Article

The prevalence of acne in adults 20 years and older

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Abstract

Acne, one of the most common skin diseases, is often mistakenly thought to affect exclusively the teenaged group. However, a significant number of patients either continue to experience acne or develop new-onset acne after the teenaged years. A survey was designed to assess the prevalence of acne in the teenaged years, and aged 20 to 29 years, 30 to 39 years, 40 to 49 years, and 50 years and older. Adults aged 20 years and older were asked to complete surveys distributed at various sites on our university campus and medical complex. Of 1013 participants aged 20 years and older, 73.3% (n = 744) reported ever having acne. After the teenaged years, women were more likely to report having acne than men, with the difference being statistically significant in all age groups. The prevalence of acne reported in women versus men was as follows: 20 to 29 years, 50.9% (n = 276) versus 42.5% (n = 201) (P = .0073); 30 to 39 years, 35.2% (n = 152) versus 20.1% (n = 73) (P < .0001); 40 to 49 years, 26.3% (n = 93) versus 12.0% (n = 36) (P < .0001); and 50 years and older, 15.3% (n = 41) versus 7.3% (n = 18) (P = .0046). Our results are based on the participant's own perception of the presence or absence of acne rather than a clinical evaluation. Acne continues to be a common skin problem past the teenaged years, with women being affected at higher rates than men in all age groups 20 years or older.

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... Acne is a multifactorial inflammatory disease affecting pilosebaceous follicles [94]. Key elements in its pathogenesis are Propionibacterium acnes, keratinocyte hyperproliferation in the follicle, androgen-mediated increase in sebum production, and inflammation [94]. ...
... Acne is a multifactorial inflammatory disease affecting pilosebaceous follicles [94]. Key elements in its pathogenesis are Propionibacterium acnes, keratinocyte hyperproliferation in the follicle, androgen-mediated increase in sebum production, and inflammation [94]. In recent years, several studies have been performed linking the expression of AhR and the appearance of acne [94,95]. ...
... Key elements in its pathogenesis are Propionibacterium acnes, keratinocyte hyperproliferation in the follicle, androgen-mediated increase in sebum production, and inflammation [94]. In recent years, several studies have been performed linking the expression of AhR and the appearance of acne [94,95]. In 2014, Fabbrocini et al. demonstrated the presence of an increased AhR expression in the skin lesions of patients affected by acne living in Campania (Italy), where epidemiological studies have suggested a possibly increased exposure to environmental dioxins [95]. ...
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Aryl Hydrocarbon Receptor (AhR) is an evolutionary transcription factor which acts as a crucial sensor of different exogenous and endogenous molecules Recent data indicate that AhR is implicated in several physiological processes such as cell physiology, host defense, proliferation and differentiation of immune cells, and detoxification. Moreover, AhR involvement has been reported in the development and maintenance of several pathological conditions. In recent years, an increasing number of studies have accumulated highlighting the regulatory role of AhR in the physiology of the skin. However, there is evidence of both beneficial and harmful effects of AHR signaling. At present, most of the evidence concerns inflammatory skin diseases, in particular atopic dermatitis, psoriasis, acne, and hidradenitis suppurativa. This review examines the role of AhR in skin homeostasis and the therapeutic implication of its pharmacological modulation in these cutaneous inflammatory diseases.
... Acne skin problems often occur, although unlike other diseases, they can make a person experience dermatological and psychological problems. [2] . Although acne does not cause death, someone who has acne problems usually has a problem with self-confidence [1][2][3] . ...
... [2] . Although acne does not cause death, someone who has acne problems usually has a problem with self-confidence [1][2][3] . It was reported that as many as 85% of the human population had acne problems at the age of < 25 years (12-25 years) and 15-20% at the age of > 25 years [2] . ...
... Although acne does not cause death, someone who has acne problems usually has a problem with self-confidence [1][2][3] . It was reported that as many as 85% of the human population had acne problems at the age of < 25 years (12-25 years) and 15-20% at the age of > 25 years [2] . There are several factors that cause teenagers and adults to experience acne problems, including stimulating natural oil (sebum) activity in the sebaceous glands and hair follicle areas on the face, stress, hormonal activity, irritation due to scratching and bacterial [4] . ...
Article
This study aimed to test the antibacterial activity of n-hexane and methanol extracts of white cempaka flowers (Magnolia alba) against Propionibacterium acnes bacteria. The extract was obtained by using the maceration method for 72 hours. Each extract was tested for its antibacterial properties using the disc diffusion method with the variant concentration of the extract used was 0.05%; 2%; 4%; 6%; and 8%. The results showed that the methanol extract had a higher inhibition zone than the n-hexane extract. In n-hexane extract, the lowest concentration of 0.05% showed an inhibition zone of 6.6 mm and the highest concentration of 8% had an inhibition zone of 9.6 mm. Whereas in methanol extract, the inhibition zone obtained was 7.3 mm at a low concentration of 0.05%, but at the highest concentration of 8% the inhibition zone obtained was 11.6 mm. The effect of extract concentration on the diameter of the inhibition zone formed is very significant (directly proportional), where the higher the concentration used, the larger the diameter of the inhibition zone produced. Antibacterial testing for both extracts showed a weak (< 10 mm) to moderate (> 10 mm) bacterial inhibition, which was similar with the inhibition zone obtained from the positive control (11-11.3 mm; moderate bacterial inhibition).
... Acne vulgaris is a multifactorial skin disease that frequently occurrs after puberty (Skroza et al., 2018). It continues to be a common and stressful skin problem even after teenage years and especially affects females at higher rates than males (Collier et al., 2008). Emerging evidence suggests that increased sebum production and alterations of sebum composition, including skin surface lipids (SSLs), are among the most pivotal factors in the pathogenesis of acne (Zouboulis et al., 2014;Camera et al., 2016;Zhou et al., 2018). ...
... Acne is a common dermatosis characterized by increased sebum production and inflammatory response (Melnik, 2015). It frequently occurs in teenagers and continues to late adolescence or early adulthood (Collier et al., 2008). Teenagers are prone to have numerous inflammatory and non-inflammatory comedonal lesions in T-zone (forehead, nose, and upper cheeks); however, the female type of adult acne presents deep-seated, long-lasting small nodules and cysts in the U-zone (chin, jawline, and neck) (Holzmann and Shakery, 2014;Dreno et al., 2018). ...
... In the current study, we substantiated that levels of SFA and MUFA from sebum were at higher levels in adult female acne patients than in control females, whereas no significant difference in these FAs was observed in male subjects. These observations might partly explain the increased rates of acne in women than men after puberty (Collier et al., 2008). Furthermore, we observed markedly increased levels of SA in the chin of female patients, consistent with the fact that adult women have a specific appearance of U-zone acne. ...
Article
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Fatty acid (FA) metabolism has been involved in acne vulgaris, a common inflammatory skin disease frequently observed in adolescents and adults, but it remains poorly defined whether the distributions or location of FA in facial sebum and those in the circulation differentially correlate with the disease. In a cohort of 47 moderate acne patients and 40 controls, sebum samples from forehead and chin areas were collected using Sebutape adhesive patches, and erythrocytes were separated from the fasting blood. Total FAs were analyzed by the gas chromatograph-mass spectrometry method. Compared to control female subjects, female patients showed increased levels of saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs) from both facial areas, whereas decreased levels of polyunsaturated fatty acids (PUFAs) from chin areas were observed. Interestingly, the levels of docosahexaenoic acid (DHA) in the circulating erythrocytes were significantly decreased in male patients compared with control. In addition, DHA levels in erythrocytes were positively correlated with PUFAs from sebum only in male subjects. Furthermore, female patients with moderate acne had more severe sebum abnormity and chin-specific FA profiles, consistent with higher acne incidences than males in adulthood, especially in the chin areas. Importantly, serum insulin-like growth factor 1 (IGF-1) levels were positively correlated with SFAs and MUFAs from sebum only in male subjects. In summary, differential spatial FA distributions in facial sebum and correlation with those in erythrocytes and IGF1 levels in serum may shed some light on the pathology of acne in male and female adults.
... Acne is a chronic inflammatory disorder of the pilosebaceous unit with various manifestations, including noninflammation and inflammation lesions. Collier et al. (2008) investigated 1013 Americans aged 20 years and older; 73.3% (744) reported ever having acne, more women suffer from acne than men. 1 Four major factors involved in acne pathogenesis are excessive sebum production, follicular hyperkeratinization, hyper-colonization of the duct by Cutibacterium acnes (formerly Propionibacterium acnes), and the production of inflammation. 2 Moreover, the hormone plays a crucial role in the pathogenesis of acne. ...
... Collier et al. (2008) investigated 1013 Americans aged 20 years and older; 73.3% (744) reported ever having acne, more women suffer from acne than men. 1 Four major factors involved in acne pathogenesis are excessive sebum production, follicular hyperkeratinization, hyper-colonization of the duct by Cutibacterium acnes (formerly Propionibacterium acnes), and the production of inflammation. 2 Moreover, the hormone plays a crucial role in the pathogenesis of acne. ...
Article
Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the serum testosterone, estradiol, progesterone levels in women with acne vulgaris. Methods: We conducted a cross-sectional descriptive study, and 175 women with acne vulgaris were examined; their serum estradiol, progesterone, testosterone were analyzed by chemiluminescence technique and compared with the healthy control group. Results: Increased serum hormone levels in women with acne vulgaris were accounted for 29.7%, and hyperandrogenism was accounted for 16.0% of cases. We found significant differences in testosterone levels (mean value, 55.67±25.56 versus 38.37±10.16 ng/dL, p<0.05) respectively in the acne group and the control group. However, the estradiol level of the acne group (323.15±93.31 pmol/L) was lower than the control group (370.94±58.88 pmol/L) with p<0.05). No statistically significant differences were found for progesterone (0.60±0.38 versus 0.50±0.15 ng/mL, p>0.05) levels. Moreover, we did not find the relationship between serum hormone levels and the severity of acne vulgaris. Conclusion: This study showed that the female acne vulgaris patients may have high serum testosterone levels and low serum estradiol levels compared with those of female controls. However, hormone alterations had no correlation with the acne grades.
... Acne is a common skin disorder that presents frequently both to the internists and the dermatologists. Studies have shown that acne vulgaris may be familial, occurs more frequently in females, although males have more severe disease [2]. It is more common in adolescents and young adults and rare in children less than 10 years and adults older than 50 years [3]. ...
... However, these studies were conducted in both males and females. Interestingly, a US study by Collier et al. [2] consisting of 1,013 participants of both genders reported a mean age of 48.0 years which was higher than the mean age in this study. A possible explanation may due to their research design which was community based. ...
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Introduction: androgens play an important role in the pathogenesis of acne vulgaris. They cause hyperkeratinization of the pilosebaceous follicles and seborrhea. Endocrine diseases characterized by increased levels of androgens often present with acne vulgaris. A correlation between serum androgen levels and acne severity exists, and the assessment of serum androgen levels is therefore essential in women with severe acne vulgaris and treatment resistant acne. Methods: the study was conducted in the Dermatology Clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla. Seventy females with acne vulgaris and seventy females without acne vulgaris were recruited as subjects and controls respectively. Blood samples were taken from subjects and controls to measure levels of serum testosterone, dehydroepiandrosterone sulfate (DHEAS) and androstenedione. Acne severity was measured using global acne grading system (GAGS). Results: the median levels of DHEAS and androstenedione (1.20μg/ml and 1.80ng/ml respectively) were higher in subjects than 1.00μg/ml and 1.70ng/ml in controls respectively, although these findings were not statistically significant. There was also no significant difference between the levels of serum testosterone in both the subjects and the controls. No correlation existed between levels of serum androgens and acne severity. Conclusion: there was no statistically significant difference in the serum androgen levels between the subjects and the control population, and no relationship between androgen levels and severity of acne vulgaris was demonstrated.
... Acne vulgaris is a chronic inflammatory condition of the pilosebaceous unit that affects up to 85% of adolescents (1). However, research conducted over the last years shows that an increasing number of adults, particularly adult women, suffer from this condition (2). ...
... After the teenage years, women are more often affected by acne compared with men (1). A survey conducted in France among 3,305 adult women (aged 25-40 years) found that 24% of women had physiological acne, while 17% had clinical facial acne, with an overall prevalence of 41%. ...
Article
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Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne.
... 13,14 Some interesting differences between sexes were encountered. In our study, acne was associated with women >24 years, which was seen in previous studies, 15,16 while men are more affected as adolescents and young adults, differently from 1 study with 1384 patients had found no difference between genders in acne age. 17 The predominance of acne on the face is well known, both in daily practice and in the literature, and this was also the case in this study. ...
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Introduction/Objectives Acne is present in about 90% of teenagers and 12% to 14% of adults. Face and trunk are the most affected areas. Lesions can result in postinflammatory hyperpigmentation and scarring, leading to reduced quality of life. Asynchronous teledermatology has been increasingly used around the world, facilitating patient access to dermatologists. Our objectives were to assess: (1) clinical features of acne patients according to gender, age, severity, site of lesions, excoriation, postinflammatory hyperpigmentation (PIH), and atrophic scar (AS) and (2) how many referrals to in-person consultations with dermatologists could be avoided using asynchronous teledermatology in primary care attention? Methods We analyzed images, demographic and clinical data of 2459 acne patients assisted by teledermatology, with the aim to confirm the diagnoses, to classify acne severity according to grades I to IV, and to search for the presence of postinflammatory hyperpigmentation, atrophic scars, and/or excoriated acne (EA). We compared the clinical and biological data, looking for associations among them. Results Acne severity and age were associated with the most common sequels: postinflammatory hyperpigmentation (mainly on the trunk and in females, P < .0001) and atrophic scars (mainly on the face and in males, P < .0001). We also observed different frequencies according to age and sex: 13 to 24 years in males ( P = .0023); and <12 ( P = .0023) and 25 to 64 years old ( P <.0001) for females; 68% of the patients had no need for in-person dermatologists’ referral, being kept at primary care attention with proper diagnosis and treatment. Conclusion Clinical features of acne and its sequels differ according to gender, age, site, and severity. The new findings of PIH associated with women and AS, with men, may help offer a more personalized management to patients. Teledermatology was suitable for the majority of the acne cases in primary care.
... The majority of patients with acne vulgaris (67.6%) were found in the age group range of 18 to 29 years, which is a reflection that this skin disease is common in adolescents and often continues into adulthood. 25 While this disease usually begins at puberty, it can start even younger. The current study showed 18.3% of acne patients were less than 5 years of age. ...
Article
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Background: Skin diseases are among the major contributors of disease burden in Ethiopia affecting individuals of all age. Extemporaneous compounding of topical medications serves as a necessary option to treat skin diseases when manufactured medications could not meet specific patient needs. Different classes of drugs are commonly used for the treatment of dermatologic diseases. Failure to periodically assess the prescribing pattern and patient needs may lead to inappropriate planning and implementation that ultimately compromise the service. Periodic prescription analysis for compounded medications helps to monitor the prescription pattern with respect to medication selection, disease condition, dosage form types and other relevant parameters. The current study was conducted to analyze the pattern of compounding prescriptions for dermatologicals in ALERT hospital. Methods: A cross-sectional design was conducted by retrospectively evaluating compounding prescription records of January and July, 2021. A total of 460 prescriptions in the hospital community pharmacy were systematically selected. Data related to disease pattern, product selection and dosage form type were extracted and analyzed. Data analysis was done using software for the statistical package for social science version 25.0. Results: A total of 441 prescriptions containing dermatological products for compounding were analyzed. Most patients were female (62.8%) and aged 30-64 years (44.0%). Psoriasis (36.2%), acne vulgaris (15.3%), and rosacea (13.4%) were the top 3 skin diseases for which the compounding preparations were prescribed. Salicylic acid (38.0%) was the most frequently prescribed drug followed by betamethasone (20.2%); while white petrolatum (47.2%) was the most common diluting agent used for compounding. Conclusion: Psoriasis was the major dermatologic disease for compounding prescriptions and salicylic acid was the most frequent product used in compounding for treatment of the prescribed skin diseases.
... [8][9][10][11][12][13][14] Although peak prevalence is seen in 16-20-year-olds, 15,16 acne is common in adult women as well. 17 Isotretinoin, 13-cis-retinoic-acid, is the single most effective therapy for severe acne. With unparalleled efficacy, [18][19][20] it is the only acne medication that can offer a significant durable response to an estimate 85% of acne patients. ...
Article
Background Acne is a common, chronic inflammatory condition seen in nearly all teenagers and many adult females, with a global lifetime prevalence between 70-85%. While a majority of individuals with acne can be appropriately managed with a combination of topical therapies, oral antibiotics, and/or oral anti-androgens, 10-20% of individuals will have acne severe enough to warrant isotretinoin. When necessary, isotretinoin is highly effective and the only drug to offer the likelihood of a durable response. Aims To review the literature regarding known adverse effects of isotretinoin therapy and nuances during and post-isotretinoin therapy important to patient care. Materials and Methods A literature search was conducted for original, English-language case reports, case series, original studies and/or meta-analyses published between 1982-2021 on isotretinoin, related adverse effects, and laboratory assessment and treatment nuances during and after a course of isotretinoin. Results Adverse events categories include mucocutaneous (e.g., xerosis, cheilitis, epistaxis), ocular (xerophthalmia, nyctalopia, blepharitis, conjunctivitis), non-specific gastrointestinal, musculoskeletal (myalgia, pre-mature epiphyseal plate closure, DISH), neurologic (idiopathic intracranial hypertension, hearing loss, tinnitus). Most adverse events are mild, self-limiting, and/or resolve with drug discontinuation. Teratogenicity is of utmost concern especially given the risk of patient nonadherence to iPLEDGE precautions. Laboratory testing at baseline and after month 2 of therapy or upon reaching maximum daily dose may be sufficient. Utilizing creatine kinase and gamma-glutamyl transferase in lieu of aspartate aminotransferase and alanine aminotransferase may better assess hepatic function during treatment. Improved formulations of isotretinoin may improve absorption and decrease reliance on patient adherence to a high-fat diet. Dermabrasion and fully ablative laser procedures should be avoided in the immediate post-isotretinoin period. Discussion Although adverse events associated with isotretinoin therapy are common, a majority of side effects are limited, self-resolving (with completion of treatment course) without long-term implications, and/or easily managed. Unfortunately, the advent of the internet and social media has given a platform to misleading law-firm claims and medical pseudoscience inaccuracies that may frighten patients in need of treatment, ultimately delaying or even preventing therapy. Conclusion It is important that physicians are knowledgeable about the nuances of isotretinoin therapy, including efficacy, real potential adverse events, and appropriate laboratory monitoring. By honing this expertise, physicians may confidently counsel and guide patients through a course of isotretinoin to achieve a more permanent solution for their acne and improve their quality of life.
... Little mention is made directly or indirectly in published literature to the patient preference for Quality of Life reasons to escalating treatment choices up the ladder to a more efficacious treatment option. Also there is little discussion made of the mental health issues caused to a patient by a disease but not directly related to the disease [11][12][13][14][15][16]. ...
... AV is the most frequent disease of the skin and is a typical condition, affecting approximately 85% of teenagers [2], with males most frequently affected in younger ages, and females in adult ages [3]. Acne lesions occur mainly in the body areas where the pilosebaceous units are more represented such as the face, back, and chest. ...
Article
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Acne Vulgaris (AV) and Hidradenitis suppurativa (HS) are common chronic inflammatory skin conditions that affect the follicular units that often coexist or are involved in differential diagnoses. Inflammation in both these diseases may result from shared pathways, which may partially explain their frequent coexistence. MicroRNAs (miRNAs) are a class of endogenous, short, non-protein coding, gene-silencing or promoting RNAs that may promote various inflammatory diseases. This narrative review investigates the current knowledge regarding miRNAs and their link to AV and HS. The aim is to examine the role of these molecules in the pathogenesis of AV and HS and to identify possible common miRNAs that could explain the similar characteristics of these two diseases. Five miRNA (miR-155 miR-223-, miR-21, and miRNA-146a) levels were found to be altered in both HS and AV. These miRNAs are related to pathogenetic aspects common to both pathologies, such as the regulation of the innate immune response, regulation of the Th1/Th17 axis, and fibrosis processes that induce scar formation. This review provides a starting point for further studies aimed at investigating the role of miRNAs in AV and HS for their possible use as diagnostic-therapeutic targets.
... Acne vulgaris is a common, puberty-associated, cutaneous disorder, with a lifetime incidence of nearly 100%, that is defined by lesions that result from the inflammation of plugged pilosebaceous units. 1,2 Lesion pathogenesis is multifactorial and includes contributions from the hormonal activation of sebaceous glands and Cutibacterium acnes bacteria-associated follicle inflammation. ...
Article
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Background Acne vulgaris is a common cutaneous disorder. Diet and metabolism, specifically glycemic content and dairy, influence hormones such as insulin, insulin-like growth factor 1, and androgens, which affect acnegenesis. Objective To systematically review high-quality evidence regarding the association of dietary glycemic and dairy intake with acnegenesis. Methods A comprehensive literature search, without timeline restriction, of MEDLINE (completed between October and November 2021) for English-language papers that examined the association between diet and acne was conducted. The evidence quality was assessed using the Ottawa quality assessment scale. Results The literature search yielded 410 articles, of which 34 articles met the inclusion criteria. The literature on whether dairy product intake is associated with acnegenesis is mixed and may be dependent on sex, ethnicity, and cultural dietary habits. High glycemic index and increased daily glycemic load intake were positively associated with acnegenesis and acne severity, an observation supported by randomized controlled trials. Conclusion High glycemic index, increased glycemic load, and carbohydrate intake have a modest yet significant proacnegenic effect. Increased dairy consumption may have been proacnegenic in select populations, such as those in which a Western diet is prevalent. The impact of diet on acnegenesis is likely dependent on sex and ethnicity. Further randomized trials are necessary to fully characterize the potential associations.
... Progressive chronological aging is associated with a reduced prevalence of acne. Whereas adolescent individuals have the highest prevalence of Acne vulgaris, exceeding 85%, this prevalence was found to be 51%/43% for females/males in the age group of 20-29-yearolds, 35%/20% for 30-39-year-olds, 26%/12% in 40-49-year-olds, and 15%/7% in the group of individuals older than 50 years of age [70]. The reduction in acne prevalence with chronological aging was traditionally explained by reduced sebum production. ...
Article
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Adipocytes from the superficial layer of subcutaneous adipose tissue undergo cyclic de- and re-differentiation, which can significantly influence the development of skin inflammation under different cutaneous conditions. This inflammation can be connected with local loading of the reticular dermis with lipids released due to de-differentiation of adipocytes during the catagen phase of the hair follicle cycle. Alternatively, the inflammation parallels a widespread release of cathelicidin, which typically takes place in the anagen phase (especially in the presence of pathogens). Additionally, trans-differentiation of dermal adipocytes into myofibroblasts, which can occur under some pathological conditions, can be responsible for the development of collateral scarring in acne. Here, we provide an overview of such cellular conversions in the skin and discuss their possible involvement in the pathophysiology of inflammatory skin conditions, such as acne and psoriasis.
... Acne vulgaris (AV) is one of the most common skin diseases in different societies; accordingly, almost all people have faced this issue at least once in their life (Bhate and Williams, 2013). Although it was wrongly believed that only the adolescent group are affected, post-adolescent acne has occurred primarily in females (Collier et al., 2008). AV does not appear to be a severe and life-threatening illness; however, it affects patients' quality of life and self-confidence (Dunn et al., 2011;Tan et al., 2008). ...
Article
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Background Acne vulgaris (AV) is one of the most prevalent skin disorders evolving in pre and post-adolescent periods. Conventional therapies indicate many adverse events and limitations; nonetheless, botanical agents are proposed for minimal side effects and faster action. This study aimed to assess the clinical efficacy of topical Rosmarinus officinalis and clindamycin/benzoyl peroxide in patients with AV. Methods Fifty healthy subjects (42 females, 8 males) with mild to moderate AV were randomly assigned (1:1) into two groups, clindamycin and benzoyl peroxide gel 1%/5% (group A), and rosemary gel (group B). They received a thin layer of topical gels on the affected area twice daily for twelve weeks. A total number of inflammatory lesions (TIL), total number of comedones (TC), and pustules and papules at baseline, weeks 4, 8, and 12 were measured as primary outcomes. Safety evaluations and the DLQI test were also performed. Results After 12 weeks of therapy, TIL, TC, the number of pustules and papules declined in both groups; however, only group B indicated significant differences at weeks 4, 8, and 12 (p<0.05). Moreover, TIL and TC diminished more rapidly in group B. Even though all adverse events vanished within the first week of the study, their incidence exhibited significant variations (p<0.05). Conclusion This study revealed that rosemary gel significantly improved the healing of AV symptoms, and it might be utilized as a potential agent for treating AV.
... Non-inflammatory acnes include open comedones known as whiteheads and closed comedones known as blackheads (Berry et al. 2020). The persisting scarring in some individuals might also lead to psychological and emotional disturbances in some (Collier et al. 2008) and will be discussed in the following sections. ...
Chapter
The human microbiome includes microorganisms and their cumulative genetic details that reside in the human body. Skin, the body’s most external organ and exposed to the external environment, is an ecosystem with 1.8 m² area. It has a varying epidermal thickness, folds, and appendages in different areas including along with varying moisture and temperature level on the skin surface. Microbial colonization on the skin surface starts from the time of birth. The mode of delivery affects the colonization process to a considerable extent. The group of microbes colonizing the skin surface is determined by physical and chemical features of it, which applies to microbes inhabiting the gut and other ecological niches in the body as well. There is several common important characteristics shared commonly by gut and skin, where both are (1) heavily vascularized, (2) richly perfused, (3) densely innervated, (4) integrated to the immune system, (5) highly associated with the endocrine system, (6) extensively colonized with recognizable microbiota, and (7) both helps our body to communicate with its external environment. It has variously been reported that a close and bidirectional association within the gut and skin in maintaining the homeostasis and allostasis of skin and also gastrointestinal (GI) health. Therefore, numerous intestinal pathologies have been linked to skin comorbidities. It has been found that skin is directly impacted by the various circumstances that principally affect the intestine. Similarly, various gastrointestinal disorders could be linked to distinct dermatological entities. In the same context, a growing body of proof proposes an association of intestinal dysbiosis with many regular inflammatory skin pathologies including atopic dermatitis (AD), psoriasis, rosacea, and acne vulgaris. And the realization of this interconnected association between skin and gut has resulted in a new concept of the “Gut-Skin Axis.” An intimate bidirectional engagement between the gut and the skin has been well established by growing research evidence in this domain. Recent reports have indicated that the administration of specific Lactobacilli strains to mice can significantly alter the overall skin phenotype. Despite increasing research efforts in this domain, a systematic investigation of the “Gut-Skin Axis” remains ill explored by both gastroenterology as well as dermatology researchers. And in this context, here we are discussing various aspects of the Gut-Skin Axis and its role in the general well-being of individuals.
... A cne vulgaris is a common inflammatory skin disease, which occurs during puberty. Acne affects approximately 85% of young adults and may persist into adulthood (1). The pathogenesis of acne is multifactorial, including increased production of sebum, abnormal keratinization, inflammation, and proliferation of Cutibacterium acnes bacteria (2). ...
Article
The association between diet and acne has been growing in concern. Every country has its own food culture. A few studies surveyed the influence of Asian cuisine on acne. This study investigated the association between acne severity and diet/lifestyle factors in 2,467 Thai adolescents and adults. The data were collected from the validated semi-quantitative food frequency questionnaire. The prevalence of mild acne was 52%, moderate acne was 22%, and 8% severe acne in Thai adolescents and adults. No acne was found in 18% of participants. The dietary factors associated with increased acne severity were the consumption of chocolate >100 grams/weeks (aOR, 1.29; 95% CI, 1.07-1.56), oily and fried food >3 times/week (aOR, 1.84; 95% CI, 1.07-3.16) and white rice (aOR, 1.80; 95% CI, 1.24-2.63). On the contrary, the factors associated with decreased acne severity were the consumption of sugar-free tea (aOR, 0.61; 95% CI, 0.43-0.87), and vegetables (aOR, 0.74; 95% CI, 0.62-0.89).
... Concept: Acne vulgaris is a chronic inflammatory cutaneous disease of the pilosebaceous unit and the most common cutaneous disorder affecting adolescents and young adults. It has a significant impact in psychological morbidity with even suicidal tendencies [3,4].The prevalence of acne vulgaris in adolescents range from 35 to over 90 percent [5,6]. ...
Article
We present the more relevant aspects of the 10 most frequent dermatologic diagnostics: acne, fibroepithelial polyps, atopic dermatitis, seborrheic dermatitis, molluscum contagiosum, melanocytic nevi, psoriasis, actinic keratosis, seborrheic keratosis and viral warts. We describe their pathogenesis, clinical features, their management and preventive actions to avoid the progression of the conditions.
... It is possible that insufficient amounts of protective antibodies to C. acnes for prevention of acne vulgaris thereby lead to recurrence of acne vulgaris (Nakatsuji et al., 2008). Furthermore, age is a potential factor, as it has been reported that opportunistic C. acnes ribotypes are predominantly present in lesions of acne vulgaris in adolescents and young adults (Barnard et al., 2016), whereas the abundance of C. acnes declined in aged skin (Collier et al., 2008), and the abundance of Corynebacterium spp. conversely increased on the aged skin (Li et al., 2014). ...
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The serological lateral flow immunoassay (LFIA) was used to detect circulating antibodies to skin bacteria. Next-generation sequencing analysis of the skin microbiome revealed a high relative abundance of Cutibacterium acnes but low abundance of Staphylococcus aureus and Corynebacterium aurimucosum on human facial samples. Yet, results from both LFIA and antibody titer quantification in 96-well microplates illustrated antibody titers that were not correspondent, and instead negatively correlated, to their respective abundance with human blood containing higher concentrations of antibodies to both S. aureus and C. aurimucosum than C. acnes . Acne vulgaris develops several unique microbial and cellular features, but its correlation with circulating antibodies to bacteria in the pilosebaceous unit remains unknown. Results here revealed that antibodies to C. acnes and S. aureus were approximately 3-fold higher and 1.5-fold lower, respectively, in acne patients than in healthy subjects. Although the results can be further validated by larger sample sizes, the proof-of-concept study demonstrates a newfound discrepancy between the abundance of skin bacteria and amounts of their corresponding antibodies. And in light of acne-correlated amplified titers of specific anticommensal antibodies, we highlight that profiling these antibodies in the pilosebaceous unit by LFIAs may provide a unique signature for monitoring acne vulgaris.
... Acne vulgaris (AV) is a common skin disease that affects more than 85% of adolescents [1]. It is a multifactorial process in which several factors have been implicated, including hormonal effects, follicular hyperkeratinization, proliferation of Propionibacterium acne, as well as inflammatory, environmental, and genetic factors [2]. ...
... The mean ± SD age of participants was 24.5 ± 4.07 years and females were more affected than males. The data are in agreement with Collier et al. who reported that acne vulgaris continues to be a common dermatological problem in late adolescence, with females being more affected than males aged 20 years or older (Collier et al., 2008). This study found a 40% familial occurrence, which is consistent with Biswas et al. and Ghodsi et al. who observed a positive family history in causation of acne vulgaris (Biswas, 2010;Zahra Ghodsi et al., 2009). ...
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Introduction Acne vulgaris is a disease of the pilosebaceous unit that primarily affects teenagers and young adults. It relates to significant psychological morbidity and, on rare occasions, fatality due to suicidal tendencies. Though Unani medicines have been used to treat it for millennia, scientific investigations and evidence-based literature are rare. Thus, the purpose of this study was to determine the efficacy of the herbal formulation Ṭilā-i Muhāsa consisting of Azadirachta indica A. Juss., Albizia lebbeck L., and Iris ensata Thunb. in treating acne vulgaris as well as the influence on patients’ quality of life. Methods In this clinical trial, 31 clinically diagnosed patients with acne vulgaris received Ṭilā-i Muhāsa to be applied on the afflicted site every night and washed off with normal water after 20-30 minutes, of whom 30 completed the protocol therapy. The primary outcome measures were changes in subjective parameters such as comedones, papules, pustules, erythema, and itching, assessed on a 4-point grading scale, and change in investigator’s global assessment for overall disease severity, at baseline, 7th, 14th, and 21st days. The secondary outcome measure was change in quality of life (QoL) assessed on the Cardiff acne disability index (CADI). Results The per-protocol analysis of subjective parameters revealed statistically significant improvement in comedones, papules, pustules, erythema, nodules, and itching. Additionally, statistically significant improvement in IGA and QoL were also detected. Conclusion The findings of the present study indicated that topical use of Ṭilā-i Muhāsa is an effective and well-tolerated therapeutic option for patients with moderate to severe acne vulgaris.
... Acne, one of the most common skin conditions treated by dermatologists and other health care professionals (HCPs), generally affects adolescents and young adults, but it can persist later in adulthood despite treatment. [1][2][3][4][5] Clinically, acne typically presents in various forms, with truncal acne presenting in more than half of the patients with facial involvement. [6][7][8][9][10][11] Despite its varying presentations and chronic nature, current guidelines offer little guidance to facilitate personalized or longitudinal management of patients. ...
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Background Acne is a chronic disease with a varying presentation that requires long-term management. Despite this, the clinical guidelines for acne offer limited guidance to facilitate personalized or longitudinal management of patients. Objectives To generate recommendations to support comprehensive, personalized, long-term patient management that address all presentations of acne and its current and potential future burden. Methods The Personalising Acne: Consensus of Experts panel consisted of 13 dermatologists who used a modified Delphi approach to reach consensus on statements related to longitudinal acne management. The consensus was defined as ≥75% voting “agree” or “strongly agree.” All voting was electronic and blinded. Results Key management domains, consisting of distinct considerations, points to discuss with patients, and “pivot points” were identified and incorporated into the Personalised Acne Care Pathway. Long-term treatment goals and expectations and risk of (or fears about) sequelae are highlighted as particularly important to discuss frequently with patients. Limitations Recommendations are based on expert opinion, which could potentially differ from patients' perspectives. Regional variations in health care systems may not have been captured. Conclusions The Personalised Acne Care Pathway provides practical recommendations to facilitate the longitudinal management of acne, which can be used by health care professionals to optimize and personalize care throughout the patient journey.
... 5 The residual scars from acne can affect a patient's self-esteem leading to psychological issues like depression, anxiety, and even suicidal ideation. 6 Inflammation is one of the major factors involved in acne which is proven by the detection of many interleukins (IL-1, IL-8) in comedones and the presence of lymphocytes and macrophages in early, non-inflammatory acne lesions. [7][8][9][10] Other pro-inflammatory mediators, such as leukotrienes (LTs) and prostaglandins (PGs), are implicated in the initiation and progression of acne. ...
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Chapter
Skin conditions like acne vulgaris have been linked to hormonal imbalance as well as microbiota pertaining to the brain-gut-skin axis. Having acne and distressed skin conditions also have links to cognitive and behavioural indisposition, often due to deficiency of certain nutrients and thereby giving rise to the approaches discussing gut-brain-skin axis. This has been addressed widely by the supplementation of diet with probiotics. This keeps the human skin microbiome in check, thereby eliminating the growth of commensal skin bacteria and maintaining skin microbiome homeostasis. The use of probiotics has proven beneficial in acne conditions facing antibiotic resistance and inhibiting inflammation in severe cases. This has increased the demand for oral probiotics to modulate and treat skin conditions. This section will focus on different approaches in the use of such probiotic supplements for treating acne, various interplaying factors, effects, and advancements.
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Abnormal mosaicism is the coexistence of cells with at least two genotypes, by the time of birth, in an individual derived from a single zygote, which leads to a disease phenotype. Somatic mosaicism can be further categorized into segmental mosaicism and nonsegmental somatic mosaicism. Acne is a chronic illness characterized by inflammatory changes around and in the pilosebaceous units, commonly due to hormone- and inflammatory signaling-mediated factors. Several systemic disorders, such as congenital adrenal hyperplasia, polycystic ovarian syndrome, and seborrhoea-acne-hirsutism-androgenetic alopecia syndrome have classically been associated with acne. Autoinflammatory syndromes, including PAPA, PASH, PAPASH, PsAPASH, PsaPSASH, PASS, and SAPHO syndromes include acneiform lesions as a key manifestation. Mosaic germline mutations in the FGFR2 gene have been associated with Apert syndrome and nevus comedonicus, two illnesses that are accompanied by acneiform lesions. In this review, we summarize the concept of cutaneous mosaicism and elaborate on acne syndromes, as well as acneiform mosaicism.
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The disordered skin microbiome has been reported to contribute to the pathogenesis of acne vulgaris, for which benzoyl peroxide (BPO) has long been recommended as the first-line therapy. However, there are no data regarding the effect of BPO treatment on skin microbiota and the epidermal barrier in young adults with acne vulgaris. Thirty-three patients with acne vulgaris and 19 healthy controls were enrolled in the study. All patients received topical treatment with BPO 5% gel for 12 weeks. The epidermal barrier was analyzed at baseline and after treatment. Microbial diversity was analyzed using a high-throughput sequencing approach targeting the V3-V4 region of 16S rRNA genes. After receiving treatment with BPO, patients had significant improvement in their Global Acne Grading System (GAGS) score, porphyrin, and red areas (p < 0.05), and the presence of sebum, stratum corneum hydration (SCH), and transepidermal water loss (TEWL) increased (p < 0.05). When compared with baseline, microbial diversity was significantly reduced after treatment, as calculated by the goods coverage (p = 0.0017), Shannon (p = 0.0094), and Simpson (p = 0.0017) diversity indices. The prevalence of the genus Cutibacterium (before treatment: 5.64 [3.50, 7.78] vs. after treatment: 2.43 [1.81, 3.05], p = 0.011) was significantly reduced after treatment while Staphylococcus (before treatment: 43.80 [36.62, 50.98] vs. after treatment: 53.38 [44.88, 61.87], p = 0.075) tended to increase. The abundance of Staphylococcus was negatively associated with SCH (p = 0.008, r = −0.286). Despite its contribution to an improved GAGS score, BPO treatment for acne vulgaris may reduce microbial diversity and damage the epidermal barrier. This article is protected by copyright. All rights reserved.
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Adult acne is defined as a presence of acne beyond the age of 25 years. Two main subtypes can be identified: persistent acne and late-onset acne (beginning after the age of 25 years), which are responsible for 80 and 20% of cases, respectively. Women have a high prevalence and incidence when compared with men. Hyperandrogenism is the main aetiology associated with acne in this age group. Stress-related worsening of acne is a common complaint. Due to the visibility of acne, it is known to have psychosocial impact that can influence person's perceptions regarding their self-appearance, resulting in poor quality of life. Adult acne is often refractory to treatment as older skin presents increased irritancy to topical applications and has potential for bacterial resistance. Treatment failures with antibiotics occur in up to 80% of adult women. Antiandrogens are associated with the risk of feminisation of male foetus, hepatotoxicity, hyperkalaemia etc. Isotretinoin which is given in severe cases is proved to be potent teratogen. In this backdrop, there has been a need for gentle and effective way of treatment, and homoeopathy has the answer. Homoeopathy has a holistic approach having the general acceptance and compliance amongst masses; it has been considered safe in pregnancy and during lactation period. Further, no bacterial resistance develops after prolonged use of homoeopathic medicines. Earlier studies conducted signify the action of homoeopathic medicines in the treatment of adolescent acne with effective results. Not many studies have focused or conducted on the adult acne. This review suggests conducting the future research studies on adult acne through homoeopathic medicine.
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Anti-acne herbal formulations are utilized for the treatment of acne vulgaris with the additional benefit of not creating adverse effects, unlike synthetic drugs. Phytoconstituents present in methanolic extracts of Glycyrrhiza glabra have antibacterial and antioxidant properties. An approved UV spectrophotometer confirmed the presence of glycyrrhizin in these extracts. Extracts loaded with Carbopol  940 were utilized for the preparation of herbal drug-loaded ethosomal gel formulations (EF1, EF2, and EF3) at various times and followed the assessment of ethosomal gel formulation. The evaluation of ethosomal gel formulation done by pH, viscosity, spreadability, texture analysis, differential scanning calorimetry, FT-IR spectral analysis, in vitro drug release study, and antioxidant activity against Propionibacterium acnes. Herbal ethosomal gel formulation demonstrated antibacterial potential and was additionally assessed for skin permeation by gamma scintigraphy utilizing hydrophilic radiotracer 99mTc-DTPA and lipophilic radiotracer 99mTc-MIBI. Significant permeation (1.3 μg/mg) was seen with a hydrophilic radiotracer named 99mTc-DTPA-PHF and this proposed that the formulation was equipped with sustained drug delivery for the treatment of moderate to an extreme type of acne.
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Introduction: Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne. Areas covered: Herein, the author discusses the treatment of comedonal, papulopustular and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases. Expert opinion: The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.
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I In current literature review the physicochemical properties, peculiarities of mode of action and pharmacokinetics of azelaic and influence of azelaic on pathogenetic aspects of acne are characterized.
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Current data on the acne pathogenesis are given. According to the authors, dermatosis is becoming more prevalent among women of mature age. Issues related to the clinical picture, effect of exogenous and endogenous factors on the course of acne, and psychosocial characteristics of delayed acne manifestations in women are described in detail. The essential role of medical and cosmetic products for the complex therapy of acne is discussed. The authors describe their own experience of treating delayed acne using the Hyseac line of medical and cosmetic products in a combination with microdermabrasion and no-needle mesotherapy using the vitaPeel/vital О2 device.
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b>Hintergrund: In den letzten 30 Jahren wurde die topische photodynamische Therapie (PDT) zur Behandlung eines breiten Spektrums von kosmetischen, entzündlichen und infektiösen Hauterkrankungen mit variablen und oft kontrastierenden Ergebnissen untersucht. Allerdings kann es für den nicht fachkundigen Arzt schwierig sein, diese Ergebnisse zu bewerten, da verschiedene empfindlichkeitssteigernde Stoffe, Konzentrationen, Formulierungen, Lichtquellen und Bestrahlungsprotokolle verwendet wurden. Darüber hinaus haben viele dieser Studien als Fallberichte und unkontrollierte Studien von wenigen Fällen eine schlechte Design-Qualität. Zusammenfassung: Mit dem Ziel, den potenziellen Nutzen von PDT für die Behandlung von infektiösen und entzündlichen Hauterkrankungen sowie ausgewählten kosmetischen Indikationen zu klären, suchten wir nach randomisierten kontrollierten klinischen Studien, nicht randomisierten Vergleichsstudien, retrospektiven Studien und Fallreihenstudien mit einer Anzahl von mindestens 10 Patienten, die seit 1990 veröffentlicht wurden. Später haben wir die Ergebnisse neu bewertet, um einen einfachen kritischen Überblick zu geben. Die Kernbotschaften: Literaturbelege scheinen die Verwendung von ALA- und MAL-PDT zur Behandlung von häufigen Hauterkrankungen wie Akne, Warzen, Kondylomen und Leishmania-Hautinfektionen sowie zur Photorejuvenation, d. h. zur kosmetischen Korrektur ausgewählter kosmetischer Alterungs- und Lichtalterungsschäden stark zu unterstützen. Für andere Erkrankungen sind die Evidenz und die Stärke der Empfehlung niedriger, und kontrollierte randomisierte Studien mit verlängerten Nachbeobachtungen sind notwendig, um den klinischen Nutzen und andere potenzielle Vorteile gegenüber den aktuellen Behandlungsoptionen zu beurteilen.
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Acne is a frequently presented dermatological condition brought about by an interplay among inflammation, increased sebum production, hyperkeratinisation, and predominantly Propionibacterium acnes (renamed as Cutibacterium acnes) proliferation, leading to debilitating psychological scars. However, it has been shown that it is the loss of microbial diversity in the skin and the imbalance among C. acnes phylotypes that brings about acne rather than the C. acnes species as a whole. Interestingly, recent evidence suggests that other microorganisms may be implicated, such as the fungi Malassezia and the bacteria Cutibacterium granulosum. A plethora of scientific evidence suggests that the gut microbiome is implicated in the overall health and physiology of the host; studies show that the gut microbiome of acne patients is distinct and depicts less microbial diversity compared to individuals without acne. Herein, using the key terms: acne, C. acnes, IGF-1, sebum, and gut microbiome, we carried out a review of the literature, using Google Scholar and PubMed, and discussed the role of the gut and skin microbiome in relation to acne, as a narrative review. The role of hormones, diet, sebum, and stress in relation to the gut microbiome was also investigated. Therapeutic implications and the use of pre-/postbiotics are also deliberated upon. In this light, future research should investigate the relationship between the gut microbiome and the agreed upon factors of acne pathology, potentially leading to the discovery of novel acne treatments with milder side effects.
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Acne vulgaris is a multifactorial chronic disorder of the pilosebaceous unit. Established treatments include topical retinoids, antibiotics in mild cases, and oral antibiotics and isotretinoin in moderate to severe cases. Anti-androgens and other hormonal therapies constitute another group of drugs in the armamentarium of acne management. These can be used in patients who do not respond to the aforementioned treatments or when other systemic drugs cannot be tolerated. Recent approval of topical androgen receptor blocker is an additional armamentarium for the management of acne. Considering limited systemic exposure and good efficacy, it has potential for wide usage in patients with acne. In this article, we critically review currently available hormonal treatment options based on published literature search of an electronic database (MEDLINE/PubMed) performed through June 2021. J Drugs Dermatol. 2022;21(6):618-623. doi:10.36849/JDD.6494.
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Background: Acne vulgaris varies in clinical severity, from minimal comedonal disease to severe hemorrhagic and ulcerative lesions with scarring. While a family history confers a higher risk for developing acne, the correlation between heritability and clinical severity remains unclear. Objective: To examine the natural history and heritability of severe acne with scarring in patients undergoing isotretinoin therapy. Methods: A total of 101 subjects with severe acne with scarring and its variants, including acne conglobata and acne fulminans, were enrolled. All subjects and adult family members underwent an interview regarding their acne, and a corresponding "historical" Investigator's Global Assessment (hIGA) score (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe) was assigned. Study assessors performed an "examination" Investigator's Global Assessment (eIGA) based on the clinical examination of each subject (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe). A detailed family history and pedigree were documented. Results: Most subjects were Caucasian (44.5%) and male (79.2%) who had previously used doxycycline and/or minocycline (86.1%). The mean eIGA and hIGA scores were 2.7 and 4.4, respectively. 37.2% of subjects had one first-degree relative with a history of moderate or severe acne with scarring; of note, of the patients with hemorrhagic disease, 30% had at least one parent with moderate or severe acne. Conclusions: Severe forms of acne often "cluster" in families, underscoring the heritable nature of acne and the prognostic value of a family history of moderate or severe disease.
Article
Objective. To evaluate the nature of changes in hormonal homeostasis among patients with acne, depending on menstrual function disorders. Acne is a common skin disease characterized by the development of an inflammatory process in the sebaceous glands; at the age of 1224, it is equally observed in boys and girls, and at an older age, it mainly affects women. Acne has a complex pathogenesis, in which hereditary, metabolic, immune and endocrine mechanisms are realized. It is often found in women with a violation of menstrual function. The aim of the study was to evaluate the nature of changes in hormonal homeostasis among patients with acne, depending on menstrual function disorders. Materials and methods. The study involved 65 patients with acne, who were divided into two groups: group I was formed by 40 patients with acne having menstrual disorders; group II included 35 patients with acne without menstrual function disorders. The groups were comparable by social status and age; all were residents of the Perm Region, all gave voluntary written consent to participate in the study. The study included general clinical techniques, dermatological status and laboratory methods including biochemical blood analysis with indicators of lipid spectrum, glucose, total protein, zinc, liver enzymes, pituitary hormones (FSH, LH, TSH, prolactin) and sex hormones. Methods of parametric and nonparametric statistics were used to analyze the data obtained. Results. In patients with acne, minor metabolic changes were detected, equally with and without menstrual cycle disorders. In the study of hormonal homeostasis, it was noted that in acne patients with menstrual cycle disorders, hyperprogesteronemia was determined much more often (80.0 6.3 %). The remaining sex hormones and pituitary hormones had insignificant changes in both the groups studied. Conclusions. Acne, accompanied by a disturbance of menstrual function, is characterized by change in hormonal homeostasis in the form of an increased level of blood progesterone. In acne patients with a normal menstrual cycle, hormonal changes are insignificant. The metabolic disorders observed in acne do not depend on the character of the menstrual cycle. Patients with acne having menstrual dysfunction require joint management and treatment by both dermatovenerologist and gynecologist. In other cases, dermatological tactics is the basic one.
Article
Acne affects more than 640 million people worldwide, including about 85% of adolescents. This inflammatory dermatosis affects the entire population, from teenagers to adults, which reinforces the need to investigate it. Furthermore, in adults, acne has serious consequences, including a psychological impact, low self‐esteem, social isolation, and depression. Over the last years, the understanding of acne pathophysiology has improved, mainly thanks to the identification of the pivotal role of the microbiota. The aim of this review was to screen the most recent scientific literature on adult acne and the newly tested treatments. Clinically, therapeutic innovations for the treatment of acne have been recently developed, including pre/probiotics, new molecules, and innovative formulations associated, however, with fewer side effects. Moreover, clinical trials are underway to use off‐label molecules that seem to be proving their value in the fight against adult acne.
Article
Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the serum testosterone, estradiol, and progesterone levels in women with acne vulgaris. Methods: We conducted a cross-sectional descriptive study, and 175 women with acne vulgaris were examined; their serum estradiol, progesterone, and testosterone were analyzed by chemiluminescence technique and compared with the healthy control group. Results: Increased serum hormone levels in women with acne vulgaris accounted for 29.7%, and hyperandrogenism accounted for 16.0% of cases. We found significant differences in testosterone levels (mean value, 55.67±25.56 versus 38.37±10.16 ng/dL, p<0.05) respectively, in the acne group and the control group. However, the estradiol level of the acne group (323.15±93.31 pmol/L) was lower than the control group (370.94±58.88 pmol/L), with p-value under 0.05. No statistically significant differences were found for progesterone (0.60±0.38 versus 0.50±0.15 ng/mL, p>0.05) levels. Moreover, we did not find the relationship between serum hormone levels and the severity of acne vulgaris. Conclusion: This study showed that female acne vulgaris patients may have high serum testosterone levels and low serum estradiol levels compared with those of female controls. However, hormone alterations had no correlation with acne severity.
Article
Acne is one of the most common skin diseases whose disfiguring results may cause psychological problems. Despite of the various choices in the treatment of acne, new therapy with fewer complications and lower relapse rate is still in need. In this study, we aim to evaluate the clinical efficacy of a new therapy using selective sebaceous gland electro-thermolysis and non-thermal plasma (NTP) in refractory acne patients. Treatments were given at a monthly interval for three times. The last visit was set at 3 months after the third treatment. Thirty-six moderate to very severe acne patients were enrolled. All the patients got more than 50% clearance after the third treatment. The excellent response rate was 44% at 1 month after the third treatment and 50% at 3 months after the third treatment. Porphyrin and erythema values were significantly reduced after the third treatment. No irreversible complication was reported. Selective sebaceous gland electro-thermolysis combined with NTP can be a safe and effective new option in the treatment of acne.
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The author generalizes and summarizes information about epidemiology, pathogenesis, diagnostics and treatment of acne in women. Anti-inflammatory, anti-microbial and keratolytic properties of azelaic acid for the external therapy of acne are examined.
Article
Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the serum testosterone, estradiol, progesterone levels in women with acne vulgaris. Methods: We conducted a cross-sectional descriptive study, and 175 women with acne vulgaris were examined; their serum estradiol, progesterone, testosterone were analyzed by chemiluminescence technique and compared with the healthy control group. Results: Increased serum hormone levels in women with acne vulgaris were accounted for 29.7%, and hyperandrogenism was accounted for 16.0% of cases. We found significant differences in testosterone levels (mean value, 55.67±25.56 versus 38.37±10.16 ng/dL, p<0.05) respectively in the acne group and the control group. However, the estradiol level of the acne group (323.15±93.31 pmol/L) was lower than the control group (370.94±58.88 pmol/L) with p<0.05). No statistically significant differences were found for progesterone (0.60±0.38 versus 0.50±0.15 ng/mL, p>0.05) levels. Moreover, we did not find the relationship between serum hormone levels and the severity of acne vulgaris. Conclusion: This study showed that the female acne vulgaris patients may have high serum testosterone levels and low serum estradiol levels compared with those of female controls. However, hormone alterations had no correlation with the acne grades.
Article
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Anti-acne herbal formulations are used for the treatment of acne vulgaris with the added advantage of not producing adverse effects unlike synthetic drugs. Acne is an inflammatory skin disease that occurs due to blockages in polysebase and inflammation that are caused by bacteria. Topical and systemic antibiotics are always used for treatment of acne, but the gradual resistance to antibiotics can affect the success rate of acne cure. Medicinal plants play an important role in the development of potent therapeutic agents. Plant based drugs provide outstanding contribution to modern therapeutics as a source of many valuable secondary metabolites which serves as plant defence mechanis ms against predator such as microorganism, insects and herbivores which have been proved to be potentially active compounds. There is a tremendous increase in search of antimicrobial plant extracts due to the fact that the resistance offered against antibiotic by the microorganism, in short the effective life span of any antibiotic is limited. Propionibacterium acnes are common pus-forming microbes responsible for the development of various forms of acne. In the present study anti-acne gels were prepared using polymer carbopol 940 along with the hydroalcoholic extracts of plants fruits of Luffa acutangula, leaves of Amaranthus spinosus and Morus alba and evaluated for their physicochemical properties, like pH, washability, extrudability, spreadability and viscosity. The formulations (PHG1-PHG6) were tested for the anti-acne activity by well diffusion method against Propionibacterium acnes. Results showed that the gels were non-irritant, stable and possess anti-acne activity. The efficacy when tested with a standard was almost same to that of Clintop (Marketed gel). This suggests that fruits of Luffa acutangula, leaves of Amaranthus spinosus and Morus alba have potential against acne causing bacteria and hence they can be used in topical anti-acne preparations and may address the antibiotic resistance of the bacteria.
Article
Background: Acne vulgaris (AV) is a common dermatosis. For moderate to severe AV, isotretinoin is the first-line treatment. Chemical peeling with supramolecular salicylic acid (SSA) was developed with water solubility and advanced skin penetration properties. In the present study, we investigated the efficacy and safety of oral low-dose isotretinoin combined with 30% SSA chemical peeling. Methods: Thirty-three moderate-to-severe acne patients were enrolled and received oral low-dose (0.2-0.4 mg/kg/d) isotretinoin and were then randomly assigned to receive 30% SSA or not on each side of the face with 2-week intervals for four sessions. Photos, the number of lesions, GAGS score, skin indices (melanin, erythema, pore, and texture), hydration, and transepidermal water loss (TEWL) were assessed at 0, 2, 4, 6, and 10 weeks. Side effects, efficacy, and satisfactory rates were recorded. Results: A total of 29 patients completed the study. Oral isotretinoin combined with SSA decreased response time compared to isotretinoin monotherapy, with significantly improved GAGS score, count of lesions, and efficacy (%) at 4-6 weeks. Skin indices of melanin, erythema, pore, and texture evaluated at week 10 were improved as well. Oral isotretinoin with or without SSA was effective by the lesion clearance; only SSA significantly improved the TEWL. All the side effects were temporary and tolerable, and no adverse effects were observed. Conclusion: Oral low-dose isotretinoin combined with 30% SSA is safe and effective, which advanced the onset of action and improves lesion clearance.
Article
The efficacy and safety of commercial low‐concentration glycolic acid products on acne were evaluated by recruiting volunteers accompanying mild to moderate acne of different ages and genders, which is a clinical practice for acne. We recruited a total of 30 volunteers according to the inclusion criteria, conducting clinical evaluation and skin physiological index testing, VISIA skin analysis, distributing products, and informing the trial method. Clinical testing and assessment will be carried out in weeks 0, 1, 2, and 4. 27 acne volunteers finished the entire trial. After 4 weeks of using low‐concentration glycolic acid products, most subjects experienced significant improvement in their skin lesions and the GAGS score. At the same time, the VISIA test showed that the subjects had an obvious amelioration in facial porphyrins, which was statistically significant, and there was a slight improvement in residual spots and erythema. The skin physiological indexes showed that the skin hydration value increased from 236.2 ± 98.05 to 278.2 ± 90.26 after 14 days. At the end of the test, the skin hydration value dropped to 234.6 ± 81.88. Regarding the melanin and erythema, the value decreased in the 4th week significantly. Repeated use of 5% low‐concentration glycolic acid improves the appearance and chromaticity of the treatment site. It increases the brightness L* and reduces the redness a*. This study shows that low concentrations of glycolic acids have a good effect on the treatment of mild to moderate acne. It may pay the way to carry out further large‐scale clinical research.
Article
Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin. An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities. Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible. Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.
Article
The review summarizes and systematizes data accumulated in the world research literature, which are related to the role of P. acnes in the pathogenesis of acne, its microbiology and antibacterial resistance; it also examines antibacterial drugs for the external therapy of acne and recommendations for their use.
Article
Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the serum testosterone, estradiol, progesterone levels in women with acne vulgaris. Methods: We conducted a cross-sectional descriptive study, and 175 women with acne vulgaris were examined; their serum estradiol, progesterone, testosterone were analyzed by chemiluminescence technique and compared with the healthy control group. Results: Increased serum hormone levels in women with acne vulgaris were accounted for 29.7%, and hyperandrogenism was accounted for 16.0% of cases. We found significant differences in testosterone levels (mean value, 55.67±25.56 versus 38.37±10.16 ng/dL, p<0.05) respectively in the acne group and the control group. However, the estradiol level of the acne group (323.15±93.31 pmol/L) was lower than the control group (370.94±58.88 pmol/L) with p<0.05). No statistically significant differences were found for progesterone (0.60±0.38 versus 0.50±0.15 ng/mL, p>0.05) levels. Moreover, we did not find the relationship between serum hormone levels and the severity of acne vulgaris. Conclusion: This study showed that the female acne vulgaris patients may have high serum testosterone levels and low serum estradiol levels compared with those of female controls. However, hormone alterations had no correlation with the acne grades.
Article
The review covers the key achievements of proteome studies using mass spectrometry and two-dimensional electrophoresis methods in the field of dermatology Works studying the most prevalent chronic dermatoses such as psoriasis, atopic dermatitis, acne vulgaris and mycosis fungoidea are examined. Proteome analysis in dermatology is a promising technique today because it makes it possible to study molecular pathogenic mechanisms of skin chronic diseases in a greater detail. In addition, proteome technologies are aimed at searching for potential disease biomarkers and targets for drugs.
Article
Background Multiple Sclerosis (MS) is a chronic immune-mediated disease of the Central Nervous System with an undetermined etiology. Retinoids may have immunomodulatory effects that favorably influence MS progression. No observational studies have explored the relationship between exposure to retinoids and risk of acquiring MS. Methods We performed a nationwide cohort study in the Danish population in the period 1998-2016 comparing MS incidence in three groups: users of systemic retinoids, users of topical retinoids (negative control group) and users of non-retinoid acne drugs (control group). We used data from the Danish Multiple Sclerosis Registry (DMSR), the Danish National Prescription Registry and The Danish National Patient Registry. Linkage was obtained through the personal identification number (CPR number). We addressed confounding by three-way propensity score (PS) matching weights. Additionally, to evaluate a cumulative dose-response effect for systemic retinoids on MS incidence, we conducted a case-control study nested within the cohort. Results A total of 257,193 users of non-retinoid acne drugs, 130,560 users of topical retinoids, and 75,610 users of systemic retinoids were included. Systemic retinoid use was not associated with a reduced risk of MS compared to non-retinoid acne drugs in crude (HR 0.80 [95% CI, 0.61 to 1.05]) and weighted analyses (HR 0.89 [95% CI, 0.67 to 1.20]). There was no evidence of a cumulative dose-response association between systemic retinoids and MS incidence. Conclusions Use of systemic retinoids was not associated with a reduced incidence of MS compared to use of non-retinoid acne drugs in this study.
Article
A survey of 1066 healthy women and 1089 healthy men aged 18-70 years, performed to determine the prevalence of facial acne, showed that clinical acne was not confined to adolescents. Though it was more prevalent among men than women at 18, beyond the age of 23 clinical acne was more prevalent among women as the prevalence in men gradually declined. At 40-49 years 3% of men and 5% of women still had definite, albeit mild, clinical acne, and at 50-59 years 6% of men and 8% of women had physiological acne. The surprisingly high prevalence of acne in adults may be related to antibiotic treatment or, in women, to the use of oral contraceptives or cosmetics, though this survey did not study their influence. Further studies in different populations are needed to establish the prevalence of acne in the community, and its distribution.
Article
It has been suggested that cystic acne is rare in women 15 to 44 years of age and infrequent in men. To determine the prevalence of acne, we analyzed the primary data from the National Health and Nutrition Examination Survey (NHANES) that included a cutaneous examination of a stratified random sample of 20,749 noninstitutionalized U.S. residents. We calculated the prevalence of various disease states based on NHANES primary data and the NHANES population weights. Prevalence estimates and male/female ratios of these estimates were calculated. From 1971 to 1974, the projected prevalence of acne conglobata (grade IV acne) for women and men 15 to 44 years of age in the United States was 250,000 and 570,000, respectively. At the time of examination, an additional 582,000 women and 749,000 men were projected to have moderate acne with cysts and scars. Therefore the prevalence of acne conglobata and acne of at least a moderate degree with cysts and scars was 832,000 for women and 1,319,000 for men 15 to 44 years of age. The male/female ratio for acne with cysts and scars is approximately 1.6:1. The NHANES examination data demonstrate that acne with cysts and scars is common in both men and women.
Article
Despite scarring being a recognized sequel of acne, the actual extent and incidence of residual scarring remains unknown. One hundred and eighty-five acne patients were included in this study (101 females, 84 males). Patients were selected from acne clinics and their acne scarring was examined. The scarring was quantified according to a lesion count and allocated a score. The type and extent of scarring was correlated to the age and sex of the patient, the site of the acne, the previous acne grade according to the Leeds Technique, acne type (noted in clinic at the original referral time) and duration of acne, before adequate therapeutic measures had been instituted. Results indicate that facial scarring affects both sexes equally and occurs to some degree in 95% of cases. Total scarring on the trunk was significantly greater in males, as was hypertrophic and keloid scarring in these sites (P < 0.05). There were significant correlations between the initial acne grade and the overall severity of scarring in all sites and in both sexes (P < 0.01). Superficial inflamed papular acne lesions as well as nodular lesions were capable of producing scars. A time delay up to 3 years between acne onset and adequate treatment related to the ultimate degree of scarring in both sexes and in all three sites. This emphasizes the need for earlier adequate therapy in an attempt to minimize the subsequent scarring caused by acne.
Article
Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years. The clinical features of 200 patients over the age of 25 years, referred to our department for treatment of acne. were evaluated with a view to establishing possible aetiological factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity, consisting principlly of inflammatory lesion, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had features of hyperandrogenicity. One hundred and sixty-four patients (82%) had failed to respond to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with one or more courses of isotretinoin. External factors, such as cosmetics. drugs and occupation, were not found to be significant aetiological factor. A family history revealed that 100 (50%) of patients had a first-degree relative with post-adolescent acne. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers. External factors do not seem to have a significant aetiological role. Two main clinical groups were identified: those with persistent acne and those with late-onset acne. A minority of women also had features of hyperandrogenicity. These patients, and those with late-onset acne, may represent a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.
Article
Topical tretinoin is effective treatment for both acne and photoaging. This creates a problem for insurers that cover medication costs, because treatment of acne is often covered but treatment of photoaging is not. The age distributions of patients with acne or photoaging are likely to be very different. Therefore, one approach insurers can use is an age cutoff for covering the cost of topical tretinoin therapy. Our purpose was to determine at what age patients are more likely to receive tretinoin for treatment of acne vulgaris versus other conditions to provide a rational basis for insurers to set coverage cutoffs. National Ambulatory Medical Care Survey data for the years 1990 to 1994 were analyzed to ascertain the age distribution of acne vulgaris office visits and treatment with topical acne agents including tretinoin. These data were compared to office visits and tretinoin treatment of wrinkles, solar elastosis, and other conditions. The mean age (+/- standard deviation) of patients seen for acne vulgaris was 24.3 +/-11.5 years old. The age distribution of topical tretinoin treatment paralleled the age distribution of acne. Tretinoin treatment of acne and of nonacne conditions were equal at an age of 44. The distribution of outpatient visits for acne treatment is skewed toward older patients and persists beyond age 40. A rational age cut-off for coverage of topical tretinoin treatment is 40 years.
Article
Skin diseases such as acne are sometimes thought of as unimportant, even trivial, when compared with diseases of other organ systems. To address this point directly, validated generic questionnaires were used to assess morbidity in acne patients and compare it with morbidity in patients with other chronic diseases. For 111 acne patients referred to a dermatologist, quality of life was measured using the Dermatology Life Quality Index, Rosenberg's measure of self-esteem, a version of the General Health Questionnaire (GHQ-28) and the Short Form 36 (SF-36). Clinical severity was measured using the Leeds Acne Grade. Population quality of life data for the SF-36 instrument were available from a random sample of adult local residents (n = 9334) some of whom reported a variety of long-standing disabling diseases. All quality of life instruments showed substantial deficits for acne patients that correlated with each other but not with clinically assessed acne severity. The acne patients (a relatively severely affected group) reported levels of social, psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain or arthritis. Acne is not a trivial disease in comparison with other chronic conditions. This should be recognized in the allocation of health care resources.
Article
Acne is usually perceived as a disease of teenagers, and most epidemiological studies have focused on adolescents. The primary objective was to investigate the prevalence of acne in a representative sample of French females. Information about skin type, life-style factors influencing acne and quality of life were also recorded. A self-administered questionnaire was sent to 4,000 adult women aged 25-40 years, after a validation test by three dermatologists. A definition of acne severity, according to questionnaire answers, was established before the questionnaire was sent out. A total of 3394 women completed the questionnaire of which 3,305 were useable. The data showed a prevalence of acne in 17% of the population, and physiological acne in 24%. Thus, the total acne prevalence was 41%. Forty-nine per cent of the acne patients had acne sequelae (scars and/or pigmented macules). Forty-one per cent of adult acne patients had not experienced acne during their adolescence. A premenstrual flare and stress was recorded as causing acne in 78% and 50%, respectively. Twenty-two per cent of acne subjects were currently receiving therapy. For most patients, acne did not severely impair their quality of life. This study shows a prevalence of acne in 41% of women in the general population. A high proportion of these acne cases are late onset acne.
A clinical assessment of acne scarring
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