Acne vulgaris is one of the most common chronic inflammatory skin disorders, affecting up to 85–90% of adolescents and young adults worldwide at some stage of their life [1]. It involves a complex interplay between hormonal changes, sebaceous gland hyperactivity, follicular hyperkeratinization, proliferation of Cutibacterium acnes, and inflammation of the pilosebaceous unit [2]. Although traditionally viewed as a self-limiting cosmetic concern, acne exerts a significant psychosocial burden, leading to anxiety, low self-esteem, and social withdrawal, particularly among young adults navigating academic and social transitions [3]. The prevalence of acne among university populations, including medical and allied health students, underscores the need to evaluate their understanding and management behaviors toward the condition. Effective management of acne requires a rational and evidence-based therapeutic approach, incorporating topical retinoids, benzoyl peroxide, antibiotics, and, in more severe cases, hormonal or systemic agents [4]. However, inappropriate use of these medications—often through self-medication—can result in adverse outcomes such as antimicrobial resistance, post-inflammatory hyperpigmentation, and steroid-induced dermatitis. The World Health Organization defines self-medication as the selection and use of medicines by individuals to treat self-recognized illnesses without professional supervision. While responsible self-care has a place in primary health, unregulated self-medication can lead to incorrect diagnosis, inappropriate drug selection, drug interactions, masking of underlying diseases, and misuse of antibiotics [5]. The psychosocial burden of acne often deters young adults from seeking professional care, either due to embarrassment or the misconception that acne is a trivial condition. The widespread influence of digital media further promotes unverified home remedies and cosmetic products through influencers and online forums, fostering self-diagnosis and irrational self-treatment. Such practices can aggravate acne, delay appropriate therapy, and contribute to antibiotic misuse. In India, the easy over-the-counter availability of potent corticosteroid and antibiotic combination creams (e.g., clobetasol with fusidic acid) compounds the problem, leading to steroid-modified acne and antimicrobial resistance. As future healthcare professionals, health-science students form a pivotal group whose awareness and behaviors can shape both personal health outcomes and future patient practices [6,7]. Therefore, assessing their level of awareness, attitudes, and self-medication behaviors toward acne treatment is essential for developing effective educational modules and preventive strategies. Understanding these parameters among medical, dental, nursing, and paramedical students can highlight existing knowledge gaps, reveal behavioral trends, and inform curriculum-based interventions promoting rational drug use. Hence, this study was undertaken to evaluate the awareness, attitudes, and self-medication practices regarding acne and its management among health-science students in a tertiary-care university setting.

Study Design and Setting A descriptive cross-sectional study was conducted in department of dermatology, SVS, Medical College & Hospital among undergraduate students enrolled in medical, dental, nursing, and paramedical colleges under SVS Educational Society, Mahabubnagar, Telangana. The study was carried out over a period of six months, from January to June 2019, after obtaining approval from the Institutional Ethics Committee. Participation was voluntary, and informed consent was obtained from all participants prior to data collection. Study Population The study population included students of all academic years and both genders pursuing undergraduate courses in Medicine (MBBS), Dentistry (BDS), Nursing (B.Sc/GNM), and Paramedical sciences (Medical Laboratory Technology, and Allied Health Sciences). Students who were absent during data collection or who declined consent were excluded. Sample Size Calculation The sample size for this cross-sectional study was estimated using the standard formula for a single population proportion: n=(Z^2×p×(1-p))/d^2 Where n= required sample size, z=standard normal deviate for a 95% confidence level (1.96), p= anticipated prevalence of the outcome, and d= desired absolute precision (margin of error). Based on the study by Raikar and Manthale [8], which reported a 77.4% prevalence of self-medication for acne among Indian undergraduate medical students, the following values were used:p=0.774, 1-p=0.226, and d=0.05. Substituting these values: n=((1.96)^2×0.774×(1-0.774))/((0.05)^2 )=(3.8416×0.1749)/(0.0025)=268.8 Hence, the minimum required sample size was approximately 269 participants. However, a total of 284 completed questionnaires were analyzed to enhance the representativeness of the study. Sampling Technique A stratified random sampling technique was employed. Each professional course (medical, dental, nursing, and paramedical) was considered a stratum, and proportional allocation was used to ensure adequate representation from each group. Within each stratum, simple random sampling was used to select participants across different academic years. Data Collection Tool A pre-tested, semi-structured, self-administered questionnaire was used to collect data. The questionnaire was developed after reviewing similar validated tools from previous studies [9-11]. It comprised four sections: Sociodemographic details (age, gender, academic course, and year of study) Awareness regarding acne and its management (causes, treatment options, use of prescription vs. over-the-counter medications) Attitudes toward acne and acne medications (beliefs about acne being a medical condition, perceived stigma, and preference for professional consultation) Self-medication practices (type of drugs used, source of information, frequency, and adverse effects). The questionnaire was validated by a panel of dermatologists and pharmacologists for content validity (CVI = 0.91) and pilot-tested on 30 students to assess reliability (Cronbach’s α = 0.83). Data from the pilot study were not included in the final analysis. Data Collection Procedure Participants were approached in classrooms after prior permission from institutional authorities. The purpose of the study was explained, and confidentiality was assured. Students were requested to complete the questionnaire anonymously within 15–20 minutes. Completed forms were collected immediately to minimize information bias. Operational Definitions Awareness was defined as correct knowledge of acne etiology, treatment options, and possible adverse effects of self-medication. Self-medication referred to the use of any allopathic or alternative medication for acne without consulting a registered medical practitioner. Positive attitude was defined as agreeing with statements supporting evidence-based treatment and discouraging self-medication. Data Management and Statistical Analysis Collected data were coded and entered into Microsoft Excel and analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (frequency, percentage, mean ± SD) were calculated for sociodemographic variables and responses. Associations between categorical variables (e.g., gender, course of study, year) and self-medication practices were assessed using the Chi-square test. A p-value < 0.05 was considered statistically significant. Subgroup analysis compared awareness and attitudes between medical and non-medical streams to identify educational gaps influencing self-medication behaviors. Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee. Participation was voluntary, and informed consent was obtained from all participants. No personal identifiers were recorded, and data confidentiality was maintained throughout the study.

Sociodemographic Characteristics (Table 1) A total of 284 students participated in the study, comprising medical (n=84; 29.6%), dental (n=72; 25.4%), nursing (n=68; 23.9%), and paramedical (n=60; 21.1%) students. The mean age of participants was 20.9 ± 1.8 years (range: 18–25 years). Females constituted 62.7% (n=178) and males 37.3% (n=106) of the sample. Distribution across years of study was fairly uniform, with first-year (25.7%), second-year (22.5%), third-year (25.0%), and final-year students (26.8%). Table 1. Sociodemographic profile of participants (N = 284) Variable Category Frequency (n) Percentage (%) Gender Male 106 37.3 Female 178 62.7 Age (years) 18–20 118 41.5 21–23 132 46.5 >23 34 12.0 Course Medical 84 29.6 Dental 72 25.4 Nursing 68 23.9 Paramedical 60 21.1 Year of study I year 73 25.7 II year 64 22.5 III year 71 25.0 IV year / Interns 76 26.8 Awareness Regarding Acne and Its Treatment (Table 2) Overall, 79.9% of students were aware that acne is a medical condition caused by multifactorial etiologies such as hormonal imbalance and poor hygiene, while 20.1% believed it to be primarily a cosmetic issue. Antibiotics (56.0%), topical retinoids (48.6%), and benzoyl peroxide (42.6%) were the most recognized evidence-based treatments. Only 38.0% knew that overuse of topical steroids can aggravate acne, and just 32.4% were aware of antibiotic resistance due to unsupervised use. Table 2. Awareness regarding acne and its treatment (N = 284) Awareness Parameter Correct Response (%) Incorrect/Unsure (%) Acne is a medical condition 79.9 20.1 Hormonal imbalance contributes to acne 82.0 18.0 Poor facial hygiene is the main cause 64.8 35.2 Topical antibiotics are standard therapy 56.0 44.0 Retinoids are used for comedonal acne 48.6 51.4 Overuse of steroids worsens acne 38.0 62.0 Antibiotic misuse causes resistance 32.4 67.6 Attitudes Toward Acne and Its Management (Table 3) A majority (68.7%) of participants agreed that acne negatively affected their self-confidence, while 42.6% reported social embarrassment. When asked about preferred treatment-seeking behavior, 53.5% stated they would first consult a dermatologist, 27.1% would consult a general practitioner, and 19.4% preferred self-medication. Nearly 61.3% agreed that online sources influence their treatment choices, and 48.9% considered home remedies to be safer than pharmacological treatments. Table 3. Attitudes toward acne management (N = 284) Attitude Statement Agree (%) Neutral (%) Disagree (%) Acne affects self-confidence 68.7 14.8 16.5 Social embarrassment due to acne 42.6 24.3 33.1 Prefer dermatologist consultation 53.5 20.4 26.1 Prefer self-medication for mild acne 19.4 21.1 59.5 Believe herbal/home remedies safer 48.9 27.1 24.0 Online content influences choice 61.3 20.1 18.6 Figure 1 shows a stacked bar chart comparing students’ attitudes toward acne treatment across different disciplines. Medical and dental students demonstrated a greater inclination to consult a dermatologist (approximately 60–62%), whereas nursing and paramedical students exhibited a higher preference for self-medication (about 25–30%). Medical and dental students showed significantly higher inclination for dermatologist consultation compared to nursing and paramedical students (p < 0.05). Self-Medication Practices (Table 4) Out of 284 participants, 124 (43.7%) reported self-medication for acne in the past 12 months. Self-medication was most common among dental students (52.8%), followed by medical (46.4%), nursing (38.2%), and paramedical students (35.0%) (p = 0.041). Commonly self-administered medications included topical antibiotics (37.9%), steroid creams (29.0%), herbal preparations (24.2%), and oral antibiotics (20.2%). The primary sources of information were social media (45.2%), peers (26.6%), and pharmacists (17.7%). Only 11.3% of self-medicating students reported any adverse effect (mostly irritation and peeling). Table 4. Self-medication patterns among students (N = 284) Variable Category Frequency (n) Percentage (%) Used self-medication Yes 124 43.7 No 160 56.3 Most common agents used Topical antibiotics 47 37.9 Topical steroids 36 29.0 Herbal/home remedies 30 24.2 Oral antibiotics 25 20.2 Source of information Social media 56 45.2 Peers 33 26.6 Pharmacist 22 17.7 Family 13 10.5 Reported side effects Yes 14 11.3 No 110 88.7 Association between Awareness, Attitude, and Self-Medication (Table 5) Participants with high awareness (≥70%) had the lowest prevalence of self-medication (33.8%), while those with moderate (50–69%) and low (<50%) awareness demonstrated progressively higher self-medication rates (43.2% and 59.3%, respectively). The association between awareness level and self-medication practice was found to be statistically significant (χ² = 12.6; p = 0.001). Table 5. Association between awareness and self-medication practice Awareness Level Practiced Self-Medication (%) p-value High (≥70%) 33.8 0.002 Moderate (50–69%) 43.2 Low (<50%) 59.3 Overall Awareness–Attitude–Practice (AAP) Score (Table 6) Composite scoring was performed (0–10 scale each). Mean awareness score was 6.4 ± 1.7, mean attitude score 7.1 ± 1.5, and mean practice score 4.2 ± 1.9. Pearson’s correlation analysis revealed a significant negative correlation between awareness and practice scores (r = –0.42, p < 0.001), indicating that higher awareness corresponded to lower self-medication. Table 6. Correlation between awareness, attitude, and practice scores (N = 284) Variables Correlated Correlation Coefficient (r) p-value Interpretation Awareness vs. Practice –0.42 <0.001 Moderate negative correlation Awareness vs. Attitude +0.48 <0.001 Moderate positive correlation Attitude vs. Practice –0.36 <0.001 Negative correlation

The present cross-sectional study explored awareness, attitudes, and self-medication practices regarding acne treatment among undergraduate medical, dental, nursing, and paramedical students. Although the majority recognized acne as a medical condition, misconceptions persisted about causation, treatment, and the safety of unsupervised drug use. Nearly half reported self-medicating for acne, reflecting an important gap between knowledge and behavior. Approximately 80% of respondents correctly identified acne as a multifactorial dermatological condition, consistent with findings from previous studies conducted in Saudi Arabia where awareness levels among university students ranged between 70% [12],whereas in India 85% of students implicated diet as a cause and 65% cited puberty—indicating awareness of multiple contributing factors [13]. Despite this general awareness, detailed understanding of first-line therapeutic agents was suboptimal — less than half of the participants could correctly identify topical retinoids or benzoyl peroxide as standard first-line treatments. Comparable patterns have also been recorded in Saudi Arabian health‐science students where over 52.4% practiced self‐medication for acne, suggesting limited therapeutic knowledge despite awareness, indicating persistent educational gaps in translating theoretical knowledge into rational practice [14]. The lack of awareness regarding antibiotic resistance is concerning. Only one-third of our participants recognized that inappropriate antibiotic use could worsen resistance. Cutibacterium acnes resistance to macrolides and tetracyclines is a growing global problem, with rates exceeding 50% in certain region [15]. The Global Alliance for the Improvement of Acne Outcomes recommends restricting antibiotics to ≤12 weeks and combining them with non-antibiotic topical therapy to minimize resistance [4]. Despite this, over-the-counter access and misconceptions continue to drive misuse, particularly among youth. The psychosocial impact of acne was clearly evident; nearly 70% reported reduced self-confidence. This aligns with international evidence showing that acne substantially impairs self-esteem and quality of life, comparable to chronic diseases such as asthma or diabetes [1, 3]. Emotional distress often motivates individuals to pursue rapid cosmetic relief rather than medical consultation. Although more than half of respondents expressed willingness to consult a dermatologist, a substantial proportion of students believed herbal or home remedies were safer than prescription drugs More than 60% of participants reported relying on online and social-media platforms as their main source of acne-related information. The influence of digital media and online creators has significantly reshaped public perceptions of dermatologic care. Such findings emphasize that even health-science students—despite their educational background—remain susceptible to misinformation online, reinforcing the importance of digital-health literacy training within university curricula to foster critical appraisal of online health information. The most commonly misused agents were topical antibiotics and steroid-containing creams—similar to findings from multicentric Indian surveys showing widespread steroid misuse for acne and pigmentation disorders [16]. Over-the-counter sales of potent corticosteroid combinations (e.g., clobetasol, betamethasone) remain inadequately regulated in India despite Schedule H restriction [17]. Dental and medical students reported higher self-medication than nursing or paramedical peers, possibly reflecting greater pharmacological familiarity and access. This paradox—high knowledge yet high self-use—has also been observed among pharmacy students in Croatia and Turkey [18,19]. Academic confidence, peer influence, and limited time for consultations often reinforce such behavior. The main information sources for self-medication were social media and peers rather than pharmacists or clinicians, paralleling trends seen among Nigerian students [20]. Reliance on informal networks highlights the urgency for educational campaigns emphasizing rational drug use and pharmacist-guided counseling. Statistical analysis demonstrated that poor awareness was strongly associated with self-medication (p = 0.002). Students scoring below 50% on knowledge items were nearly twice as likely to self-medicate. Furthermore, negative attitudes—such as believing self-medication is harmless—correlated with higher practice scores. These findings support the Awareness-Attitude-Practice (AAP) behavioral model, which posits that knowledge influences beliefs that ultimately shape behavior [21]. Similar AAP linkages have been observed in studies on antibiotic use among healthcare students, where inadequate awareness translated to irrational prescribing or consumption patterns. In our context, improved awareness about acne etiology, treatment hierarchy, and drug safety could potentially mitigate harmful self-medication. In this study, senior-year students showed slightly higher awareness but paradoxically higher self-treatment, perhaps reflecting overconfidence and easier access to medications through clinical exposure—a pattern documented among Slovenian and Turkish health students as well [19,22]. The observed trends underscore the need for structured dermatologic education and rational-drug-use modules within undergraduate curricula. Integrating interactive teaching on acne management, antibiotic resistance, and corticosteroid misuse could foster better attitudes. Moreover, regulation of non-prescription corticosteroid and antibiotic sales must be strengthened. Digital-health literacy also deserves attention. With most students obtaining acne information online, integrating critical appraisal skills into curricula can help future clinicians evaluate online content. Studies show that interventions teaching students to assess health information credibility significantly improve discernment of misinformation [23]. Strengths and Limitations This study’s strengths include its multi-disciplinary sampling design covering four health-science faculties and use of a validated questionnaire with high internal consistency. However, it relied on self-reported data, introducing potential recall and desirability biases. Being single-centered, results may not fully represent all Indian universities. Additionally, the study did not explore knowledge depth regarding non-allopathic products or the influence of advertisements, which future mixed-methods research could address. Future Research Longitudinal and interventional studies are warranted to evaluate how educational reforms or awareness campaigns influence acne-related behaviors. Exploring the role of community pharmacists and online vendors in self-medication could also inform regulatory policies. Integrating dermatologic literacy within community-oriented programs might reduce self-treatment not only among students but also the general population.

In conclusion, although most students were aware that acne is a medical condition, significant gaps persisted regarding evidence-based therapy, antibiotic resistance, and risks of steroid misuse. Nearly half practiced self-medication, driven by online influence and peer advice. Higher awareness and positive attitudes correlated with reduced self-medication, emphasizing the need for targeted educational and regulatory strategies. Developing structured dermatology modules, reinforcing pharmacy regulations, and promoting digital-health literacy are essential to curb irrational self-medication and ensure safe acne management among future healthcare professionals.

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