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Background: Acne is predominantly known as a skin disorder of the adolescent population. However, current research indicates that the prevalence of adult patients with acne, especially among women, is increasing. Objective: The objective of this study was to evaluate differences between adults and teenagers with regard to acne prevalence, patient sex, acne severity, and quality of life. In adult patients, we considered differences in family history of acne, onset, and smoking habits. Design: We performed a retrospective study of a total of 1,167 patients with acne who attended our outpatient clinic from January 2008 to March 2015. Participants: The study population was divided into two groups: adolescent acne and adult acne. Among the adult subjects, 385 were female and 69 were male; among the adolescent subjects, 378 were female and 335 were male. Measurements: The severity of acne was recorded using the Global Acne Grading System. The impact of acne on quality of life was investigated using the Assessment of Quality of Life questionnaire. Results: Study results show that acne in female patients was more prevalent than in male patients. The evaluation of acne severity showed that "mild acne" is the most frequent form. With regard to smoking habits, time of onset, and family history of acne, we did not find any statistically significant differences between the sexes. Conclusion: In both sexes, there are some differences in adult acne versus the adolescent form. Treating adult acne demands a different approach to diagnosis and a tailored management plan that considers all of the variables involved.
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Acne is widely considered a chronic skin
disease that primarily aects individuals going
through puberty, with a prevalence among this
population of almost 95 percent.1 However,
although acne is principally a disorder of
adolescence, current research indicates that
the prevalence of adult patients with acne
is increasing.2 Three dierent groups of acne
patients can be considered: preadolescent,
adolescent, and post-adolescent patients.3–5 An
extensive survey carried out on a total of 1,013
men and women showed that the prevalence of
acne was 50.9 percent, 35.2 percent, 26.3 percent,
and 15.3 percent among women aged 20 to 29
years, 30 to 39 years, 40 to 49 years, and 50 years
and older, respectively.6 According to the time of
onset, two subtypes of adult acne are recognized:
persistent and late-onset. Persistent acne is
a continuation or relapse of the disease from
adolescence into adulthood and middle age,7,8
while the late onset type involves patients aged
25 years and older who have not previously been
aected by acne vulgaris. Both subtypes more
frequently aect women and are often associated
with inammation, changes in pigmentation,
and scarring. Late-onset acne is thought to be
less common than persistent acne; in a cross-
sectional study involving adult female patients
diagnosed with acne at a general dermatology
clinic, Schmitt et al9,10 reported that 80 percent
of women showed persistent acne.This latter
type of acne has been reported to be generally
mild to moderate in severity and to present with
more inammatory lesions and fewer comedones
compared to adolescent acne.7,11 It generally
aects the face, particularly the mandibular
region, the zone below the jawline, the cervical
region, and sometimes the chest.12
Adult acne pathogenesis involves several
endogenous and exogenous factors. Examples
of the former include endocrine disorders, the
chronic stimulation of innate immunity,14 and
genetic predispositions,12–14 those of the latter
include cosmetics,7–15 stress,14 and tobacco.7,8
Adult acne is a chronic condition that appears
to impact the quality of life in adult patients more
than in their younger counterparts,13–16 with
considerable psychological, social, and emotional
impacts6,17,18 and up to a 40-percent prevalence of
psychiatric comorbidity.19
Currently, adult acne treatment should be
tailored to address the specic characteristics
of this adult population, including other factors
beyond acne severity.
Study design. We performed a retrospective
study that included 1,167 acne patients from our
database who attended our outpatient clinic from
January 2008 to March 2015.Patients aected
by “mild,intermediate, and “severe acne were
included in this study. The study population was
divided into two groups: adolescent acne (aged
12–25 years) and adult acne (aged > 25 years).
In the adult population, there were 385 women
and 69 men, while in the adolescent population,
there were 378 girls and 335 boys. A detailed
history and examination was carried out for
Background: Acne is predominantly known as a skin
disorder of the adolescent population. However, current
research indicates that the prevalence of adult patients
with acne, especially among women, is increasing.
Objective: The objective of this study was to evaluate
dierences between adults and teenagers with regard to
acne prevalence, patient sex, acne severity, and quality
of life. In adult patients, we considered dierences in
family history of acne, onset, and smoking habits. Design:
We performed a retrospective study of a total of 1,167
patients with acne who attended our outpatient clinic
from January 2008 to March 2015. Participants: The
study population was divided into two groups: adolescent
acne and adult acne. Among the adult subjects, 385 were
female and 69 were male; among the adolescent subjects,
378 were female and 335 were male. Measurements:
The severity of acne was recorded using the Global Acne
Grading System. The impact of acne on quality of life
was investigated using the Assessment of Quality of Life
questionnaire. Results: Study results show that acne in
female patients was more prevalent than in male patients.
The evaluation of acne severity showed that “mild acne”
is the most frequent form. With regard to smoking habits,
time of onset, and family history of acne, we did not nd
any statistically signicant dierences between the sexes.
Conclusion: In both sexes, there are some dierences in
adult acne versus the adolescent form. Treating adult acne
demands a dierent approach to diagnosis and a tailored
management plan that considers all of the variables
KEYWORDS: Adult acne, persistent acne, late onset acne,
risk factor, sex dierences
Adult Acne Versus Adolescent
Acne: A Retrospective Study of
1,167 Patients
Drs. Tolino, Mambrin, Zuber, Balduzzi, Marchesiello, Bernardini, and Proietti are with the Sapienza University of Rome, Polo
Pontino in Terracina, Italy. Drs. Skroza and Potenza are associate professors at Sapienza University of Rome, Polo Pontino.
J Clin Aesthet Dermatol. 2018;11(1):21–25
FUNDING: No funding was provided for this study.
DISCLOSURES: The authors have no relevant conicts of interest relevant to the content of this article.
CORRESPONDENCE: Nevena Skroza, MD. Email:
each patient, including the collection of data
on sex, age, acne severity, and smoking habits;
family history of acne and age of onset were
selectively investigated in the adult population.
Severity of acne was recorded using the
Global Acne Grading System (GAGS). This system
divides the face, chest and back into six areas
(forehead, left cheek, right cheek, nose, chin
and chest and back) and assigns a factor to each
area on the basis of severity.
The impact of acne on quality of life was
investigated by administering the Assessment of
Quality of Life questionnaire (AQoL) to patients.
The questionnaire scale includes 19 items
that measure factors regarding acne severity
and psychological morbidity related to the
disease. Each question in the survey is scored
using a six-point scale, with 0=remarkable
deterioration of quality of life and 6=little
deterioration of quality of life. The total score
of the questionnaire is 114 points. Measuring
the impact of acne on quality of life allows us
to understand the disease perception from the
patient’s point of view.
Statistical analysis. Quantitative data were
expressed as mean and ± standard deviation.
Chi-square (χ2) and Student’s t-tests were
used for categorical and quantitative variables,
respectively. Statistical signicance was set at
p>0.05. Statistical analyses were performed
using the Statistical Package for Social Sciences
version 21.0 software package (IBM Corp.,
Armonk, New York).
We retrospectively analyzed data from our
acne outpatient database. Out of the 1,167
patients suering from acne, 454 (41.3%) were
adults and 713 were adolescents (58.7%).
Among adults, female sex was more prevalent,
with 385 (85%) female patients versus 69
(15%) male patients. In the adolescents, female
patients numbered 378 (53%) versus 335 male
patients (47%) (Figure 1).
The evaluation of acne severity showed that
“mild acne” was the most frequent form in all
subgroups (92% in adult females, 82% in adult
males, 89% in teenage females, and 77% in
teenage males, respectively). Additionally, the
least frequent form was “severe acne” (1% in
adult females, 3% in adult males, 1% in teenage
females, and 1% in teenage males). Finally,
“moderate acne” was observed homogeneously
in all subgroups, though both male groups
showed a little higher prevalence of such in
comparison with the female groups (15% in
adult males and 22% in teenage males versus
7% in adult females and 10% in teenage
females) (Figure 2).
Furthermore, we considered family history
and onset of acne and in male and female adults
(Table 1). Smoking habits were investigated in
both the adolescent and adult groups. In the
total of 454 patients examined, 322 (70.9%)
patients (50 male [72.5%] and 272 female
[70.6%]) declared a family history of acne
(p=0.872). Regarding the time of onset, 321
(70.7%) out of 454 patients (43 male [62.3%]
and 278 female [72.2%]) were classied as
having “persistent” adult acne, while 133
(29.3%) out of 454 (26 male [37.7 %] and 107
female [27.8%]) presented with the “late-onset
“ type of adult acne (p=0.129). Moreover,
smoking habits were identied in 74 patients
(16.3%) (17.4% male and 16.1% female)
(p=0.068). Based on these data, we did not nd
any statistically signicant dierences in the
considered items among the sexes.
Among the adolescent subgroups, 15 of the
713 patients declared having a smoking habit.
Signicant dierences in sex distribution were
found between the adult population versus the
adolescent population in terms of smoking. In
the adult acne group, women who smoked were
more prevalent (62 women vs. 12 men), while,
in the teenager group, the prevalence of those
who smoked was similar among both sexes
(Figure 3). Data for family history, onset of acne,
and smoking habits are summarized in Table 1.
Based on the AQoL score, acne has a
signicantly negative impact on quality of life
(Figure 4), especially in the female population
(female adolescents: 45/114 points and female
adults: 35/114 points; male adolescents: 60/14
points and male adults: 70 /114 points).
FIGURE 1. Distribution of adult acne group and teenage acne group between the sexes
FIGURE 2. Acne severity among men and women in adult and teenage acne groups
Acne is a chronic inammatory skin disease
that primarily aects the face, chest, and
back, with a prevalence of almost 95 percent
in adolescents. Several large studies have
reported a prevalence of adolescent acne
ranging from 81 to 95 percent in young men
and 79 to 82 percent in young women.20,21 Its
prevalence is increasing in the adult population
too, particularly in women, even if literature
lacks exact data on the subject. The rst study
on adult acne prevalence by Cunlie et al22
demonstrated that acne incidence was higher
among adolescent men than adolescent
women. However, Cunlie and colleagues
found that, in adults 18 years of age and older,
this prevalence decreases for both sexes, but
becomes more prevalent in adult women than
adult men. In 1999, Goulden et al23 conrmed
that clinical facial acne aects adult women
more frequently than it does men. In this study,
the prevalence of post-adolescent acne was
three percent in men and 12 percent in women
in a population of randomly selected individuals
with similar demographic characteristics. The
authors further noted that the mean age of
patients with acne increased from 20.5 years
to 26.5 years from 1989 to 1999. Moreover, 82
percent of aected people had persistent acne
subtypes. In our study, which included 454
adult patients, women were predominantly
aected (85%) compared to men (15%), while
in younger individuals (n=713), the two sexes
were similarly aected. In opposition to the
study of Cunlie et al,22 the prevalence of acne
in our study population did not decline between
the ages of 24 to 44 years, but did decrease
after the age of 45 years.23 The prevalence of
acne in adult women was also analyzed in the
study by Collier et al.6 The result of this research
showed that 50 percent of women were aected
in the third decade of life and that acne was
more common in women than in men at all
ages after age 20 years (p<0.05). Variations in
the prevalence of the disease among dierent
ethnic groups have also been reported. A study
on 2,895 women of dierent ethnicities showed
that acne was more prevalent in women with
darker skin types (African American: 37%;
Hispanic: 32%) versus in those with lighter
skin (Asians 30%; Caucasians 24%; and Indians
23%).24 Moreover, in Asians, inammatory
acne forms are more frequent than non-
inammatory forms (20% vs. 10%), whereas,
TABLE 1. Family history, onset of acne, and smoking habits and in male and female adult acne patients
Family history
Yes 322 (70.9%) 50 (72.5%) 272 (70.6%)
No 132 (29.1%) 19 (27.5%) 113 (29.4%)
Persistent 321 (70.7%) 43 (62.3%) 278 (72.2%)
Late-onset 133 (29.3%) 26 (37.7%) 107 (27.8%)
Smoking habit
Yes 74 (16.3%) 12 (17.4%) 62 (27.8%)
No 380 (83.7%) 57 (82.6%) 323 (83.9%)
FIGURE 3. Among the adolescent subgroups, 15/713 patients declared having a smoking habit. Signicant dierences in sex distribution were
found in the adult population vs. the adolescent population. In the adult acne group, women who smoked were more prevalent (62 versus 12)
than men, while in the adolescent group, the prevalence of smokers was similar between both sexes.
FIGURE 4. Acne-related quality of life score is lower among participants with acne compared to those without, especially among women.
Mean AQoL: Sex Dierences
in Caucasians, non-inammatory acne is more
prevalent (14% vs. 10%).
Based on the time of onset, two subtypes of
adult acne can be described: persistent acne and
late-onset acne. In our study, 321 (70.7%) out
of 454 patients showed persistent forms of acne,
while 133 (29/3%) out of 454 presented a “late
onset “ type of adult acne (p=0.129).
Inammation, change in pigmentation, and
scarring characterized both subtypes, albeit
there were some dierences in term of lesions
localization and therapy.
The clinical lesions of adult acne are typically
considered to be dierent than those of
adolescent acne.25 Furthermore, young men
are more aected than young women and
generally show the most severe forms of the
disease, while adult acne mainly aects women
presenting with seborrhea, comedones, and
inammatory lesions. The evaluation of acne
severity in our study showed that “mild acne”
is the most frequent form in male and female
patients of both adolescent and adult ages;
also, in all groups, the least frequent form was
“severe acne.
Morphologically, the classical presentation of
adult acne consists of inammatory papulo-
pustular lesions in the lower half of the face.
The acne usually presents gradually and is
mild-to-moderate in severity, in contrast with
adolescent forms. In the literature, two clinical
proles of adult acne have been described.13 One
shows hyperseborrhea and non-inammatory
lesions diuse in all areas of the face with
abundant open or closed small comedones,
while the other consists of predominant
inammatory lesions, long-lasting nodules, and
cysts on the lower one-third of the face, neck,
and jawline. This latter type of presentation has
been described as “chin acne. Capitanio et al,26
in 2010, described a new clinical presentation
of adult acne called “comedonal postadolescent
acne,” which is characterized by inammatory
lesions and large, prominent cyst-like
comedones homogeneously distributed on the
whole face with a relative absence of lesions on
the lower half of the face and jawline. Khunger
et al,27 in a study involving 280 Indian patients,
revealed that adult acne usually presents as
inammatory papules and pustules (in 83% of
patients) that are mild to moderate in severity.
Moreover, in the Indian population, comedonal
acne is rare in comparison with adolescent acne;
however, cystic acne is not uncommon and was
present in 12 percent of the patients studied.
This traditional description of adult acne was
recently revised by Dreno et al in 20149 with
an observational, prospective international
study on 374 adult female patients with acne.
The results illustrate that post-adolescent
acne is very similar in severity to adolescent
acne in up to 90 percent of women, involving
multiple areas of the face (e.g., mandibles,
temples, cheeks). In 6.4 percent of cases, the
women presented only inammatory lesions
and 17.1 percent had only comedonal acne. In
addition, only 12 percent of women presented
with lesions localized on the mandibular area.16
Truncal involvement was reported in 48.4
percent of patients, and, notably, women with
truncal acne also had multiple other body areas
aected. Other important additional clinical
features have been reported, such as post-
inammatory hyperpigmentation (commonly
present in the cheek26 [38.2%] and mandibular9
[26.1%] areas), scars, which are frequently
atrophic and present in 58.8 percent of patients
studied, particularly in women with mandibular
presentation;9 hyperseborrhoea; and erythema.
The pathogenesis of adult female acne is very
complex and remains incompletely elucidated.
Similar to adolescent acne, the pathogenesis of
adult female acne involves an interplay of excess
sebum production, abnormal keratinization
within the follicle, and bacterial colonization
of the pilosebaceous duct by Proponibacterium
acnes.28 Furthermore, hormones, the use of
cosmetics and/or drugs, and chronic stress have
been put forward as possible etiological factors.
Genetics also play a strong role; Goulden et al2
showed that the majority of patients (67%)
have a rst-degree family history of post-
adolescent acne. In our study, with respect to
the total of 454 adult patients examined, 322
(70.9%) patients (50 males [72.5%] and 272
females [70.6%]) declared a family history of
acne (p=0.872). In another study,9 job stress
was associated with more severe forms of
acne in women; women with localized acne
were also more likely to report higher stress
levels (6.0–6.4 vs. 5.1) and a psychologically
stressful job (68.6–73.6% vs. 58.8%). In this
study, it was also reported that 24.8 percent
of patients were smokers; notably, there was a
signicantly higher proportion of subjects with
severe acne among smokers in comparison
with among nonsmokers (17.4%). Smoking
has been related with abnormal follicular
keratinization and inammation through
lipide peroxidation of sebum in comedones
by inicting oxidative stress. According to the
data in our study, adult acne patients smoke
more than their younger counterparts, with
statistically signicant results in both sexes
Adult acne is mainly mild-to-moderate
in severity, but treatment failure and a
chronic, relapsing course may increase the
self perception of symptom severity with a
resulting negative impact on quality of life.
In several papers, acne severity was similar
between the two sexes but quality of life was
more impaired in women than in men.18–29
Acne duration seems to be an important factor
responsible for the worse perception of the
disease by women. Adult acne in women has
been associated with depression, anxiety,
psychological stress, and suicidal ideation.3
Moreover, Tan et al18 observed that other
factors such as increased age and longer
acne duration (> ve years) are related with
a greater impairment in quality of life in
Only a few studies investigating sex
dierences in adult acne have been reported in
the literature; our study evaluates dierences
between men and women regarding acne
severity, smoking habits, family history
of acne, and time of onset. Signicant
dierences in gender distribution have been
found between the adult and the adolescent
populations. As for prevalence, adult acne is
more prevalent in women than in men, while
in adolescents, the prevalence is quite similar
in both sexes. Moreover, data about acne
severity show that “severe acne” and “mild
acne” forms are observed homogeneously in all
groups; only “moderate acne shows a slightly
higher prevalence in male than in female
As for smoking habits, time of onset, and
family history of acne, we did not nd statistically
signicant dierences between the sexes.
Limitations. Our study presents some
limitations, in that it is retrospective and
monocentric in nature. Moreover, our clinical
evaluation was based on the GAGS without
considering the lesions and distribution patterns
of acne that can dier between sexes, according
to literature data.25
Acne is one of the most common skin disorders
worldwide and occurs primarily at puberty with
a prevalence of almost 95 percent. Although
it is principally a disorder of adolescence,
the prevalence of adult patients with acne,
particularly adult women with acne, is increasing.
The higher prevalence of adult acne in the
female population prompted us to investigate
whether other variables could present signicant
dierences between sexes. These dierences
have recently gained attention in many branches
of medicine, including dermatology, so we
selectively addressed our interest to the dierent
forms of acne, family history of the disease, time
of onset, smoking habits, and quality of life in
both sexes. This restriction could represent a
limit of the present study but it also represents
a starting point for further research on factors
inuencing adult acne. As this study reports only
the results from our outpatient clinic, it would
be auspicable to include experiences from other
centers in order to obtain the most statistically
signicant data.
Our results agree with the literature data
on adult acne: women are aected more by
acne (85%) than men (15%); family history
represents one of the main risk factors (70%);
the persistent form of acne is more prevalent
(70.7%) than the late-onset form; mild acne is
the predominant form (87%); and there is a large
number of smokers among adults with acne than
among younger individuals with acne. Finally,
there is evidence of a negative impact of acne
on quality of life in both adult and adolescent
female patients. Some dierences of adult acne
from adolescent acne in both sexes were noted
in our study; as such, each demands a dierent
approach to diagnosis and treatment, and we
recommend a tailored management plan that
considers all of the variables involved.
1. Burton JL, Cunlie WJ, Staord I, Shuster S. The
prevalence of acne vulgaris in adolescence. Br J
Dermatol. 1971;85(2):119–126.
2. Goulden V, Clark S, Cunlie W. Post-adolescent
acne: a review of clinical features. Br J Dermatol.
3. Del Rosso JQ, Harper JC, Graber EM, et al. Status
report from the American Acne & Rosacea Society
on medical management of acne in adult women,
part 1: overview, clinical characteristics, and
laboratory evaluation. Cutis. 2015;96(6):376–382.
4. Tanghetti EA, Kawata AK, Daniels SR, et al.
Understanding the burden of adult female acne. J
Clin Aesthet Dermatol. 2014;7(2):22–30.
5. Perkins AC, Maglione J, Hillebrand GG, et al. Acne
vulgaris in women: prevalence across the life span.
J Womens Health (Larchmt). 2012;21(2):223–230.
6. Collier CN, Harper JC, Cafardi JA, et al. The
prevalence of acne in adults 20 years and older. J
Am Acad Dermatol. 2008;58(1):56–59.
7. Rivera R, Guerra A. [Management of acne in
women over 25 years of age]. Actas Dermosiliogr.
8. Williams C, Layton AM. Persistent acne in women:
implications for the patient and for therapy. Am J
Clin Dermatol. 2006;7(5):281–290.
9. Dréno B, Thiboutot D, Layton AM, et al. Global
Alliance to Improve Outcomes in Acne Large-scale
international study enhances understanding of
an emerging acne population: adult females. J Eur
Acad Dermatol Venereol. 2015;29(6):1096–1106.
10. Schmitt JV, Masuda PY, Miot HA. [Acne in women:
clinical patterns in dierent age-groups]. An Bras
Dermatol. 2009;84(4):349–354.
11. Addor FA, Schalka S. Acne in adult women:
epidemiological, diagnostic and therapeutic
aspects. An Bras Dermatol. 2010;85(6):789–795.
12. Knaggs HE, Wood EJ, Rizer RL, Mills OH. Post-
adolescent acne. Int J Cosmet Sci. 2004;26(3):129–
13. Preneau S, Dreno B. Female acne—a dierent
subtype of teenager acne?. J Eur Acad Dermatol
Venereol. 2012;26(3):277–282.
14. Dumont-Wallon G, Dreno B. [Specicity of acne
in women older than 25 years]. Presse Med.
2008;37(4 Pt 1):585–591.
15. Poli F, Dreno B, Verschoore M. An epidemiological
study of acne in female adults: results of a survey
conducted in France. J Eur Acad Dermatog Venereol.
16. Marks R. Acne and its management beyond
the age of 35 years. Am J Clin Dermatol.
17. Plunkett A, Merlin K, Gill D, et al. The frequency of
common nonmalignant skin conditions in adults
in central Victoria, Australia. Int J Dermatol. 1999;
18. Tan JK, Li Y, Fung K, et al. Divergence of
demographic factors associated with clinical
severity compared with quality of life impact in
acne. J Cutan Med Surg. 2008;12(5):235–242.
19. Henkel V, Moehrenschlager M, Hegerl U, et al.
Screening for depression in adult acne vulgaris
patients: tools for the dermatologist. J Cosmet
Dermatol. 2002;1(4):202–207.
20. Lello J, Pearl A, Arroll B, et al. Prevalence of acne
vulgaris in Auckland senior high school students.
N Z Med J. 1995;108(1004):287–289.
21. Lucky AW, Biro FM, Huster GA, et al. Acne vulgaris
in early adolescent boys: correlations with
pubertal maturation and age. Arch Dermato.
22. Cunlie W J, Gould DJ. Prevalence of facial acne
vulgaris in late adolescence and in adults. Br J
Med. 1979;1(6171):1109–1110.
23. Goulden V, Stables GI, Cunlie WJ. Prevalence
of facial acne in adults. J Am Acad Dermatol.
24. Perkins AC, Cheng CE, Hillebrand GG, et al.
Comparison of the epidemiology of acne vulgaris
among Caucasian, Asian, Continental Indian and
African American women. J Eur Acad Dermatol
Venereol. 2011;25(9):1054–1060.
25. Dreno B. Treatment of adolescent acne ; a new
challenge. J Eur Acad Dermatol Venereol. 2015;29
Suppl 5:14–19.
26. Capitanio B, Sinagra JL, Bordignon V, et al.
Underestimated clinical features of postadolescent
acne. J Am Acad Dermatol. 2010;63(5):782–788.
27. Khunger N, Kumar C. A clinic epidemiological
study of adult acne: is it dierent from adolescent
acne?. Indian J Dermatol Venereol Leprol.
28. Thiboutot D, Gollnick H, Bettoli V, et al. New
insights into the management of acne: an update
from the Global Alliance to Improve Outcomes
in Acne group. J Am Acad Dermatol. 2009;60(5
29. Holzmann R, Shakery K. Postadolescent acne in
females. Skin Pharmacol Physiol. 2014;27 Suppl
1:3–8. JCAD
... The prevalence of acne was about 9.4% of the global population, and it affects over 85% of adolescents. 1 It is among the three dermatoses that affect the population in the world, and usually begins in adolescence and disappears in the mid-twenties. 2 The pathophysiology of acne is complex with multifactorial etiology. Abnormal follicular keratinization, increased sebum production secondary to hyperandrogenism, follicular colonization, inflammation, endocrine disorder, and hormone-based therapies have been implicated in the pathogenesis of acne. ...
... Similarly, previous studies revealed a higher prevalence of acne in females than males, with male-to-female ratio of 1:1.8. 1,2,25 This finding could be attributed to hormonal changes affecting females during menstruation, contraceptive use, and endocrine abnormalities (PCOS). 3 The vast majority of participants were young adults, with a mean age of 26.0 years (SD: 4.2). ...
... Acne primarily affects adolescence; however, the prevalence of acne in adult patients is increasing. 2 The study results demonstrated that most patients weighed 50-70 kg and had a family history of acne vulgaris. In previous studies, acne severity was associated with overweight/obese and family history of acne. ...
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Purpose: Acne vulgaris is a skin disorder primarily affecting teenagers and young adults. Acne relapse is the main drawback of oral isotretinoin (OI), which is the golden therapy for severe acne. This study aimed to assess the rate and predictive factors of acne relapse among Sudanese patients using OI. Patients and Methods: A cross-sectional study was conducted in a dermatology and venereology clinic-Sudan, using a self-administered questionnaire and data collection sheet. Patients using OI for acne treatment were enrolled in the study. Chi-square test and logistic regression analysis were used to evaluate the association between variables. P-value <0.05 was considered statistically significant. Results: 225 acne patients (mean age: 26.0±4.2 years, females: 88.9%) were included in this study. OI daily dose ranged from 0.25 to 1 mg/kg/day, with frequent daily doses of 40-49 mg (57.3%) over 3-6 months (81.8%). Around one-third of patients (36%) received maintenance therapy after completion of OI course. At a 2-year follow-up, approximately 36% of patients experienced acne relapse that commonly occurred within 6-18 months after the last OI therapy. Early discontinuation of OI was a positive predictor of acne relapse which was 3.99 times greater in patients who had early discontinued OI than those completing the planned OI course (OR=3.99; p=0.002). OI cumulative doses of 120-139 mg/kg and 140-159 mg/kg were negative predictors of acne relapse (OR=0.23; p=0.001 and OR=0.15; p=0.02, respectively). Most patients (94.2%) received prescription OI, and 76.4% of women were advised to use contraceptives. About 69% of patients practiced skin care. Conclusion: About one-third of patients experienced acne relapse. Early discontinuation and low cumulative doses of OI are the main risk factors for acne relapse. Long-term therapy of OI, with cumulative doses of 120-159 mg/kg, would be beneficial to reduce acne relapse.
... The pathogenesis of acne involves the colonization and proliferation of Corynebacterium acnes, resulting in the inflammatory process, hyperkeratinization, and sebum hyperproduction. 2,3 The negative effects of acne vulgaris include depression, antisocial behavior, and even unemployment. The prevalence of acne vulgaris is 90%-95% of the population. ...
... The prevalence of acne vulgaris is 90%-95% of the population. 3,4 Acne commonly occurs during adolescence, and it is found less often during the pre-and post-adolescent periods. 3 Adolescent acne predominantly occurs in males, while post-adolescent acne is usually found in females. ...
... 3,4 Acne commonly occurs during adolescence, and it is found less often during the pre-and post-adolescent periods. 3 Adolescent acne predominantly occurs in males, while post-adolescent acne is usually found in females. 5 However, post-adolescent acne or adult acne can also affect male patients. ...
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Objective: To evaluate the characteristics of post-adolescent male patients with acne in terms of the onset of the condition, its clinical course and severity, and the behaviors associated with its severity. Materials and Methods: A prospective, cross-sectional study was conducted on adult males with acne who visited Siriraj Hospital, Thailand. All male acne patients aged 21 years and older were enrolled. Diagnoses and physical examinations were performed by dermatologists. Results: Seventy-two patients (mean age, 26.9 [± 4.3] years) were included. Persistent acne, relapse acne, and late-onset acne (onset at age ≥ 21 years) were reported in 62.5%, 33.3%, and 4.2% cases, respectively. Persistent acne tended to subside at 26 years of age, whereas late-onset acne tended to start at 28 years of age. The acne severity was mild in most cases. Pimple-picking, followed by frequent face washing, were common habits among male acne patients. Shaving influenced the severity in some adult male with acne. Conclusion: Adult male acne commonly presented as inflammatory lesions and comedones on the cheeks. They commonly had an onset earlier than 21 years old and continued into adulthood, but the post-adolescent severity tended to be mild. While several factors have been reported elsewhere to be involved in the severity of acne, this study found that only shaving influenced severity.
... В большинстве случаев встречается персистирующее акне, которое наблюдается у 73,2-82% женщин со взрослым акне [11,[14][15][16][17][18]. Акне с поздним началом встречается гораздо реже -у 20-40% женщин [8,19,20]. ...
... В клиническом течении и проявлениях акне у взрослых женщин имеются свои особенности [4,15]. Как правило, процесс развивается постепенно и варьирует у большинства пациенток от легкой до средней степени тяжести. ...
In recent years, there has been an increase in the proportion of AFA in the structure of acne incidence. The etiopathogenesis of the disease is multicomponent and has not been fully elucidated. It is assumed that hormonal factors and chronic activation of innate immunity are involved in the process against the background of genetic predisposition, which are stimulated by external environmental factors: daily stress, Western-style diet, tobacco use, hormonal drugs, cosmetics. The article presents a modern classification of the clinical course of AFA and scales for assessing the severity of the course of the disease: GEA (Global Acne Severity Scale) and AFAST (Adult Female Acne Scoring Tool). AFA is predominantly characterized by a mild or moderate course. Treatment requires a personalized approach with particular attention to the individual needs and characteristics of adult women. When choosing a topical therapy, the doctor should consider the less pronounced oiliness of the skin, the slow progression of the disease with the outcome in hyperpigmentation and scarring. Modern acne treatment regimens include systemic and topical therapy along with proper basic skin care. The most effective topical agents include retinoids, which can induce a specific biological response by binding and activating retinoic acid receptors. Comedonal and mild papulopustular acne are indications for adapalene monotherapy for acne in adult women. Adaklin (0.1% adapalene) cream is a highly effective first choice for the pathogenetic treatment of AFA. Rational mono- and combination therapy with adapalene is the key to successful external therapy of mild and moderate AFA and prevention of post-acne. The review provided up-to-date, evidence-based information on the clinical presentation, etiopathogenesis, and treatment of adult female acne (AFA).
... Następnym jest trądzik o opóźnionym początku, czyli nie występującym w wieku dojrzewania, a po nim. Ostatnim podtypem jest trądzik nawracający późny, charakteryzujący się zmianami pojawiającymi się w okresie młodzieńczym, które ustąpiły i nawróciły w wieku dojrzałym [16,34,35]. ...
... Trądzik o opóźnionym początku obserwuje się u 20-40% kobiet, czyli znacznie rzadziej. Przebieg dermatozy jest zazwyczaj lekki w kierunku umiarkowanego [34,35]. ...
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One of the most common skin diseases in women is mature acne. The mechanisms that are responsible for the visible skin lesions are still being recognized, and it is impossible to put a single factor that is culpable for the development of this dermatosis. The aim of the article is to describe the possible pathogenesis of adult acne with a description of the disorders occurring at the level of skin cells. The main focus is directed to the particular role of the endocrine system in the development of adult acne in women over 25 years of age and related diseases such as polycystic ovarian syndrome. Current specialized and cosmetological therapies were also described.
... Persistent acne is a continuation or relapse of the disease from adolescence into adulthood and middle age. While the late-onset type involves patients aged 25 years and older who have not previously been affected by acne, late-onset acne is thought to be less common than persistent acne [11]. It is a chronic condition that appears to impact the quality of life in adult patients more than in their younger counterparts, with considerable psychological, social, and emotional impacts and up to a 40 percent prevalence of psychiatric comorbidity [12]. ...
... After age 25, PA can either develop slowly or late, or it can persist from AA or EA. The majority of patients in this group (60%) had PA that was persistent from AA or EA, which was consistent with the Scroza et al. study, in which 82% of the PA group was persistent acne [11]. ...
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Background Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous units associated with long-term sequelae and complications. Currently, acne in women is classified into adolescent and post-adolescent forms. However, comparative studies evaluating the clinical and laboratory parameters across various age groups in women with acne are lacking. The aim of the study is to compare the clinical and laboratory characteristics of different groups of women with acne vulgaris. Patients and methods Over 3 years (2018-2021), a cross-sectional study was carried out on 340 women with acne consulting the Dermatology and Venereology Outpatient Clinic, Basrah Teaching Hospital, Basrah, Iraq. Eligible patients were carefully evaluated and fully examined, emphasizing on signs of hyperandrogenism and scoring of acne severity. Hormonal assays of serum total testosterone (TST), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular stimulating hormone (FSH), and serum prolactin (PRL) were done. Pelvic ultrasonography was performed to identify any pelvic pathology. The patients were classified according to their age of onset. Clinical and laboratory data were compared among groups. Results Three groups were recognized: 160 patients (47%) with adolescent acne (AA) (mean age SD: 17.2±1.6 years), 80 (23.5%) with early adult-onset acne (EA) (mean age SD: 21.4±1.2 years), and 100 (29.4%) with post-adolescent acne (PA) (mean age SD: 28.7±2.9 years), which were further sub-grouped into late-onset acne (40 cases, 11.7%), and persistent acne (60 cases, 17.6%). The mean body mass index was normal in the AA group and overweight in the EA and PA groups. Moderate obesity was more frequent in PA (24%, p=0.03). While 78.5% of AA was mild to moderate acne, 77.5% of EA was moderate to moderately severe, and 72% of PA was moderately severe to severe. Clinical and biochemical markers of hyperandrogenism were seen in all groups, however, they were more frequent in PA and EA groups than in the AA group (p<005). Conclusion Clinical and biochemical hyperandrogenism were present in a significant proportion of women with acne; their prevalence was higher in post-adolescent acne than in adolescent acne. Acne that began between the ages of 20 and 25 was classified as "early adult-onset acne," and showed variable features of hyperandrogenism. A complete evaluation, regardless of age, for every female with acne, including a hormonal analysis and pelvic ultrasound examination to detect hormonal imbalances as early therapy, can help to prevent and reduce the risk of consequences.
... Acne vulgaris, or acne, is a chronic skin disorder affecting 95% of the global population, and it is considered the eighth prevalent health condition worldwide [1,2]. This disease starts as soon as age nine and continues into adulthood, and it has huge psychosocial impact on individuals. ...
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Acne is a common chronic skin condition with serious physical and psychosocial consequences. In some cases, the appearance of pimples, whiteheads, or blackheads on the face, neck, and back may lead to scarring, disfiguring, depression, frustration, and anxiety in patients. Current treatments rely on antibiotics to eradicate Cutibacterium acnes (C. acnes), the bacterium responsible for this skin condition. However, these approaches do not scavenge the reactive oxidative species (ROS) generated during disease development and raise concerns about the increase in antimicrobial resistance. In this study, an environmentally friendly and cost-effective self-assembly nanoencapsulation technology based on zein, a bio-based hydrophobic protein, was employed to produce multifunctional essential oil (EO)-loaded nanocapsules (NCs) with superior antioxidant and bactericidal activity toward C. acnes. The NCs displayed “smart” release of the active cargo only under the conditions that were conducive to acne proliferation on skin. Once incorporated into creams, the EO-loaded NCs led to a complete inhibition of C. acnes and demonstrated the capacity to scavenge ROS, thus preventing damage to human skin cells. The in vitro permeation studies revealed that the nanoformulated EO was able to penetrate through the epidermis, indicating its potential for the treatment of skin diseases, such as acne.
... Acne vulgaris (AV) is one of the chronic inflammatory dermatological diseases (Picardo, Eichenfield, & Tan, 2017), common in both young people and adults. The prevalence of AV in adolescents is stated as approximately 85% by some (Acer et al., 2019); based on a 2018 report, acne is described as more prevalent in those who are going through puberty, with a prevalence of almost 95% of this population (Skroza et al., 2018). This disease is characterized by comedones, papules, pustules, and nodules and it can appear on all parts of the body, including face, neck, back, etc. (Salman, Kurt, Topcuoglu, & Demircay, 2016). ...
... The Institute for Health Metrics and Evaluation (Global Burden of Disease) reported that this dermis disease occurs in about 9% of the global population with a high incidence among adolescents (85% of people aged between 12 and 25 years) [3]. It ranks among the most common skin disease worldwide, as found in the USA, UK, and France [4]. ...
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Acne vulgaris usually affects the dermal layer of the skin and is revealed frequently in young adulthood and adolescence. It has serious psychosocial comorbidities. We conducted the present systematic review and meta-analysis to elucidate the association of acne vulgaris with psychiatric comorbidities and quality of life as well as the brain-derived neurotrophic factor (BDNF) level. A systematic review and meta-analysis of the published articles were carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We investigated diverse databases: Web of Science, PubMed, the Cochrane Library, Embase, PsycINFO, and CINAHL to search for articles reporting the prevalence of psychosocial comorbidities among patients with acne vulgaris from database inception through June 2022. The outcomes were depression, anxiety, symptom checklist-90-R (SCL-90-R), quality of life, self-esteem, stress, loneliness, and BDNF concentrations. Of 3647 articles identified, 23 met the inclusion criteria. Patients with acne vulgaris have a significantly higher level of anxiety, depression, and stress (P<0.05). Yet, the reported findings of the SCL-90-R, self-esteem, loneliness, and BDNF scores among patients suffering from acne vulgaris were variable and did not differ significantly compared to healthy participants (P>0.05), hampering any conclusive findings on absolute prevalence. Subgroup analysis and comparison showed that heterogeneity between studies was likely due to factors, including country, study design, and assessment tools. This comprehensive review and meta-analysis revealed that anxiety, depression, and stress are significantly more frequent among patients suffering from acne vulgaris. These findings confirm that acne vulgaris has both psychiatric and medical characteristics and requires a multidisciplinary approach.
Background: Acne vulgaris is a common skin disorder in pilosebaceous units that is self-limited, especially in adolescents. This disease not only causes permanent physical complications but also psychosocial effects that harm the quality of life. Telemedicine has grown its popularity in recent years, especially during the COVID-19 pandemic. Store and Forward (SAF) teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability, and clinical outcomes similar to face-to-face visits. Objective: We sought to compare the severity of acne vulgaris by teledermatology with face-to-face consultations. We also observe the capability of teledermatology in establishing the severity of acne vulgaris. Methods: This study is an observational analytic study with a cross-sectional design involving 105 patients with a diagnosis of acne vulgaris based on inclusion and exclusion criteria. The characteristics of age and sex were recorded. The severity of acne vulgaris was established directly by the resident and teledermatologically by the dermatologist consultant. Teledermatology was carried out based on photo documentation of five facial lesion areas; namely forehead, chin, right cheek, left cheek, and the entire face, along with photos from the history submitted by the resident. An assessment for acne vulgaris severity was carried out based on the classification from the International Consensus Conference on Acne Classification System. This classification divided acne vulgaris as mild, moderate, and severe with an ordinal measuring scale. A compatibility test was also performed to determine the comparison between teledermatology and face-to-face consultations in establishing the severity of acne vulgaris. Comparison of the severity of acne vulgaris was assessed by the kappa value. Results: Acne vulgaris was found more common in women (n=71, 67.6%) and those aged 18 to 22 years (n=55, 52.4%). Most of the subjects have moderate severity based on face-to-face consultations and teledermatology examination (n=52 (49.5%) and n=50 (47.6%), respectively). The value of the capability test between teledermatology and face-to-face consultations in comparing the severity of acne vulgaris is 0.611, which means the capability is considered good. Conclusion: In this study, the teledermatology examination shows good conformity when compared with face-to-face consultations in assessing severity of acne vulgaris.
Background Irritation with topical retinoids presents a significant impediment to acne treatment adherence. Two studies assessed the irritation potential of tazarotene 0.045% lotion versus adapalene 0.3% gel and trifarotene 0.005% cream. Methods In two double-blind, 12-day modified cumulative irritation patch studies, healthy adults (N = 20 each) had two active patches, containing 0.1 cc of tazarotene 0.045% lotion and either adapalene 0.3% gel (Study 1) or trifarotene 0.005% cream (Study 2), and one control patch (no product) placed on their upper back. Skin irritation was assessed and patches were replaced every 2-3 days. Results In Study 1, tazarotene 0.045% lotion and adapalene 0.3% gel were both mildly irritating, though irritation was lower overall with tazarotene 0.045% lotion. In Study 2, significantly greater irritation was observed with trifarotene 0.005% cream than tazarotene 0.045% lotion, beginning two days after the first patch application and at each subsequent visit. In sub-analyses of data from both studies, irritation among participants with acne was similar to the overall study populations. Conclusions In two head-to-head studies comparing the irritation potential of third- and fourth-generation retinoids, tazarotene 0.045% lotion was significantly less irritating than trifarotene 0.005% cream and numerically less irritating than adapalene 0.3% gel.
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Although acne is usually recognized as an adolescent skin disorder, the prevalence of adults with acne is increasing. There is surprisingly a paucity of data on the prevalence and clinical features of postadolescent acne in the adult Indian population. The clinical and epidemiological data of adult acne were evaluated with a view to establishing possible contributing etiological factors and observing whether clinical features differ from adolescent acne. Patients over the age of 25 years presenting with acne in a tertiary care hospital were included in the study. A detailed history and examination was carried out, with a stress on aggravating factors. Hormonal imbalances were investigated in females with alopecia, obesity, hirsutism and menstrual irregularity. Severity of acne and complications like scarring and psychological stress were included. Out of 280 patients included in the study 82.1% were women and 17.9% were men. The mean age of the patients was 30.5 years. Persistent acne was observed in 73.2%, while it was late onset in 26.8%. Majority of the patients had inflammatory papular acne (55%), whereas comedonal acne was the least common (6%). Most common predominant site of involvement was cheek (81%), followed by chin (67%), and mandibular area (58.3%). Family history of acne was present in 38.6%. Premenstrual flare was seen in 11.7% of female patients, obesity in 6.4%, hirsutism in 5.7% and alopecia in 1.8%, but raised laboratory markers of hyperandrogenism were observed in only 3.08%. Scarring was observed in a majority of patients (76.4%) and psychological stress in 52.8% patients. Adult acne is predominant in women, and as compared to adolescent acne is more inflammatory, with involvement of the cheeks and lower half of the face, while comedones are rare. Facial scarring occurs in a majority and stress is common, which emphasizes that adult acne should not be neglected.
Acne presenting in adult women is commonly encountered in clinical practice. Many affected women have had acne during their teenaged years, have tried several therapies in the past, and are seeking effective treatment. Others are frustrated by the inexplicable emergence of acne as an adult when they never had it as a teenager. Both groups seek an explanation of why they have acne, are often psychosocially affected by its effects on appearance and self-esteem, and all are wanting effective and safe treatment. Clinicians are encouraged to connect favorably with each patient through careful history and physical examination and to consider underlying causes of androgen excess. Practical approaches to examination and laboratory evaluation are discussed.
Parts 1 and 2 of this 3-part series provided an overview of the epidemiology, visible patterns, and important considerations for clinical and laboratory evaluation of acne vulgaris (AV) in adult women and reviewed the role of proper skin care and topical therapies in this patient population. In Part 3, oral therapies including combination oral contraceptives, spironolactone, antibiotics, and isotretinoin are discussed along with important considerations that clinicians should keep in mind when selecting oral agents for management of AV in adult women.
Acne is affecting an increasing number of adult females and so can no longer be considered as a disease of adolescence. The disease has a greater negative impact on the quality of life of adult females than their younger counterparts. Adult female acne may persist from adolescence or may have its first occurrence once adulthood has been reached. The clinical presentation and pathogenesis of adult female acne may be somewhat different to that of adolescent acne and this may require a different treatment approach. Genetic and hormonal factors are thought to play key roles in the pathogenesis of adult female acne and the disease is characterized by a chronic evolution with frequent relapses requiring long-term maintenance therapy. Fixed-dose retinoid/antimicrobial combinations may be of interest for the treatment of adult female acne given that subgroup analysis of clinical trials has indicated that they are effective against both inflammatory and non-inflammatory lesions in these patients. These treatments may also be of interest, given the chronic course of the disease in adult females, the high likelihood of the presence of antibiotic-resistant P. acnes and the poor adherence of patients to other long-term therapies. Oral hormonal treatment or isotretinoin may be required in patients with severe acne or disease that is refractory to other treatments. Additional clinical studies of acne treatments specifically conducted in adult female patients are required to increase the evidence base on which future treatment recommendations can be based. © 2015 European Academy of Dermatology and Venereology.
Acne in the adult female often presents as a chronic condition that can have a considerable negative psychological, social and emotional impact on the affected individual. Estimated prevalence rates of adult female acne vary widely according to study type. Case reports and clinical examinations estimate the prevalence of clinical acne at 10-12%, while survey estimates of physiological disease states are as high as 54%. Two subtypes of adult female acne may be defined according to time of onset: ‘persistent' and ‘late-onset', accounting for approximately 80 and 20% of cases, respectively. Postadolescent acne is generally mild-to-moderate in severity and presents with more inflammatory lesions and fewer comedones compared to adolescent acne. Furthermore, the impact of acne on the quality of life is often greater in adult females than in younger individuals. Despite these important differences, the key principles of acne treatment in the adult female do not differ significantly from those of other age groups. However, specific characteristics relating to the adult female should be considered when selecting a treatment regimen.
Background Acne vulgaris is increasingly recognized in adult women; however, few studies have formally evaluated the clinical presentation and factors associated with acne in this population.Methods This prospective, observational international study evaluated the clinical characteristics and lifestyle correlates of acne in adults (≥25 years) at a dermatology visit for acne. Investigators conducted a detailed clinical examination and administered a validated questionnaire that covered medical history, disease evolution, lifestyle habits, previous treatments, skin care and quality of life.ResultsIn this study (n = 374), acne was mild or clear/almost clear in 47.3% of subjects; however, the study visit was not required to be an initial consultation for acne and as such, many patients were already on treatment. Most women (89.8%) had acne involving multiple facial zones (cheeks, forehead, mandibular area, temples) with a spectrum of facial acne severity similar to adolescents. Mixed facial acne (both inflammatory and non-inflammatory lesions present) was the most common presentation; 6.4% of women had inflammatory acne only (no non-inflammatory lesions reported) and 17.1% had comedonal acne with no inflammatory lesions. Truncal acne was present in 48.4% of patients. A small subset (11.2%) had acne localized only to the mandibular area. Compared to the women without localized acne, those with mandibular acne were more likely to be employed (90.5% vs. 78.6%), reported greater daily stress levels (5.8 vs. 5.1), and were more likely to say their jobs were psychologically stressful (71.4% vs. 57.5%). Women with mandibular acne alone were significantly less likely to have a global acne severity rating of moderate or higher (7.1% vs. 50.1%), truncal acne (19.0% vs. 51.9%), post-inflammatory hyperpigmentation (23.8% vs. 51.9%) and erythema (19.0% vs. 48.4%). At the completion of the study visit, this group was also more likely to receive a prescription for an anti-androgen (16.7% vs. 7.7%).Conclusions This study represents the first objective assessment of the facial distribution of acne lesions in adult women presenting to the dermatology office. The data surprisingly indicate that the acne distribution in almost 90% of cases is similar to that seen in adolescent acne. The stereotype of adult female acne being due to hormonal disturbances presenting as inflammatory acne localized only to the mandibular area was not found in the majority of this large group. The large majority (93.7%) of women had facial comedones. We recommend that the general treatment approach for adult acne should include agents that target each of the acne lesion subtypes. Subgroup analyses of recent large-scale controlled clinical trials have shown that many adult women respond well to standard first-line acne therapy.
Objective: Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women. Design: Cross-sectional, web-based survey. Setting: Data were collected from a diverse sample of United States females. Participants: Women ages 25 to 45 years with facial acne (≥25 visible lesions). Measurements: Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity. Results: A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin, and forehead and was characterized by erythema, postinflammatory hyperpigmentation, and scarring. Average age of adult onset was 25±6 years, and one-third (33.7%) were diagnosed with acne as an adult. The majority (80.3%) had 25 to 49 visible facial lesions. Acne was perceived as troublesome and impacted self-confidence. Makeup was frequently used to conceal acne. Facial acne negatively affected health-related quality of life, was associated with mild/moderate symptoms of depression and/or anxiety, and impacted ability to concentrate on work or school. Conclusion: RESULTS highlight the multifaceted impact of acne and provide evidence that adult female acne is under-recognized and burdensome.
• To assess the prevalence and severity of acne vulgaris in young adolescent boys, we studied 219 black and 249 white boys in fifth through ninth grades in Cincinnati, Ohio. The mean age was 12.2 ± 1.4 years, with a range of 9 to 15 years. Pubertal maturation was scored as Tanner pubic hair stages (PH I to V) and pubertal stages (PS I to IV) that included testicular volume assessment. Acne was scored by number of comedonal (open plus closed comedones) and inflammatory (papules plus pustules) lesions. Comedonal and inflammatory lesions were analyzed separately and evaluated both as numerical scores and as grades (1, ≤10 lesions; 2,11 to 25 lesions; and 3, ≥26 lesions). Grades 2 and 3 were considered clinically significant acne. Acne became progressively more severe with advancing maturity. Mean acne scores correlated better with PS and pubic hair than with age. Black subjects were more mature than white subjects. Black boys in PS I and II had significantly more comedones than white boys; white boys had significantly more inflammatory lesions at PS I and III. Clinically significant comedonal acne was already present in PS I and occurred in 100% of boys in PS IV. In contrast, no boys at PS I and only 50% at PS IV had significant inflammatory acne. Midfacial acne dominated. We concluded that acne prevalence and severity correlate well with advancing pubertal maturation in young adolescent boys. Comedonal acne was more frequent and severe than inflammatory disease. Awareness of the extent and severity of acne in preadolescents and young adolescents may ultimately provide rationale for early intervention and thus prevention of severe acne vulgaris. (Arch Dermatol. 1991;127:210-216)
— We examined 1555 school children aged 8 to 18 and graded them according to the presence and severity of acne lesions on the face and neck. Comedones were present in a large proportion of even the youngest children and were virtually universal by the mid-teens. Clinical acne appeared 2 years earlier in girls than boys and the maximum prevalence was reached at age 14 in girls and 16 in boys. Thereafter the prevalence of the more severe grades of acne continued to increase steadily in boys, but declined in girls. The age of the menarche in girls did not affect the severity of acne which ultimately developed. More girls than boys sought medical advice despite the generally milder form of the disease in girls.
Acne vulgaris is a common skin disease with a large quality of life impact, characterized by comedones, inflammatory lesions, secondary dyspigmentation, and scarring. Although traditionally considered a disease of adolescence, reports suggest it is also a disease of adults, especially adult women. Our objectives were to determine acne prevalence in a large, diverse group of women and to examine acne by subtype and in relation to other skin findings, measurements, and lifestyle factors. We recruited 2895 women aged 10-70 from the general population. Photographs were graded for acne lesions, scars, and dyspigmentation. Measurements were taken of sebum excretion and pore size, and survey data were collected. Of the women studied, 55% had some form of acne: 28% had mild acne, and 27% had clinical acne, 14% of which was primarily inflammatory and 13% of which was primarily comedonal. Acne peaked in the teenage years, but 45% of women aged 21-30, 26% aged 31-40, and 12% aged 41-50 had clinical acne. Women with inflammatory acne were younger than those with comedonal acne (p≤0.001), and postmenopausal women had less acne than age-matched peers (p<0.0001). Acne was associated with facial hirsutism (p=0.001), large pores (p=0.001), and sebum excretion (p=0.002). Smokers had more, primarily comedonal, acne than nonsmokers. The cross-sectional design precludes conclusions about progression of acne with age. Participation was restricted to women. The photographic nature of the study imposes general limitations. Techniques used in this study were not sufficiently sensitive to identify cases of subclinical acne. More than a quarter of women studied had acne, which peaked in the teens but continued to be prevalent through the fifth decade.