{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T15:56:08Z","timestamp":1774367768692,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Romanian Ministry of Research, Innovation and Digitization through Program 1\u2014Development of the National Research and Development System, Subprogram 1.2\u2014Institutional Performance\u2014Projects for funding the excellence in RDI","award":["29 PFE\/30.12.2021"],"award-info":[{"award-number":["29 PFE\/30.12.2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Metabolic preconditioning, characterized by conditions like obesity and insulin resistance syndrome, disrupts hormonal balance. Elevated androgen levels stimulate excessive sebum production and follicular cell proliferation, leading to acne lesions. Similarly, thyroid hormone imbalances affect sebaceous gland activity, epidermal lipid composition, and skin cell turnover, impacting acne occurrence and severity. This study aimed to assess the potential contribution of metabolic and endocrine preconditions to acne development. A total of 389 patients diagnosed with acne were included and divided into three groups: the metabolic precondition group (MPG, N = 163, 41.9%), the endocrine precondition group (EPG, N = 162, 41.65%), and the control group (CG, N = 89, 22.88%). Data related to the degree of acne severity and comorbidities of interest were collected from the patients\u2019 medical records. In the groups with concomitant diseases, moderate and severe acne were significantly more prevalent (56.44% and 41.10% in MPG, and 35.80% and 61.11% in EPG) compared to the control group (5.61% and 4.89%). The most prevalent preconditions observed were insulin resistance syndrome in MPG (63.8%) and autoimmune thyroiditis in EPG (95.06%). Significant age-related differences in acne severity were found across all study groups (p &lt; 0.05). In MPG, the age variable was significantly higher in the presence of mild acne, while in EPG, the age variable was significantly lower for the mild acne group. A positive association was observed between the severity of acne and insulin resistance syndrome, obesity, autoimmune thyroiditis, and hypothyroidism (p &lt; 0.05). Risk analysis indicated a significantly higher risk (RR &gt; 1, 95% CI RR &gt; 1, p &lt; 0.001) of developing moderate and severe acne in the presence of these preconditions. The presence of both metabolic and endocrine preconditions significantly increased the likelihood of developing severe acne, leading to the hypothesis that both conditions may be contributing factors to the development of acne.<\/jats:p>","DOI":"10.3390\/ijms25020721","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T10:06:43Z","timestamp":1704449203000},"page":"721","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Exploring the Metabolic and Endocrine Preconditioning Associated with Thyroid Disorders: Risk Assessment and Association with Acne Severity"],"prefix":"10.3390","volume":"25","author":[{"given":"Alexa Florina","family":"Bungau","sequence":"first","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0296-6592","authenticated-orcid":false,"given":"Delia Mirela","family":"Tit","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3236-1292","authenticated-orcid":false,"given":"Simona Gabriela","family":"Bungau","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5071-9601","authenticated-orcid":false,"given":"Cosmin Mihai","family":"Vesa","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7625-8177","authenticated-orcid":false,"given":"Andrei-Flavius","family":"Radu","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruxandra Cristina","family":"Marin","sequence":"additional","affiliation":[{"name":"Fundeni Clinical Hospital, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura Maria","family":"Endres","sequence":"additional","affiliation":[{"name":"Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lavinia-Cristina","family":"Moleriu","sequence":"additional","affiliation":[{"name":"Department III of Functional Sciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1056\/NEJMcp033487","article-title":"Acne","volume":"352","author":"James","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1136\/bmj.1.6171.1109","article-title":"Prevalence of Facial Acne Vulgaris in Late Adolescence and in Adults","volume":"1","author":"Cunliffe","year":"1979","journal-title":"Br. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1046\/j.1365-2133.1997.d01-1144.x","article-title":"Post-Adolescent Acne: A Review of Clinical Features","volume":"136","author":"Goulden","year":"1997","journal-title":"Br. J. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1001\/archderm.1994.01690030095016","article-title":"Acne Revisited","volume":"130","author":"Shalita","year":"1994","journal-title":"Arch. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.clindermatol.2016.10.007","article-title":"Drug-Induced Acne","volume":"35","author":"Kazandjieva","year":"2017","journal-title":"Clin. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"298","DOI":"10.4103\/0378-6323.199581","article-title":"Update on Etiopathogenesis and Treatment of Acne","volume":"83","author":"Bhat","year":"2017","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.jaad.2006.08.048","article-title":"Guidelines of Care for Acne Vulgaris Management","volume":"56","author":"Strauss","year":"2007","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/j.1365-2133.1970.tb12875.x","article-title":"Perifollicular Elastolysis","volume":"83","author":"Varadi","year":"1970","journal-title":"Br. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jaad.2016.02.1220","article-title":"Dietary Glycemic Factors, Insulin Resistance, and Adiponectin Levels in Acne Vulgaris","volume":"75","author":"Altunay","year":"2016","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_10","first-page":"281","article-title":"Insulin Resistance in Severe Acne Vulgaris","volume":"32","author":"Cengiz","year":"2015","journal-title":"Postep. Dermatol. I Alergol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13098-018-0311-z","article-title":"Metabolic Syndrome and the Skin: A More than Superficial Association. Reviewing the Association between Skin Diseases and Metabolic Syndrome and a Clinical Decision Algorithm for high Risk Patients","volume":"10","author":"Stefanadi","year":"2018","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3066","DOI":"10.1161\/CIRCULATIONAHA.105.539528","article-title":"Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus","volume":"112","author":"Wilson","year":"2005","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kassi, E., Pervanidou, P., Kaltsas, G., and Chrousos, G. (2011). Metabolic Syndrome: Definitions and Controversies. BMC Med., 9.","DOI":"10.1186\/1741-7015-9-48"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4103\/0019-5154.113950","article-title":"Garima Metabolic Syndrome and Skin: Psoriasis and Beyond","volume":"58","author":"Padhi","year":"2013","journal-title":"Indian J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"479354","DOI":"10.1155\/2015\/479354","article-title":"Insulin Resistance and Skin Diseases","volume":"2015","author":"Napolitano","year":"2015","journal-title":"Sci. World J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.clindermatol.2017.09.006","article-title":"Acne Vulgaris: The Metabolic Syndrome of the Pilosebaceous Follicle","volume":"36","author":"Melnik","year":"2018","journal-title":"Clin. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1007\/BF03343905","article-title":"Skin Disorders and Thyroid Diseases","volume":"24","author":"Niepomniszcze","year":"2001","journal-title":"J. Endocrinol. Investig."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/j.1468-3083.2011.04084.x","article-title":"Association of Thyroid Autoimmunity with Acne in Adult Women","volume":"26","author":"Vergou","year":"2012","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1038\/jid.2013.438","article-title":"IL-1\u03b2 Drives Inflammatory Responses to Propionibacterium Acnes in Vitro and in Vivo","volume":"134","author":"Kistowska","year":"2014","journal-title":"J. Investig. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5754","DOI":"10.1038\/s41598-020-62715-3","article-title":"Systematic Review of the Epidemiology of Acne Vulgaris","volume":"10","author":"Heng","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"174936","DOI":"10.1016\/j.ejphar.2022.174936","article-title":"Non-Conventional Therapeutical Approaches to Acne Vulgaris Related to Its Association with Metabolic Disorders","volume":"923","author":"Bungau","year":"2022","journal-title":"Eur. J. Pharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1440-0960.1997.tb01126.x","article-title":"Descriptive Epidemiology of Acne Vulgaris in the Community","volume":"38","author":"Stathakis","year":"1997","journal-title":"Australas. J. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bungau, A.F., Radu, A.F., Bungau, S.G., Vesa, C.M., Tit, D.M., and Endres, L.M. (2023). Oxidative Stress and Metabolic Syndrome in Acne Vulgaris: Pathogenetic Connections and Potential Role of Dietary Supplements and Phytochemicals. Biomed. Pharmacother., 164.","DOI":"10.1016\/j.biopha.2023.115003"},{"key":"ref_24","first-page":"585","article-title":"Specificity of acne in women older than 25 years","volume":"37","year":"2008","journal-title":"Press. Medicale"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1111\/jdv.12757","article-title":"Large-Scale International Study Enhances Understanding of an Emerging Acne Population: Adult Females","volume":"29","author":"Thiboutot","year":"2015","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0001-7310(09)70054-7","article-title":"Management of Acne in Women Over 25 Years of Age","volume":"100","author":"Rivera","year":"2009","journal-title":"Actas Dermosifiliogr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1111\/jdv.12160","article-title":"The Prevalence and Risk Factors of Adolescent Acne among Schoolchildren in Lithuania: A Cross-Sectional Study","volume":"28","author":"Karciauskiene","year":"2014","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1248\/jhs.53.596","article-title":"The Relationship between Blood Lipids Profile and Acne","volume":"53","year":"2007","journal-title":"J. Health Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Endres, L., Tit, D.M., Bungau, S., Pascalau, N.A., Maghiar \u021aodan, L., Bimbo-Szuhai, E., Iancu, G.M., and Negrut, N. (2021). Incidence and Clinical Implications of Autoimmune Thyroiditis in the Development of Acne in Young Patients. Diagnostics, 11.","DOI":"10.3390\/diagnostics11050794"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jaad.2007.06.045","article-title":"The Prevalence of Acne in Adults 20 Years and Older","volume":"58","author":"Collier","year":"2008","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_31","first-page":"e9277","article-title":"Epidemiology of Acne Vulgaris and Its Association with Lifestyle Among Adolescents and Young Adults in Hail, Kingdom of Saudi Arabia: A Community-Based Study","volume":"12","author":"Alshammrie","year":"2020","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.ygeno.2018.06.005","article-title":"Genetic Variants of Resistin and Its Plasma Levels: Association with Obesity and Dyslipidemia Related to Type 2 Diabetes Susceptibility","volume":"111","author":"Rathwa","year":"2019","journal-title":"Genomics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s11154-020-09545-w","article-title":"Type 2 Diabetes\u2014Unmet Need, Unresolved Pathogenesis, MTORC1-Centric Paradigm","volume":"21","year":"2020","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e149271","DOI":"10.1172\/jci.insight.149271","article-title":"Placental MTOR Complex 1 Regulates Fetal Programming of Obesity and Insulin Resistance in Mice","volume":"6","author":"Akhaphong","year":"2021","journal-title":"JCI Insight"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.2147\/CCID.S392165","article-title":"Acne Comorbidities","volume":"15","author":"Wang","year":"2022","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1111\/ced.12686","article-title":"Epidemiology and Risk Factors of Childhood Acne in Korea: A Cross-Sectional Community Based Study","volume":"40","author":"Park","year":"2015","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.jaad.2018.12.070","article-title":"Skin Changes in the Obese Patient","volume":"81","author":"Hirt","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"223","DOI":"10.4103\/ijd.IJD_321_20","article-title":"Metabolic Status, Obesity, and Quality of Life in Patients with Acne Vulgaris: A Cross-Sectional Case-Control Study","volume":"66","author":"Podder","year":"2021","journal-title":"Indian J. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1001\/jamadermatol.2015.4499","article-title":"Insulin Resistance and Metabolic Syndrome in Young Men with Acne","volume":"152","author":"Nagpal","year":"2016","journal-title":"JAMA Dermatol."},{"key":"ref_40","first-page":"353","article-title":"Association between Isolated Female Acne and Insulin Resistance: A Prospective Study","volume":"151","author":"Kartal","year":"2016","journal-title":"G. Ital. Dermatol. Venereol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"222","DOI":"10.33314\/jnhrc.v16i2.1178","article-title":"Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal","volume":"16","author":"Shrestha","year":"2018","journal-title":"J. Nepal Health Res. Counc."},{"key":"ref_42","first-page":"449","article-title":"Study of Lipid Profile in Adult Women with Acne","volume":"8","author":"Batista","year":"2015","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.clindermatol.2017.09.004","article-title":"Pathophysiology of the Metabolic Syndrome","volume":"36","author":"McCracken","year":"2018","journal-title":"Clin. Dermatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/ijd.12426","article-title":"Insulin Resistance in Patients with Post-Adolescent Acne","volume":"54","author":"Balta","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/1523-1747.ep12676782","article-title":"The Control and Measurement of Sebum Secretion","volume":"62","author":"Shuster","year":"1974","journal-title":"J. Investig. Dermatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1677\/joe.0.0480083","article-title":"The Effects of Thyrotrophic Hormone and of Thyroxine on the Response of the Sebaceous Glands of the Rat to Testosterone","volume":"48","author":"Ebling","year":"1970","journal-title":"J. Endocrinol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1111\/ijd.12547","article-title":"Assessment of Thyroid Function and Lipid Profile in Patients with Postadolescent Acne in a Mediterranean Population from Turkey","volume":"54","author":"Ekiz","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s00105-016-3840-0","article-title":"Severe acne in autoinflammatory diseases","volume":"67","author":"Faleri","year":"2016","journal-title":"Hautarzt"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"255","DOI":"10.4161\/derm.3.4.17066","article-title":"Idiopathic Chronic Urticaria and Thyroid Autoimmunity: Experience of a Single Center","volume":"3","author":"Nuzzo","year":"2011","journal-title":"Dermatoendocrinology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1242\/dmm.001180","article-title":"A Comprehensive Definition for Metabolic Syndrome","volume":"2","author":"Huang","year":"2009","journal-title":"Dis. Model. Mech."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/BF03346497","article-title":"Prevalence of Metabolic Syndrome in Galicia (NW Spain) on Four Alternative Definitions and Association with Insulin Resistance","volume":"32","author":"Botana","year":"2009","journal-title":"J. Endocrinol. Investig."},{"key":"ref_52","first-page":"E1082","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"139","author":"Grundy","year":"2019","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.2337\/dc23-S002","article-title":"Classification and Diagnosis of Diabetes: Standards of Care in Diabetes\u20142023","volume":"46","author":"Elsayed","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1093\/ajcn\/72.3.694","article-title":"Healthy Percentage Body Fat Ranges: An Approach for Developing Guidelines Based on Body Mass Index","volume":"72","author":"Gallagher","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"521","DOI":"10.3389\/fimmu.2017.00521","article-title":"Thyroid Autoimmunity: Role of Anti-Thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases","volume":"8","author":"Wahl","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1089\/thy.2014.0028","article-title":"Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement","volume":"24","author":"Jonklaas","year":"2014","journal-title":"Thyroid"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for the Management of Arterial HypertensionThe Task Force for the Management of Arterial Hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)","volume":"39","author":"Williams","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/j.1468-3083.2010.03685.x","article-title":"Development and Evaluation of a Global Acne Severity Scale (GEA Scale) Suitable for France and Europe","volume":"25","author":"Poli","year":"2011","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_59","unstructured":"Daniel, W.W. (1999). Biostatistics: A Foundation for Analysis in the Health Sciences, John Wiley & Sons, Ltd.. [7th ed.]."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/2\/721\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:40:56Z","timestamp":1760103656000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/2\/721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,5]]},"references-count":59,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["ijms25020721"],"URL":"https:\/\/doi.org\/10.3390\/ijms25020721","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,5]]}}}