청소년기 여드름의 임상양상과 피부건강행위

Abstract

사춘기를 보내고 있는 청소년들은 외모뿐만 아니라 깨끗한 피부를 유지 하고 관리하는데 많은 신경을 쓰고 있으며 이러한 청소년들이 가장 고민하고 스트레스를 받고 있는 대표적인 피부질환은 여드름이다. 본 연구는 남녀 고등학생의 여드름의 피부상태 및 여드름의 발생특성, 자극인자 등 여드름의 임상양상과 평상시 태도, 관리실태 등 피부건강행위를 비교, 파악하고 피부상태와 여드름정도와의 상관성, 가족력유무에 따른 여드름 발생특성 및 피부상태를 분석함으로써 청소년시기에 올바른 여드름 관리를 유도하고 차후 여드름으로 인한 문제를 예방하기 위한 기초자료를 제공하고자 하였다. 이를 위하여 현재 여드름이 있는 남녀 고등학생 352명(남학생 167명, 여학생 185명)을 대상으로 일반사항, 피부상태, 여드름 발생특성, 자극인자, 여드름에 대한 평상시 태도, 여드름 관리실태 등을 조사 분석하였으며, 자료수집 기간은 2006년 3월 20일부터 5일간 실시하였다. 자료수집방법은 5년 이상의 경력을 가진 피부미용전문인 6명을 선정하여 설문내용을 교육한 후 서울시에 위치한 남녀 고등학교를 직접 방문하여 면접식 설문조사를 실시하였으며 자료의 분석은 SPSS 12.0 프로그램으로 (Chi-Square test), t검정, Cronbach's alpha를 사용하였다. 연구결과 다음과 같은 결론을 얻었다. 첫째, 일반적인 특성으로 남녀 고등학생의 2차 성징시기에 있어서 남학생 13.75세, 여학생 12.90세로 여학생이 남학생보다 빨랐으며 유의적인 차이가 있었다(p<0.001). 또한 여드름 초발연령은 남학생이 14.02세, 여학생이 13.78세로 나타났으나 유의적인 차이는 없었다. 둘째, 남녀 고등학생의 여드름 피부상태에 있어서는 남학생은 ‘항상 번들거림’이 22.2%, ‘적당히 윤기있음’이 61.7%로 나타났고, 여학생은 ‘항상 번들거림’이 21.1%, ‘적당히 윤기있음’이 47%로 남학생이 여학생에 비해 유분상태가 통계학적으로 유의하게 높게 나타났고(p<0.01), 수분상태는 ‘세안 후 많이 당김’이 남학생 18.6%, 여학생 34.6%로 나타나 여학생이 남학생보다 수분상태가 부족한 것으로 조사되었으며 통계적으로 유의한 차이가 있었다(p<0.001). 셋째, 남녀 고등학생의 여드름 발생특성 중 발생부위에 있어서는 남학생이 이마 29.8%, 볼 22%, 입과 턱 주위 12.9%, 코 주위 15.8%, 등과 가슴 10.3%, 머릿속(두피) 5%, 목 4.3%로 나타났고, 여학생은 이마 38.9%, 볼 20.3%, 입과 턱 주위 12.8%, 코 주위 3.9%, 등과 가슴 16.7%, 머릿속(두피) 4.4%, 목 3.1%로 나타났다. 남녀학생 전체에서는 이마 34%, 볼 21.2% 순으로 조사되었고, 코 주위에는 남학생이, 등과 가슴에는 여학생이 여드름 발생율이 높았으며 통계학적으로 유의한 차이가 있었다(p<0.001). 또한 여드름의 정도는 남녀 학생간 유의적인 차이가 없었다. 가족력은 어머니 21.3%, 아버지 19.3%, 형제, 자매 33.7%로 74.3%가 가족력이 있는 것으로 조사되었으나 남녀 학생간 통계학적으로 유의한 차이는 없었다. 여드름의 흉터유무는 남학생 53.3%, 여학생 65.9%가 흉터가 있는 것으로 나타나 여학생이 남학생보다 유의적으로 흉터가 많은 것으로 조사되었다(p<0.05). 넷째, 피부상태와 여드름의 정도와의 상관성에 있어서 유분상태에 따른 여드름의 정도는 유분정도가 적으면 여드름의 grade도 낮았고 유분정도가 많으면 여드름의 grade도 높게 나타나 여드름과 유분과의 밀접한 관계를 알 수 있었으며 통계학적으로 유의적인 차이가 있었다(p<0.001). 수분상태에 따른 여드름의 정도는 수분Ⅰ, 수분Ⅱ, 수분Ⅲ군 간에 통계학적으로 유의한 차이가 없었으며, 예민상태에 따른 여드름의 정도에서는 예민군이 비예민군보다 여드름 grade가 높게 나타나 여드름과 예민정도와의 상관관계를 알 수 있었으나 유의적인 차이는 없었다. 다섯째, 가족력유무에 따른 피부상태는 유분상태만이 통계학적으로 유의한 차이가 있었으며, 가족력이 있는 경우는 유분상태가 유의적으로 높게 조사되었다(p<0.05). 가족력유무에 따른 수분상태와 예민상태는 통계학적으로 유의한 차이가 없었다. 여섯째, 남녀 고등학생의 여드름을 자극하는 인자 중에서 악화계절은 ‘상관없다’ 52.6%로 남녀학생 모두에게 가장 높았으며, 여름, 겨울이 각각 36.9%, 31.5%로 조사되어 남녀학생에게서 많은 차이는 없었으며 통계학적으로 유의한 차이가 있었다(p<0.05). 스트레스로 인해 여드름이 심해지는지에 대한 질문에는 ‘많이 심해짐’이 남학생, 여학생이 각각 7.2%, 23.2%로 여학생이 남학생보다 스트레스로 인한 여드름 발생 비율이 통계학적으로 유의하게 높았고(p<0.001), 헤어제품(무스, 스프레이)은 ‘약간 심해짐’이 남학생, 여학생이 각각 31.7%, 13.0%로 남학생이 현저히 높았으며(p<0.001), 모자와 두건의 경우는 ‘약간 심해짐’이 남학생, 여학생이 각각 27.5%, 37.3%로 여학생이 남학생보다 통계학적으로 유의하게 높았다(p<0.05). 일곱째, 남녀 고등학생의 여드름에 대한 평상시 태도에 있어서는 ‘그렇다’로 응답한 비율은 남학생과 여학생이 각각 ‘얼굴에 손을 가져가지 않는다’는 13.8%, 5.4%(p<0.01), ‘매일 머리를 감는다’는 68.3%, 42.7%(p<0.001), ‘스트레스를 해소하려고 노력한다’ 17.4%, 7%(p<0.001), ‘음식을 조절하려고 노력한다’는 11.4%, 8.6%(p<0.05)로 유의적으로 남학생이 여학생보다 높게 나타났고, ‘여드름에 대한 TV프로나 잡지를 주의 깊게 보는 편이다’는 남학생 9.6%, 여학생 21.6%로 여학생이 남학생보다 통계학적으로 유의하게 높게 나타났으며(p<0,001), 평상시 태도를 점수화한 결과 30점 만점에서 남학생 18.49, 여학생 17.57로 나타나 남학생이 여학생보다 유의적으로 높게 나타났다(p<0.05). 여드름 치료방법으로는 여드름비누가 남학생, 여학생 각각 여드름 33.5%, 31.1%로 가장 높았으며, 그 다음으로 남학생은 짜내는 치료가 21.2%, 여학생은 화장품이 22.8%, 연고가 22.8%로 나타났으며 통계학적으로 유의한 차이가 있었다(p<0.05). 여드름의 자가 관리행위에서 혼자 짜본 경험은 남학생, 여학생이 각각 82.6%, 90.8%로 여학생이 남학생보다 많았고, 짜는 방법은 ‘손으로 짠다’ 와 ‘손톱으로 긁는다’가 남학생 68.8%, 13%, 여학생 58.9%, 10.7%로 올바르지 않은 방법으로 짜는 경우는 남학생에게 많았으며, ‘면봉과 솜으로 짠다’는 남학생, 여학생이 각각 11.6%, 29.2%로 제대로 짜는 경우는 여학생이 남학생보다 많은 것으로 조사되었으며 통계학적으로 유의한 차이가 있었다(p<0.001). 그러나 짠 후의 상태는 ‘흉터 남음’ 이 남학생, 여학생이 각각 33.3%, 48.2%로 유의적으로 여학생이 남학생보다 흉터가 많이 남는 것으로 조사되었다(p<0.05). 여드름 지식습득의 경로는 남녀학생에게 가족이나 친구가 36.5%, 인터넷이 24.9%, TV, 라디오가 17.8%의 순으로 통계학적으로 유의하게 나타났다(p<0.001). 이상의 결과로 2차 성징과 여드름 초발연령은 여학생이 빨랐고, 남학생은 여학생에 비해 유분과 수분이 많았으며, 중증도 이상의 여드름의 비율이 여학생보다 높았다. 또한 가족력이 있는 군에서 가족력이 없는 군보다 유분상태가 높게 나타났고, 유분의 정도가 많을수록 여드름의 grade도 높게 나타나 여드름과 유분상태와의 밀접한 상관관계를 알 수 있었다. 여드름 자극인자 중에서는 스트레스, 모자와 두건은 여학생이 남학생보다 높았고, 헤어제품은 남학생이 여학생보다 높게 나타났다. 여드름을 짜본 경험은 여학생이 높았으며, 짜는 방법은 여학생이 솜과 면봉과 같은 올바른 도구를 사용하여 여드름을 추출하였으나 흉터의 경우 여학생이 남학생보다 더 많은 것으로 조사되어 올바른 도구를 사용하여도 제대로 짜지 않는 것을 알 수 있었다. 따라서 가족력 등 선천적인 인자는 바꿀 수 없지만 자극인자나 평상시 태도 등 후천적인 인자를 바꾸는 것은 가능하므로 후천적인 인자를 바꾸는 노력을 해야 할 것이다. 그러기 위해서는 여드름의 발생원인과 악화원인, 치료방법 등을 정확히 알고 예방하고 관리하여야 할 것이며 특히 전문가들의 올바른 교육과 조언이 청소년 시기부터 적절히 이루어 질 수 있도록 해야 할 것이다.|Adolescents in their puberty are very sensitive not only to their appearance but also to the care and management of clean skin, and pimple is one of representative skin diseases that trouble and stress adolescents. The present study purposed to help adolescents manage pimple properly and provide basic materials for preventing problems caused by pimple by comparing the clinical patterns of pimple such as pimpled skin condition and the characteristics of pimple occurrence and skin health behaviors such as attitude at ordinary times and pimple management in male and female high school students, and analyzing the correlation between skin condition and the grade of pimple, and the characteristics of pimple occurrence and skin condition according to family history. For this purpose, we conducted a survey of 352 male and female high school students who were currently pimpled (167 male students and 185 female ones) concerning general characteristics, skin condition, the characteristics of pimple occurrence, stimulating factor, attitude toward pimple attitude at ordinary times, pimple management, etc. and data was collected for 5 days from March 20 2006. In the survey, six skin care specialists with at least five years’ experience were selected and given instruction about the contents of the questionnaire, and they visited boys’ and girls’ high schools in Seoul in person and carried out the survey through interview. Collected data were analyzed through Chi-Square test, t-test and Cronbach's alpha using the SPSS 12.0 program. From the results of this study were drawn conclusions as follows. First, as for the subjects’ general characteristics, the average age of the secondary sexual character was 13.75 years in male students and 12.90 years in female students, so the secondary sexual character came appeared in female students and the difference was significant (p<0.001). In addition, pimple onset age was 14.02 years in male students and 13.78 years in female students, but the difference was not significant. Second, as for male and female high school students’ pimple skin condition, while 22.2% of male students were ‘always oily’ and 61.7% were ‘moderately glossy,’ 21.1% of female students were ‘always oily’ and 47% were ‘moderately glossy.’ Thus, male students were oilier than female students, and the difference was statistically significant (p<0.01). As for moisture condition, 18.6% of male students and 34.6% of female students replied ‘feel strained after washing the face.’ Thus, female students’ skin was less moist than male students’ and the difference was statistically significant (p<0.001). Third, as for the characteristics of pimple occurrence in male and female high school students, the regions where pimple occurred were the forehead (29.8%), the cheeks (22%), around the mouth and the chin (12.9%), around the nose (15.8%), the back and the chest (10.3%), the scalp (5%) and the neck (4.3%) in male students, and the forehead (38.9%), the cheeks (20.3%), around the mouth and the chin (12.8%), around the nose (3.9%), the back and the chest (16.7%), the scalp (4.4%) and the neck (3.1%) in female students. The percentage of pimple around the nose was higher in male students and that on the back and the chest was higher in female students, and the difference was statistically significant (p<0.001). However, no significant difference was observed in the grade of pimple between male and female students. As for family history, 74.3% of the surveyed students had family history (21.3% in mother, 19.3% in father, and 33.7% in siblings), but no statistically significant difference was observed between male and female students. As for whether to have scars made by pimple, 53.3% of male students and 65.9% of female ones had pimple scars, so the percentage was significantly higher in female students than in male ones (p<0.05). Fourth, with regard to the correlation between skin condition and the grade of pimple, the grade of pimple was low in students with non-oily skin, and high in those with oily skin. Thus, pimple was closely related with the oiliness of skin and there was a statistically significant difference (p<0.001). According to moisture condition the grade of pimple was not significantly different among moisture I group, moisture II group and moisture III group, and according to skin sensitivity the grade of pimple was higher in the sensitive group than in the insensitive group. Thus, pimple was correlated with sensitivity but not statistically significant. Fifth, among skin condition factors, only oiliness showed a statistically significant difference according to whether to have family history. That is, those with family history were significantly oilier (p<0.05). However, there was no statistically significant difference in moisture condition and sensitivity according to whether to have family history. Sixth, among factors stimulating pimple in male and female high school students, pimple was ‘not affected by season’ in 52.6% of the students, and became worse in ‘summer’ and ‘winter’ in 36.9% and 31.5%, respectively. There was no big difference between male and female students, and a statistically significant difference was observed (p<0.05). To the question of whether pimple is worsened by stress, 7.2% of male students and 23.2% of female ones replied ‘worsened much.’ Thus, the percentage of pimple caused by stress was significantly higher in female students than in male students (p<0.001). Pimple was also ‘worsened a bit’ by hair care products (mousse, spray) in 31.7% of male students and 13.0% of female ones, a statistically significant difference (p<0.001), and ‘worsened a bit’ by hats and hoods in 27.5% of male students and 37.3% of female ones, a statistically significant difference (p<0.05). Seventh, as for male and female high school students’ attitude toward pimple at ordinary times, the percentage of those who replied ‘yes’ was 13.8% of male students and 5.4% of female ones (p<0.01) to ‘Keep the hands from touching the face,’ 68.3% and 42.7% (p<0.001) to ‘Wash the hair everyday,’ 17.4% and 7% (p<0.001) to ‘Try to get rid of stress,’ and 11.4% and 8.6% (p<0.05) to ‘Try to control food.’ So, percentage of students who answered “yes” to these questions was significantly higher in male students than in female ones. However, to the question of ‘Interested in TV programs and magazine articles on pimple,’ 9.6% of male students replied “yes” while much higher 21.6% of female students did (p<0.001). When attitude toward pimple at ordinary times was scored, male students got 18.49 on the average out of 30 points, which was significantly higher than 17.57 the average score of female ones (p<0.05). With regard to treatments for pimple, 33.5% of male students and 31.1% of female ones used pimple soap, 21.2% of male ones squeezed, 22.8% of female ones used cosmetics, and 22.8% of female ones used ointment. There were statistically significant differences (p<0.05). With regard to self-management behaviors, 82.6% of male students and 90.8% of female ones had the experience of squeezing pimple by themselves. As for how to squeeze, 68.8% and 13% of male students and 58.9% and 10.7% of female ones ‘squeezed by hand’ and ‘scratched with the nails,’ respectively, and 11.6% of male students and 29.2% of female ones ‘squeezed using a cotton swab and cotton.’ Thus, the percentage of those who squeeze pimple properly was higher in female students than in male ones, and the difference was statistically significant (p<0.001). However, 33.3% of male students and 48.2% of female ones ‘had scars’ after squeezing pimple, so the percentage was significantly higher in female ones (p<0.05). For both male and female students, the sources of knowledge about pimple were families or friends (36.5%), the Internet (24.9%), TV and radio (17.8%), and statistically significant differences were observed among the sources (p<0.001). According to the results of this study presented above, the age of the secondary sexual character and pimple onset age were younger in female students, male students’ skin had more oil and moisture than female ones’, and the percentage of pimple of moderate degree and above was higher in male students. In addition, students with family history had oilier skin than those without, and the grade of pimple was higher in students with oily skin, showing a close correlation between pimple and skin oiliness. Among pimple stimulating factors, stress and hats/hoods were more stimulating to male students than to female ones, and hair products more to male students than to female students. The experience of squeezing pimple was more frequent in female students. Although a larger percentage of female students used cotton and cotton swab to squeeze pimple, but scars were more frequent in female students than male ones. This shows that pimple is not squeezed properly even if right tools are used. Although congenital factors such as family history cannot be changed, but acquired factors such as stimulating factors and attitude toward pimple at ordinary times can be changed. Thus efforts should be made to change acquired factors. For this, the causes of pimple and its worsening, treatment methods, etc. should be understood correctly, and proper prevention and management should be made. In addition, students in the adolescence should be provided with right education and advice by specialists.