Lower Facial Skin Hydration Is Associated with Greater Acne Vulgaris Severity in Indonesian University Students: A Cross-Sectional Study

Abstract

Introduction: Acne vulgaris is increasingly recognized as a skin-barrier disease, yet data linking facial hydration to graded severity in tropical Asian young adults are scarce. This study aimed to determine the association between facial skin hydration and acne vulgaris severity in Indonesian university students.

Methods: In this cross-sectional analytic study, 33 students aged 17–25 years with acne vulgaris were enrolled by purposive sampling at a Surabaya dermatology clinic. Facial stratum corneum hydration was measured by capacitance and classed as dry (<35%), normal (35–50%) or moist (>50%); severity was graded by the Lehmann/Indonesian Acne Expert Meeting criteria. Associations were tested with chi-square, odds ratios, Spearman correlation, multivariable logistic regression and receiver-operating-characteristic (ROC) analysis.

Results: Participants were predominantly female (69.7%); 54.5% had dry skin and 60.6% had moderate acne, with no severe cases. Lower hydration was significantly associated with greater severity (χ²=9.641, p=0.008; Cramér’s V=0.541). Dry skin conferred ten-fold higher odds of moderate acne (OR=10.00, 95% CI 1.94–51.54), and each 10% reduction in moisture independently raised the odds (adjusted OR=3.87, 95% CI 1.39–10.72, p=0.009). Facial moisture discriminated moderate acne well (AUC=0.792; Spearman ρ=−0.536, p=0.001).

Conclusion: Lower facial hydration is independently associated with more severe acne, supporting barrier-directed, non-comedogenic moisturization as an adjunct in acne care for Fitzpatrick III–V skin.