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7%) and most of them were female (76.7%). The majority in the acne vulgaris group had low scores on the stress scale, represented by 17 patients (56.7%). The main cause of stress in the acne vulgaris group was a major change in sleeping habits (66.7%). In the acne vulgaris group, the highest mean value of serum substance P level in high stress scale group was 168.2 pg/mL. There was a positive correlation between stress scale and serum substance P level in acne vulgaris with moderate strength and this was statistically significant (r =