acne vulgaris compared to those with clear skin.

    METHODS: This survey was conducted in Penang from October 2016 to June 2017. Respondents were those who were ≥18 years. The survey was conducted using a questionnaire which consists of three randomly selected facial pictures, with at least one acne skin and one clear skin picture.

    RESULTS: A total of 435 respondents were recruited. Two third of the respondents (76%) suffered or had suffered from acne. The skin was the first thing noticed by 76.1% respondents when viewing pictures with acne compared with 24.8% with clear skin (p <0.05). People with acne were perceived as being unattractive, sad, lonely, distant, unhealthy, disheveled and shy as compared to people with clear skin (p<0.05). People with clear skin were perceived to be healthier, confident, happy, attractive, successful and intelligent (p<0.05). Respondents were more willing to engage socially with people with clear skin rather than those with acne skin. A significantly higher proportion of respondents were likely to hire or vote for those with clear skin as compared to acne skin. People with acne were also perceived to have a lower educational level and poorer leadership quality.

    CONCLUSION: The results of this survey showed that there were significantly negative perception and psychological judgement toward individuals with acne vulgaris. These negative impacts may affect social life of the acne sufferers, their prospect of employment and career opportunities.

    Matched MeSH terms: Acne Vulgaris/psychology*
  9. Kawala C, Fernando D, Tan JK
    J Cutan Med Surg, 2014 Nov;18(6):385-91.
    PMID: 25348759
    BACKGROUND: Acne vulgaris is a common chronic disease, and evidence-based clinical practice guidelines (CPGs) can provide credible treatment information.

    METHOD: A literature search for acne CPGs published between January 2008 and September 2013 was conducted. Two reviewers independently applied the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. METHODological quality was evaluated by ranking in AGREE II domains and the highest number of items scoring above the neutral threshold score.

    RESULTS: Four CPGs fulfilled the selection criteria, and the highest ranked were the European and Malaysian. Highest scores achieved by the former were for scope/purpose, stakeholder involvement, and rigor of development and by the latter were for scope/purpose, clarity of presentation, and applicability. Applicability was the lowest scoring of all domains for all CPGs.

    CONCLUSION: European and Malaysian acne CPGs were ranked highest for methodological quality and may serve to inform clinical practice and guideline adaptation.

    Matched MeSH terms: Acne Vulgaris/therapy*
  10. Rusmadi SZ, Syed Ismail SN, Praveena SM
    J Environ Public Health, 2015;2015:591790.
    PMID: 26693230 DOI: 10.1155/2015/591790
    Many cases of dermatologic complication were reported with the use of skin lightening products. This study assessed the skin lightening practice and health symptoms among female students. Self-administered questionnaire was distributed to 104 female students (56 undergraduates and 48 postgraduates) aged 24 ± 2 years in Universiti Putra Malaysia. A total of 60.6% (N = 63) of the female students used skin lightening products (61.9% of undergraduates and 38.1% of postgraduates). Reasonable price (N = 35, 55.6%) and ingredients (N = 29, 46%) were considered the most important factors in the product selection. Most respondents purchased the product from drugstores (N = 39, 61.9%). Twenty-two respondents (34.9%) in this study experienced skin problem from the products they used. Skin peeling (N = 13, 12.5%) and acne (N = 9, 8.7%) were the most frequent symptoms experienced. Most of the respondents have the perception that lighter skin provides high self-esteem (N = 56, 53.8%) and looks beautiful and healthier (N = 54, 51.9%). The use of skin lightening products is common among female students in this study and some of these products can cause skin problems such as skin peeling, acne, and itching.
    Matched MeSH terms: Acne Vulgaris
  11. Majid, Z., Chong, A., Setan, H., Ahmad, A., Rajion, Z.A.
    MyJurnal
    This paper describes the use of stereophotogrammetry approach to measure and hence identify accurately threedimensional (3D) coordinates of important landmarks on a craniofacial surface. A "novel" technique dubbed as "natural features" technique was employed to accurately compute the 3D coordinates of selected craniofacial landmarks. The natural features technique involves the use of 3D coordinates of the natural features (such as acne, scar, corners of eyes, edge of mouth, point of chin, etc.) that appear on the craniofacial surface as an absolute stereophotogrammetric mapping control points. The 3D coordinates of the natural features were gained using digital photogrammetric bundle adjustment method. Validation of the proposed technique has firstly been carried out using mannequin and finally, it was applied on the real-life human faces. The result shows that the craniofacial landmark measurement accuracy of 0.8mm with one standard deviation can be successfully achieved by the proposed technique.
    Matched MeSH terms: Acne Vulgaris
  12. Ramli R, Malik AS, Hani AF, Jamil A
    Skin Res Technol, 2012 Feb;18(1):1-14.
    PMID: 21605170 DOI: 10.1111/j.1600-0846.2011.00542.x
    INTRODUCTION: This paper presents a comprehensive review of acne grading and measurement. Acne is a chronic disorder of the pilosebaceous units, with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity. Most patients are affected with acne vulgaris, which is the prevalent type of acne. Acne vulgaris consists of comedones (whitehead and blackhead), papules, pustules, nodules and cysts.
    OBJECTIVES: To review and identify the issues for acne vulgaris grading and computational assessment methods. To determine the future direction for addressing the identified issues.
    METHODS: There are two main methods of assessment for acne severity grading, namely, lesion counting and comparison of patient with a photographic standard. For the computational assessment method, the emphasis is on computational imaging techniques.
    RESULTS: Current acne grading methods are very time consuming and tedious. Generally, they rely on approximation for counting lesions and hence the assessment is quite subjective, with both inter and intra-observer variability. It is important to accurately assess acne grade to evaluate its severity as this influences treatment selection and assessment of response to therapy. This will further help in better disease management and more efficacious treatment.
    CONCLUSION: Semi-automated or automated methods based on computational imaging techniques should be devised for acne grade assessment.
    Matched MeSH terms: Acne Vulgaris/classification*; Acne Vulgaris/diagnosis*
  13. Hanisah A, Omar K, Shah SA
    J Prim Health Care, 2009 Mar;1(1):20-5.
    PMID: 20690482
    AIM: The objective of this study was to determine the prevalence of facial acne and its impact on the quality of life among adolescents attending secondary schools in Muar, Malaysia.
    METHODS: A cross-sectional study was conducted where 409 samples were selected using stratified cluster random sampling from two secondary schools in Muar, involving Form 1 to Form 5 students. Students were diagnosed clinically and the severity of facial acne was assessed using Global Acne Grading System. A self-reported Cardiff Acne Disability Index was used to assess the quality of life among adolescents who had acne.
    RESULTS: The prevalence of facial acne among the adolescents was 67.5% (n = 276). Facial acne increased with increasing age (p = 0.001). It was more common among males (71.1%) than females (64.6%), p = 0.165. The males also had a higher prevalence of severe acne (p = 0.001). The quality of life was affected by the severity of acne. Students with severe acne had higher levels of Cardiff Acne Disability Index (rho = 0.521).
    CONCLUSION: Facial acne is a common disorder and appears to have a considerable impact on quality of life among adolescents. The above findings should alert health care professionals and the school authorities to actively identify, manage and educate adolescents with facial acne.
    Matched MeSH terms: Acne Vulgaris/epidemiology*; Acne Vulgaris/psychology*
  14. Ismail NH, Manaf ZA, Azizan NZ
    BMC Dermatol., 2012;12:13.
    PMID: 22898209 DOI: 10.1186/1471-5945-12-13
    BACKGROUND: The role of dietary factors in the pathophysiology of acne vulgaris is highly controversial. Hence, the aim of this study was to determine the association between dietary factors and acne vulgaris among Malaysian young adults.
    METHODS: A case-control study was conducted among 44 acne vulgaris patients and 44 controls aged 18 to 30 years from October 2010 to January 2011. Comprehensive acne severity scale (CASS) was used to determine acne severity. A questionnaire comprising items enquiring into the respondent's family history and dietary patterns was distributed. Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Anthropometric measurements including body weight, height and body fat percentage were taken. Acne severity was assessed by a dermatologist.
    RESULTS: Cases had a significantly higher dietary glycemic load (175 ± 35) compared to controls (122 ± 28) (p  0.05).
    CONCLUSIONS: Glycemic load diet and frequencies of milk and ice cream intake were positively associated with acne vulgaris.
    Matched MeSH terms: Acne Vulgaris/etiology*; Acne Vulgaris/physiopathology
  15. Yap FB
    J Cosmet Dermatol, 2017 Sep;16(3):348-352.
    PMID: 27539948 DOI: 10.1111/jocd.12268
    INTRODUCTION: Low-dose isotretinoin is used to reduce side effects albeit higher relapse. This study aimed to determine the efficacy and safety of fixed-dose 10 mg daily isotretinoin for the treatment of acne.

    METHODS: This prospective study was performed between 2011 and 2015. All 150 patients were given 10 mg daily isotretinoin until a cumulative dose of 90-110 mg/kg.

    RESULTS: The mean age was 26.6 years with 64.7% moderate acne, 29.3% severe, and 6% very severe. The mean cumulative dose was 98.8 ± 6.05 mg/kg. All 150 patients had total clearance with a mean time to clearance of 24.0 weeks. Patients with severe/very severe acne had higher cumulative dosage (102.1 vs. 97.0, P 

    Matched MeSH terms: Acne Vulgaris/drug therapy*; Acne Vulgaris/metabolism
  16. Deena Clare Thomas, Arlene C T, Emilia E, Noor Syaffa Shawani Y X H
    MyJurnal
    Introduction: Rooted form the ancient times, having a white and a delicate skin has been a dream of all women as it is perceived as a perfect beauty. Due to this high desideratum, the global beauty industry had taken an advantage to this target group promising an instant white skin for as early as three days. Global industry analysts (GIA) pre- dicted that this year 2020 the global market for skin lighteners will reach $23 billion. Despite the effectiveness of using skin-lightening, some had reported of having adverse effect including dermatological as well as neurological. Methods: This is a quantitative study using descriptive analysis approach to all nursing students in Sabah. The type of sampling is using snowball sampling methods. A questionnaire was developed and distributed to all nursing colleges in Sabah. Results: A total of 161 nursing students responded. Based on this study, most of students start are using cos- metic product in the age of15years old. Using an open-ended question, the top three cosmetic products containing skin-lightening ingredients use by students are Safi(27.9%), Garnier (25.5%)and Simple(16.1.%). Majority experience acne (47.5%) and skin irritation (18.8%)after using cosmetic products containing skin-lightening ingredients while 36.6% did not experience any skin problem. It is about80% concern about safety when choosing skin care contain skin-lightening ingredients,76.9% will make an effort to read leaflet provided prior to purchasing, 69.4% aware about the list of dangerous ingredients in choosing skin care contain skin-lightening ingredients, 78.1% aware about its side effect. Conclusion: The outcome of this preliminary study lead to the conclusion that nursing students in Sa- bah are aware that using a cosmetic product contain skin-lightening ingredient is harmful for them.
    Matched MeSH terms: Acne Vulgaris
  17. Leelavathi, M., Mazlin, M.B., Adawiyah, J.
    Medicine & Health, 2013;8(1):0-0.
    MyJurnal
    Natural products are often perceived as safe due to the absence of artificial or chemical materials in its content. However, many are unaware that some of these compounds, albeit natural in existence, can cause harm. Cinnamon and lemon are two commonly used home remedies for acne. Both these naturally existing ingredients are capable of producing dermatitis upon contact with the human skin. The aim of this article is to create awareness among physicians that natural remedies are not free from harm hence, should look out for any possible untoward reactions that these products may cause. Physicians need to explore the possible use of homemade remedies to treat common or minor ailments during history taking as this information may not be given voluntarily. Early identification of the offending agent, adequate management and future avoidance could help prevent further episodes of contact dermatitis and its complications.
    Matched MeSH terms: Acne Vulgaris
  18. Malik AS, Humayun J, Kamel N, Yap FB
    Skin Res Technol, 2014 Aug;20(3):322-31.
    PMID: 24329769 DOI: 10.1111/srt.12122
    BACKGROUND: More than 99% acne patients suffer from acne vulgaris. While diagnosing the severity of acne vulgaris lesions, dermatologists have observed inter-rater and intra-rater variability in diagnosis results. This is because during assessment, identifying lesion types and their counting is a tedious job for dermatologists. To make the assessment job objective and easier for dermatologists, an automated system based on image processing methods is proposed in this study.
    OBJECTIVES: There are two main objectives: (i) to develop an algorithm for the enhancement of various acne vulgaris lesions; and (ii) to develop a method for the segmentation of enhanced acne vulgaris lesions.
    METHODS: For the first objective, an algorithm is developed based on the theory of high dynamic range (HDR) images. The proposed algorithm uses local rank transform to generate the HDR images from a single acne image followed by the log transformation. Then, segmentation is performed by clustering the pixels based on Mahalanobis distance of each pixel from spectral models of acne vulgaris lesions.
    RESULTS: Two metrics are used to evaluate the enhancement of acne vulgaris lesions, i.e., contrast improvement factor (CIF) and image contrast normalization (ICN). The proposed algorithm is compared with two other methods. The proposed enhancement algorithm shows better result than both the other methods based on CIF and ICN. In addition, sensitivity and specificity are calculated for the segmentation results. The proposed segmentation method shows higher sensitivity and specificity than other methods.
    CONCLUSION: This article specifically discusses the contrast enhancement and segmentation for automated diagnosis system of acne vulgaris lesions. The results are promising that can be used for further classification of acne vulgaris lesions for final grading of the lesions.
    KEYWORDS: acne grading; acne lesions; acne vulgaris; enhancement; segmentation
    Matched MeSH terms: Acne Vulgaris/pathology*
  19. Jalil MA, Phelawan J, Aziz MS, Saktioto T, Ong CT, Yupapin PP
    Artif Cells Nanomed Biotechnol, 2013 Apr;41(2):92-7.
    PMID: 22991968 DOI: 10.3109/10731199.2012.700519
    Acne vulgaris is adebilitating dermatologic disease, and is conventionally treated by laser therapy using a microring resonator system. An evolving understanding of laser-tissue interactions involving Propioni bacterium acneproducing porphyrins, and the development of lasers to target the sebaceous glands, has led to the development of an escalating number of laser light for acne treatment. The results show that the full width at half maximum of the proposed laser pulse of 0.15 nm can be generated using a microring resonator system. The power of the laser is 200 W and the wavelength laser is 1,032 nm, which is proposed as a treatment of acne vulgaris diseases.
    Matched MeSH terms: Acne Vulgaris/radiotherapy*
  20. Ismail R
    Med J Malaysia, 1987 Jun;42(2):124-6.
    PMID: 2971861
    Acne is one of the most common disorders affecting mankind. Although acne does not cause death, it however produces a lot of discomfort, disfigurement and psychological trauma, particularly in teenagers. Acne vulgaris is a chronic condition involving the pilosebaceous unit of the skin. It is characterised by the presence of comedones, inflammatory papules, pustules or cysts, and eventually by scarring. The end result of acne varies from hyperpigmentation, slight pitting, to extremely disfiguring scars that may develop into keloids. Acne fulminans is a rare disorder and is characterised by sudden explosive appearance of highly inflammatory, tender, crusted, ulcerated lesions involving the back, chest and face. It is one of the most scarring acute dermatologic disorders of young people. A case of acne fulminans in a young female who developed haemolysis due to dapsone is reported here.
    Matched MeSH terms: Acne Vulgaris/drug therapy*
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