An Acne Survey from the World’s Largest Annual Gathering of Twins

April 2018 | Volume 17 | Issue 4 | Original Article | 380 | Copyright © April 2018

Amanda Suggs MD,a Mathew Loesch DO PhD,b Harib Ezaldein MD,a Luisa Christensen MD,a Danyelle Dawes MD,a and Elma Baron MDa,c

aUniversity Hospitals Cleveland Medical Center, Cleveland, OH bTri County Dermatology, Cuyahoga Falls, OH cLouis Stokes VA Medical Center, Cleveland, OH

IMPORTANCE: Surveying identical twins allows us to qualitatively separate genetic and environmental factors that may contribute to acne severity. OBJECTIVE: To study a cohort of identical and fraternal twins to identify environmental factors that may influence acne severity. DESIGN, SETTING, PARTICIPANTS : A survey was administered to 139 identical and fraternal twin multiples (279 subjects) at the Annual Twins Day Festival in Twinsburg, Ohio on August 6-7, 2016. One set of triplets was included. MAIN OUTCOME(S) AND MEASURE(S): Acne incidence, severity, and triggers were analyzed using the N-1 Chi-squared test and paired, 2-tailed t test. RESULTS: The proportion of concordant pairs was significantly higher in identical (64%) vs fraternal (49%) twins (P=0.04). Acne was found to be associated with polycystic ovarian syndrome (PCOS; P=0.045), anxiety (P =0.014), and asthma (P=0.026). Identical twin pairs with acne had a higher BMI (P= 0.020) and exercised significantly less (P=0.001) than those without acne. Analyzing concordant twin pairs, the twin with more severe acne was more likely to report aggravation of acne with cosmetic product use (P=0.002) and sugar intake (P=0.048). CONCLUSIONS AND REVELANCE: This twin study further supports that there may be a genetic phenotypic link, though social and environmental factors may also have an influence in the disease process.

J Drugs Dermatol. 2018;17(4):380-382.


Identical twins are a unique population of subjects given their similar genetic makeup. Looking at concordant and nonconcordant identical twin pairs can separate genetic and environmental effects of a disease process. Concordant pairs each have the phenotype for a given disease. In nonconcordant pairs, one twin has the phenotype and one does not. The Twins Day Festival in Twinsburg, Ohio is the largest annual gathering of multiples and is an ideal setting for conducting research in twins. Studying twins, Bataille et al found that roughly 80% of the variance of acne disease is attributable to additive genetic effects and the remaining, roughly 20%, is due to unique, unshared environmental factors.1 Environmental factors contributing to acne may include stress,2 milk chocolate consumption,3 low intake of fruits and vegetables,2 and high glycemic load diets.2,4,5 The objective of this study was to support that there is a genetic, phenotypic link to acne and to identify environmental factors that may in uence acne severity.


Study Design

The study was approved by the Institutional Review Board (IRB) at University Hospitals Cleveland Medical Center. The study was conducted at the Twins Day Festival in Twinsburg, Ohio on August 6-7, 2016. Data was analyzed from August 15, 2016 to February 2, 2017. The survey was administered through the REDCap (Research Electronic Data Capture) database. Informed consent was obtained from all study participants. Parental consent was obtained from participants under the age of 18.

Study Participants

A survey was administered to 139 identical and fraternal twin multiples (279 individuals). There was one set of triplets. The metrics surveyed included demographics, medical history, family history, social history, and physical activity. The twins were surveyed regarding acne incidence, age of onset, severity, and triggers. The majority of those surveyed were from the Midwest and Northeast regions of the United States. Height and weight were taken to determine body mass index (BMI).


Data analysis was conducted using excel software (Microsoft Corporation; Redmond, WA). The proportion of concordant pairs, acne associations with other medical conditions, and acne triggers between groups were analyzed using the N-1 Chi-squared test. Comparison of BMI and physical activity