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The prevalence of acne in adults 20 years and older
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.
... Acne vulgaris affects a significant number of adult females, and a majority of females in their twenties self-report having acne [1]. The disfiguring effects of acne can have a profound impact on all aspects of life for adult females [2]. ...
... Our analysis expands on previous research by analyzing the differences in healthcare utilization for acne by sex and age and temporal patterns in prescribed treatments for acne among females by age group. While previous studies have investigated the self-reported prevalence of acne by age groups, this is the first study to analyze healthcare utilization and treatment for acne stratified by age and sex [1]. Specifically, our analysis demonstrates that there is a substantial number of dermatology visits by adult females aged 20 years and older, including those females aged 50 years and older, for acne. ...
... This finding is consistent with previous studies showing that acne is less common in adults males when compared to adult females [7,8]. However, it was surprising to see that acne accounted for more than a 1.5-fold higher proportion of dermatology visits among females compared to males ages 20-29 given that prior studies show more subtle differences in acne prevalence between these sexes in that age range [1]. We hypothesize that sex differences in dermatologic care utilization for acne may be tied to increased severity of acne among adult females as well as increased impact on quality of life in this population [7,8]. ...
Background
Acne vulgaris affects a significant number of females into adulthood. Juvenile acne and adult acne have different presentations and potentially distinctive pathogeneses. However, patterns in treatments specifically related to the adult female population have previously not been studied.
Methods
Retrospective database analysis of healthcare utilization and medications prescribed for acne using the National Ambulatory Medical Care Survey (NAMCS) data from 2002–2016 was performed.
Results
After age 20, acne accounted for an almost 2.5-fold higher proportion of dermatology visits among females compared to males (10.1% vs. 4.1%, P < 0.001). Tetracycline-class antibiotics were the most prescribed therapy within all age groups of females between 2002–2016. However, there was also a substantial rise in prescriptions of spironolactone beginning in 2012.
Conclusion
A significantly greater proportion of dermatology visits by adult females are for acne in comparison to adult males. Tetracycline-class antibiotics remain the most prescribed therapy in adult age groups despite a potentially different pathogenesis of adult acne. Therefore, there is a need for further studies comparing the effectiveness of therapies specifically for adult female acne.
... 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, and 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 part 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, and 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 part role in the pathogenesis of acne. ...
... This may provide an explanation for the inconsistent results of hormonal assessment studies that the authors of the present study referred to. 1 => Some studies show that hormonal alteration has a role in female acne vulgaris. However, there is no strict guideline yet. ...
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 plasma testosterone, estradiol, and progesterone levels in women with acne vulgaris.
Methods: We conducted a cross-sectional descriptive study, and 140 women with acne vulgaris were examined; their plasma estradiol, progesterone, and testosterone were analyzed by chemiluminescence technique and compared with the healthy control group.
Results: Increased plasma hormone levels in women with acne vulgaris accounted for 33.57%, and hyperandrogenism accounted for 20.71% of cases. We found significant differences in testosterone levels (mean value, 56.92 ± 27.64ng/dL, 60.71± 25.85ng/dL versus 38.35 ± 10.09ng/dL, p<0.01), respectively, in the moderate to severe acne group and the control group. However, the estradiol level of the moderate and severe acne groups (325.12 ± 91.79 and 305.26 ± 83.01pmol/l) was lower than the control group (368.6 ± 58.34pmol/l), with p-value under 0.05. No statistically significant differences were found for progesterone levels.
Conclusion: Female patients with moderate to severe acne vulgaris had abnormalities in plasma testosterone and estradiol levels. These abnormalities might be part roles in the pathogenesis of acne vulgaris, even when the mean levels were in the normal range.
... The prevalence of adult acne was nearly 8% in the current study. This finding is in line with previous studies, which have confirmed that acne remains a common skin disease throughout life (4,5). However, a higher prevalence than that in the current study has also been reported: in a US study (n = 1,013), 12.0% of men and as many as 26.3% of women experienced acne in their 40s (4). ...
... This finding is in line with previous studies, which have confirmed that acne remains a common skin disease throughout life (4,5). However, a higher prevalence than that in the current study has also been reported: in a US study (n = 1,013), 12.0% of men and as many as 26.3% of women experienced acne in their 40s (4). Nevertheless, the US study was based on self-reporting and focused on selected patients visiting a dermatology clinic, which may have caused bias. ...
Acne vulgaris is one of the most common inflammatory skin diseases, but there are few studies of adult acne and its association with general health. The aim of this study was to examine the prevalence and clinical characteristics of adult acne at the population level among 1,932 subjects belonging to the Northern Finland Birth Cohort 1966 Study. In addition, cardiovascular and metabolic profiles of acne cases and their controls were analysed. The prevalence of adult acne was 7.9% (n = 150) with no statistical difference between the sexes. The majority of subjects presented with papulopustular acne (77.1%). Comedo acne (10.8% of all subjects) was more common in females than in males (p < 0.005). Males with acne had more abnormality in their metabolic factors than did acne-free controls; plasma glucose and insulin levels at 60 min after the 75 g glucose load were higher in males with acne than in controls (p < 0.01 for both). Corresponding associations were not seen in females. In conclusion, adult acne is common in middle-age, presenting a slightly different clinical picture in females than in males. In addition, male subjects with acne may have a higher risk of metabolic disturbances than do controls, and thus, comprehensive evaluation of patients with adult acne is needed.
... Epidemiologic studies indicate acne affects approximately 9.4% of the global population, ranking it as the eighth most prevalent disease worldwide [1]. Up to 85% of adolescents experience acne and while often mistakenly perceived as a disease limited to teenagers, many adults are affected as well [2]. The psychosocial effects of acne are well documented and include negative impacts on self-perception, social functioning, and mental health [2,3]. ...
... Up to 85% of adolescents experience acne and while often mistakenly perceived as a disease limited to teenagers, many adults are affected as well [2]. The psychosocial effects of acne are well documented and include negative impacts on self-perception, social functioning, and mental health [2,3]. Furthermore, any severity of acne can result in long lasting scarring, a risk that tends to increase as disease severity worsens [4,5]. ...
Introduction: Acne is a common cutaneous disease affecting the pilosebaceous apparatus, in which there is hyperkeratinization, excessive sebum production, follicular colonization with Propionibacteriun acnes & inflammation. It manifests as comedones, papules, pustules, nodules & cysts on the face, neck, and trunk. Epidemiologic studies indicate acne affects approximately 9.4% of the global population, ranking it as the eighth most prevalent disease worldwide. It is a common skin condition of the face and trunk that negatively impacts the quality of life. Objectives: We evaluated the efficacy of oral doxycycline in combination with topical trifarotene in the treatment of moderate to severe acne vulgaris. Methods: This was an interventional study for 12-week duration to see the treatment outcome in moderate & severe acne patients. This study was carried out at the Dept. of Dermatology & Venereology, Enam medical college Hospital, Savar, Dhaka, Bangladesh from January 2022 to September 2022. We evaluated a new therapeutic regimen: Doxycycline 100 mg (Oral) once daily during dinner with food and enough water,21 days / month, for three consecutive months along with topical Trifarotene 0.005%w/w once daily at night after proper cleansing for the same duration. Acne severity was graded using Investigator Global Acne Assessment Scale (IGAS). Results: A total of 96 patients with moderate to severe acne were treated & among them 85 completed this study. Out of these 85, 15 are males & 70 are females. There was a marked improvement in IGAS with marked reduction in the number of inflammatory and non-inflammatory lesions between the beginning of the study and through follow up visits. Clinical response to Doxycycline Plus Trifarotene was excellent in 15%, good in 68%, moderate in 14% and mild in 3% and satisfaction to treatment was 22% very satisfied, 60% satisfied and 17% somewhat satisfied. Side effects were low and only 2.1% of cases had mild irritation. ........
... With a lifetime frequency of about 85%, AV is a very prevalent illness that predominantly affects adolescents [5]. Acne vulgaris can linger into adulthood; among women aged 20 to 29, the prevalence of AV was 50.9%, compared to 26.3% among those aged 40 to 49 [6]. ...
... In Asians, AV typically affects women, with a male-to-female ratio of roughly 1/1.1:1.25. Most of these AV cases in women have a late onset [6,8]. In adolescent populations, moderate to severe AV is prevalent in 10% to 20% and is linked to psychosocial issues [9]. ...
Background/objectives:
Acne vulgaris (AV) is the common form of acne, characterized by a polymorphic eruption of inflammatory non-papules, pustules, nodules, blackheads, and whiteheads. Acne was eighth among the top 10 disorders in terms of prevalence in 2010. The objective of this study was to see if there was any association between acne vulgaris and BMI in the young adult population.
Methods:
This is a single-center retrospective study conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Adult patients diagnosed with acne vulgaris from January 2017 to June 2022 were enrolled. The estimated sample size was reached using consecutive, non-probability sampling.
Results:
A total of 596 participants were selected as a match to the criteria of the research objectives. Of the participants, slightly more than half were males (52.5%) and the rest were females (47.5%). There was a nearly equal number of cases and controls, around 48.7% of the patients had acne while the rest did not. The majority were of the age group 18 to 19 years followed by 22 to 23 years (25.2%). A majority had a normal BMI of 18.5 to 24.9 (40.4%). A significant difference was found between the means of the BMI of the participants who had acne and those who did not (p<0.05). Conclusion: No significant association was found between age group, gender, BMI, and acne. To fully comprehend how dietary factors affect the severity of acne, more studies are required.
... Although adolescent acne affects more boys than girls, adult acne has been found to be significantly more common among women than men. 35 Most adult acne sufferers also had acne in their adolescence, but around 20% have lateonset acne. 36 Traditionally, adult acne was thought to affect the U-zone (jawline, chin, neck), and it was believed that adults had more inflammatory lesions than adolescents. ...
... 36 Traditionally, adult acne was thought to affect the U-zone (jawline, chin, neck), and it was believed that adults had more inflammatory lesions than adolescents. [35][36][37] However, in a study of 374 women (aged 25-66 years) with acne, 89.8% had facial acne involving multiple facial zones, 76.5% had mixed facial acne (inflammatory and noninflammatory lesions), and only 11.2% had acne localised to the mandibular region. 38 Another study found that adult women (N=208) selfreported prominent areas of acne on the cheeks (79.8%), forehead (77.4%), nose (50.0%), and hairline (47.6%), as well as the 'traditional' jawline (61.5%) and chin (77.9%). ...
Prof Fabbrocini gave an overview of the current European and American guidelines for acne treatment. She highlighted some important new recommendations from the Global Alliance consensus, including that oral isotretinoin should be continued until full acne clearance and that early, effective treatment is important to minimise scarring. She then discussed various gaps between guidelines and clinical practice, including adherence, scar prevention, physical modalities, dermocosmetics, skin of colour, diet, and truncal acne. Dr Stein Gold then spoke about the epidemiology of acne and the traditional and emerging concepts relating to its pathogenesis. She discussed the important role of inflammation, which is now known to be present throughout acne progression, and highlighted that inflammation is not just a response to Cutibacterium acnes proliferation. She then discussed the impact of the inflammatory process on the risk of acne scarring, the negative effects of scarring on patients, and the importance of early treatment to minimise or even prevent scarring; the problem of post-inflammatory hyperpigmentation (PIH) in patients with skin of colour; and adult acne, which predominantly affects women. Lastly, she highlighted the under-recognised problem of truncal acne which, despite affecting approximately 50–60% of patients with facial acne, lacks specific treatment guidelines. Prof Tan then discussed some interesting studies on the current and emerging treatments for PIH (tretinoin 0.1% cream, azelaic acid 15.0% gel, dapsone 7.5% gel), adult female acne (dapsone 5.0% gel, azelaic acid 15.0% gel, adapalene 0.1% gel, spironolactone), acne scarring (adapalene 0.3% gel, adapalene 0.1% or 0.3% plus benzoyl peroxide [BPO] 2.5% gel), and truncal acne (dapsone 7.5% gel, azelaic acid 15.0% foam, drospirenone 3 mg/ethinyl oestradiol 0.02 mg, trifarotene 50 µg/g cream). Trifarotene is one of the first treatments that has been shown to be effective and safe for the treatment of truncal acne in a robust Phase III programme.
... While 35.2%, 26.3% and 15.3% women are afflicted with acne among age group 30 to 39 years, 40 to 49 years and above 50 years.(Rephrase) (11).Pupils with positive family history of acne have more incidence of moderate to severe acne (1). Acne is the most deeply depressing and disturbing psychic experience which leads the way to the feelings of inferiority, general insecurity, decrease self-esteem, preoccupation and the limitations in life style (12). ...
... For the last 10 years, acne in adults has increased, particularly mild and moderate in nature (10). Data suggested that females had higher disease burden in comparison to males of Pakistancontradicting results of a Korean study showing that males have more acne in teenage(21), simultaneously corroborating a study from US demonstrating that male patients have more acne before the age of 16 years whereas females had higher incidence in adult age (11). There is a rapid fluctuation in the level of hormones and emotional status among teens. ...
Background: There is no published epidemiological study to assess the prevalence, risk factors and management of acne based on severity among youth of Pakistan which could be helpful in guiding clinical decisions. Objective: Thus, the study was aimed at finding an association of different psychosocial and physiological factors like emotional status, diet, and menstrual cycle affecting severity and duration of acne. Methods: In this cross sectional observational study with 1175 pupils, initially screened for acne, the data of only 510 pupils (43.4%) -categorized according to Lehmann grading scale- were collected from the University of the Punjab, Lahore and its beleaguered community. Results: Our data suggested that 32.74%, 47.45% and 19.80% participants were suffering from mild, moderate and severe acne, respectively. Stress (p=0.002), anger (p=0.000), smoking (p=0.003), overproduction of oil (p=0.028), protein supplement (p=0.05), intake of cheese (p=0.044) and duration of acne (p=0.000) were strongly associated with severity of acne. Among all, only 65.88% of patients were taking either oral (doxycycline) or topical (clindamycin gel) medications, while others failed to opt any treatment. Conclusion: Taken together, mild to moderate acne is common among pupils of Lahore. Therefore, it is inevitable that targeted educational modules should be designed for the youth affected by acne due to psychosocial and physiological reasons along with clinical and non-clinical management preferences
... Acne vulgaris is a common chronic inflammatory disease of hair follicles and sebaceous glands in adolescents mostly, persisting into adulthood in some patients. 1 The most common sequela of acne is acne scar. For many patients, acne scars impact their appearance a lot, leading to self-consciousness and dissatisfaction with appearance, furthermore, inducing physical, substantial social, and psychological burdens. 2 As the most common type of acne scars, atrophic acne scars (AAS) are further subclassified into M-shaped (rolling scars), U-shaped (boxcar scars), and V-shaped scars (icepick scars). ...
... AAS are common in adolescents and adults, bringing serious aesthetic, physical and psychological problems. 1 The peri-follicular inflammation involving and destructing collagen at dermal level resulted in the atrophy of epidermis and dermis in AAS. 3 Many interventions such as MFRF, fractional lasers were used as therapy for acne scars. Whereas, no standard practical protocol was established for treating AAS till now. ...
Background:
Atrophic acne scars (AAS) impact the aesthetic appearance, inducing social and psychological problems. Effective and safe therapy for AAS is urgently needed now. Microneedling fractional radiofrequency (MFRF) has emerged as a minimal invasive alteration for treating AAS lately, while the existing data on Chinese population was few.
Aims:
We aimed to explore the effectivity and safety of MFRF in Chinese patients with facial AAS and analyze the response of different subtypes to MFRF treatment.
Methods:
We conducted a retrospective analysis using data from medical records and clinical photographs of 40 Chinese patients with AAS with Fitzpatrick skin type III-IV, all of them had received 3 MFRF treatments with 1-month intervals and were followed up 3 months after the last treatment. The clinical severity was assessed throughéchelle d'évaluation clinique des cicatrices d'acné (ECCA) score at each visit. Clinical photographs were taken by VISIA. Patients were asked to evaluate their satisfaction of the treatment using a 5-point Liker scale at the last visit.
Results:
ECCA score decreased more than a half at the last visit based on the baseline. Among the three types of AAS, the M-shaped scars respond most quickly to MFRF and the U-shaped scars improved the most after 3 months follow-up. A significant improvement was seen in clinical appearance, parallel to the change of ECCA, indicating the remarkable improvement of AAS after the MFRF treatment. Concomitant active acne was controlled along with the improvement of AAS. Statistics from VISIA showed excellent improvement in pores and texture as well. Side effects including pain and erythema were transient and mild. The number of MFRF treatment sessions was positively associated with the degree of improvement. Of the total 39 patients who had given a score of satisfaction, more than 89% (35 patients) were very satisfied or satisfied with the outcome.
Conclusions:
To sum up, our study reveals that MFRF provides high efficiency in treating Chinese AAS patients with high satisfaction and low risk of adverse effects. M-shaped scars are the most sensitive type to the treatment but the U-shaped scars improve most at the last visit. The simultaneous minimization of pores and improvement of skin texture imply the increased collagen stimulated by MFRF. Regular MFRF should be considered a good choice in treating AAS.
... One of the most common inflammatory infections found more frequently in women than men is acne vulgaris [1]. It is a type of recurring infection, and its effects are persistent. ...
... Following the decision trees of study for different types of stressful situations, the initial stress testing included degradation tests for each active pharmaceutical ingredient (API), preservatives, and operating standards under various stress settings. To limit the likelihood of subsequent degradation, a degradation rate of 20% to 30% was targeted in the current investigation [1]. These peaks do not co-elute with any other peaks or with any of the APIs or preservatives, as shown by the data collected, which also enabled us to calculate the relative retention times of each API/degradation product. ...
The most well-known, effective medicines for acne therapy are clindamycin phosphate and tretinoin. For the first time, we have developed and validated a reversed-phase HPLC stability-indicating technique for the detection of clindamycin phosphate (CLP), tretinoin (TRN), and two preservatives, methylparaben (MP) and imidazolidinyl urea (IU), simultaneously in this work. Most of the chromatographic conditions in the present study were optimized to achieve better separation. The best separation results were obtained using gradient elution on a C-18 (250 × 4.6 mm), 5 µm column, with a mobile phase consisting of solution A (1 mL/L ortho-phosphoric acid in water) and solution B (methanol), at a flow rate of 1.0 mL/min, with UV detection at wavelengths of 200 nm and 353 nm. Standard parameters such as system suitability, precision, accuracy, specificity, robustness, linearity, range, detection limit, quantification limit, and reagent stability were used to validate the developed technique. According to the standards of the International Council for Harmonization, all of the experimental parameters were found to be within allowable bounds (ICH). The simultaneous concentrations of clindamycin phosphate, tretinoin, methylparaben, and imidazolidinyl urea in pharmaceutical formulations were successfully determined using the suggested approach. The proposed RP-HPLC method detected no interfering peaks in the chromatogram. We may conclude from the data that the new RP-HPLC method can be utilized in pharmaceutical laboratories to simultaneously assess clindamycin phosphate, tretinoin, and two preservatives, methylparaben and imidazolidinyl urea, for both qualitative and quantitative analyses.
... The protective effects of increased age on worsening acne or new acne-related symptoms seen in our study likely reflects the hormonal changes and overall reduced prevalence of acne in older adults. Acne is more prevalent in adult females 6 , and they are postulated to have related underlying abnormalities of ovarian, adrenal or local androgen metabolism 7 . Factors such as duration of single mask use without change, frequency of removal, effect of repetitive speech, facial movements and moisturize may also contribute to worsening acne. ...
... Furthermore, there has recently been an increased emphasis on the role of chronic inflammation and inflammatory cytokine cascades in the pathogenesis of acne. [1] Topical and oral antibiotics, topical keratolytic, hormonal agents, and topical and oral retinoids are among the traditional treatments for acne vulgaris. [2] Alternative therapies have emerged due to increased resistance to traditional treatment options, as well as undesirable side effects. ...
... 2,3 Overall estimates of acne prevalence in adolescents and young adults range widely from 12 to 99%, and in approximately 12% of men and 25% of women acne continues well into later adulthood. 4,5 Scarring and AIMH are common sequelae of acne. 2 Acne and its sequelae can have a profound impact on patient quality of life (QOL) that is often independent of severity, with one study finding that the effect of acne on QOL is similar to that of common chronic conditions such as coronary heart disease, diabetes, and epilepsy. 6,7 Patients report increased rates of anxiety and depression, lower self-esteem, and increased unemployment rates compared with age-matched control subjects. ...
Background Individualization of treatment based on acne type and severity, location,
disease burden, and patient preference is required to maximize efficacy, safety, and
adherence to therapy. Latin American populations have unique attributes that must be
considered as part of this process to improve clinical success and achieve patient goals.
Acne is more common among patients with darker skin phototypes, in whom it is often
associated with postinflammatory hyperpigmentation and scarring—the most important acne sequelae—potentially due to more frequent and more severe underlying inflammatory processes in this population.
Discussion These data argue for an early and proactive approach to managing acne in
these patients with agents that target the inflammatory processes that underlie acne and
its sequelae. As a class, retinoids offer a spectrum of activity that may be useful in
addressing the unique needs of Latin American populations.
Conclusion Trifarotene, a novel, selective retinoid, has been evaluated in relevant patient
populations
... (1) In maturity, acne frequently recurs; 26% of women and 12% of men still have acne in their forties. (2) Acne is the eighth most common illness worldwide, with the highest prevalence rates being seen in Western Europe, "high-income" North America, and southern Latin America. (3) A family history of severe acne, PCOS, the metabolic syndrome, and uncommon genetic diseases like Apert's syndrome are among the risk factors for developing acne. ...
A number of biochemical variables associated with the incidence of acne in women in the study groups were estimated. Including a test that measures the level of the luteinizing hormone stimulating hormone, a test that measures the level of follicle stimulating hormone, a test that measures the level of milk hormone, a test that measures the level of testosterone, a test that measures the level of globulin associated with sex hormones. SHBG (6.20 ± 9.65), FSH (3.201 ± 9.05) and ZN (5.37 ± 91.76) compared with control (7.19 ± 12.01), (3.32 ± 8.69) and (6.29 ± 91.57) respectively. While there was a significant increase in the level of each of the TEST hormone (0.72 ± 0.93) and LH hormone (2.38 ± 9.17) compared with the control group (0.019 ± 0.044) and (0.94 ± 3.41), respectively. The results of the study showed that within the age group 26-37 there was a decrease in the level of each of the hormone SHBG (5.40 ± 9.52), FSH (3.35 ± 8.36), and ZN (5.14 ± 90.38) compared with the control group (4.60 ± 26.54), (4.15 ± 8.91) and (4.15 ± 8.91). (3.86 ±94.16), respectively. While there was a significant increase in the level of each of the TEST hormone (0.67 ± 1.30) and LH hormone (1.84 ± 8.24) compared with the control group (0.14 ± 0.13) and (0.84 ± 3.02) respectively. The results of the study showed that within the age group >37 there was a decrease in the levels of SHBG (5.99 ± 9.64), FSH (3.77 ± 8.47) and ZN (5.99 ± 91.35) compared with the control group (7.95 ± 18.25), (0.84 ± 13.75) and (0.84 ± 13.75). 4.88 ± 88.71), respectively. While there was a significant increase in the level of each of the TEST hormone (0.81 ± 1.44) and LH hormone (1.10 ± 6.83) compared with the control group (0.12 ± 0.20) and (0.93 ± 3.52), respectively.
... Acne accounts for 0.3% of the total and 16% of the global dermatologic disease burden [1]. Acne affects approximately 85% of young people between the ages of 12 and 24 and is thus a physiologic occurrence in this group [1,5]. ...
Background: Acne and menstrual cycles are highly prevalent among young females. The hormones and their fluctuations play an important part in the menstrual cycle and its regularity, as well as acne pathogenesis. Aims: To look into the relationship between acne and the menstrual cycle and determine whether perimenstrual acne flares occur even with a regular menstrual cycle.
... [1] Acne vulgaris has lifetime prevalence and can persist into adulthood; however, usually it distresses during adolescence with a 50.9% prevalence rate of acne in women ages 20-29 years and 26.3% in women ages 40-49 years. [2] It is a condition of the pilosebaceous unit and is characterized by the appearance of lesions of the hair follicle and sebaceous gland (a small gland in the skin secretes oil or sebum to lubricate hair and skin). Sebum, the oily secretion of the latter, containing wax esters, sterol esters, cholesterol, di-and triglycerides, and squalene, makes the skin more oily that plays a key role in acne development. ...
Objectives: Acne vulgaris is an extremely common condition that occurs mostly during adolescence. It often causes non-inflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and varying degrees of scarring that leads to a negative impact on quality of life. is open label, single arm, and clinical study was conducted to evaluate the effectiveness of acne moisturizer on skin moisturization in adult subjects with mild-to-moderate acne.
Material and Methods: An open label, single-arm, and clinical study was conducted on 36 enrolled healthy male and females aged 18–35 years having acne-prone skin and with mild-to-moderate acne. Acne moisturizer (Venusia Acne) was applied twice daily and safety and effectiveness of test product was assessed before application to post-application on day 15, day 30, day 45, and day 60 at the end of study. All enrolled subjects had undergone clinical evaluation by dermatologist, instruments evaluation, and subjective evaluation on various parameters.
Results: irty-one (n = 31) subjects completed all study visits. After using Acne Moisturizer for 60 days, statistically significant (P < 0.0001) improvement from baseline was observed in skin moisturization. e product was also found effective in protecting skin barrier function (P < 0.0001) by reducing trans-epidermal water loss. Assessment of prevention of appearance of new acne and acne reduction using Investigator’s Global Assessment (IGA) Scale for acne vulgaris by dermatologist shows significant improvement from baseline to each study visit and at the end of study. Statistically significant reduction (P < 0.0001) in acne severity assessed by IGA was also observed. Moreover, significant reduction (P < 0.0001) in skin sebum level, skin blemishes, skin redness, skin pigmentation, and facial pores was also observed as assessed by instruments and 3D image analysis system. Assessment of the subject satisfaction questionnaire and subject response index was also found in parity of the outcome. Furthermore, no adverse event was recorded during the study conduction.
Conclusion: e results of this clinical study suggest that acne moisturizer helps in significantly improving skin moisturization when applied for 15 days onward. It is also safe and effective in aiding reduction of skin sebum level, skin blemishes, skin redness, skin pigmentation, and facial pores; it can be effectively used as an adjunct for management of mild-to-moderate acne prevention and acne reduction, while providing sufficient moisturization to the skin.
... Acne can be completely cured but tends to recur. 3 Many studies are reporting a relapse rate of acne after withdrawing treatment with oral isotretinoin, with the proportion varying from 2.9% to 52% depending on the patient's dose, follow-up time, and patient characteristics. [4][5][6] Understanding factors that affect relapse will help in increasing treatment efficiency. ...
Objectives: To investigate the relationship between the recurrence rate of acne treated with oral isotretinoin and some demographic characteristics.Methods: A retrospective, prospective study of 60 severe acne patients treated with isotretinoin divided into 2 groups based on cumulative dosing (60mg/kg and 120mg/kg). Recurrence was defined as the reappearance of grade 1 acne lesions according to Investigator’s Global Assessment (IGA) classification (FDA 2005) with at least 10 comedones or grade 2 or higher (at least 2 papules, pustules, or at least one nodule or cyst).Results: The mean age of the participants was 27.3 years old, 88.3% were female and the mean disease duration was 14.6 months. At the 12 month follow-up, 63.3% of patients in the study experienced relapse. The group of patients aged 18 - 29 had a recurrence rate of 71.4%, which was 1.6 times higher than the group of patients over 29 years old (44.4%); the difference was statistically significant (p < 0.05). When evaluated according to other demographic characteristics, the result showed that there was no association between the recurrence rate with gender, body mass index, disease duration, and maintenance therapy.Conclusion: The relapse rate was higher in younger patients (age 18 - 29 years). There was no association between the recurrence rate with gender, body mass index, disease duration, and maintenance therapy.
... Out of 308 patients, 174 were men and 136 were women in group 1, while Nagpal et al. [3] included 100 cases of men and 100 controls of men of the same age, and Munichandrappa et al. [5] included 45 cases and controls of men and women of the same age and sex, with 19 men and 26 women in each group. According to Collier et al study, [6] acne affects women more frequently than men, most likely because puberty affects women sooner. ...
Objective: The study's goals are to identify a causal connection between insulin resistance (IR) and hirsutism and acne vulgaris, as well as to evaluate the severity of the two conditions in relation to rising IR. Study design: An analytical cross-sectional study Place and Duration: This study was conducted at Primary Health Care Corporation, Qatar from August 2021 to August 2022. Methodology: In a predetermined proforma, a patient's entire clinical history as well as required variables, such as height, weight, body mass index (BMI), etc., were recorded in order to establish a link between IR and acne with/without hirsutism and only hirsutism.A HOMA-IR value of more than 2.5 was regarded as important and indicative of IR. Global Acne Grading System (GAGS) was used to determine the degree of acne, and the Modified Ferriman Gallwey Score was used to determine the severity of hirsutism (mFG). Results: The 354 participants in our study were divided into three groups: There was a statistically significant connection between IR and the severity and recurrence of acne in the Acne-only (N = 310) group. The homeostatic model assessment for insulin resistance (HOMA-IR), the modified Ferriman-Gallwey score, and recurrence were substantially correlated in the hirsutism-only (N = 26) group, demonstrating that insulin resistance increased with hirsutism severity and recurrence. In the sample of 18 people with acne and hirsutism (N = 18), higher BMI was positively linked with IR but not with the severity of both disorders. Conclusion: Causing serious, resistant acne and hirsutism, IR has come to be recognized as a significant contributory, if not causal, event. The mental stress affected by these conditions is greatly impacted, requiring a different approach to case management.
... Younger patients between the ages of 8 and 11 were coming with acne in their clinics led Friedlander et al. to hypothesize that this earlier age of puberty was the cause [24]. Acne is a persistent condition that, for unknown reasons, can occasionally last into adulthood [27][28][29][30]. According to a survey of the German population, 64% of people between the ages of 20 and 29 and 43% of people between the ages of 30 and 39 had visible acne, while 3% of men and 5% of women between the ages of 40 and 49 continued to have acne [31,32]. ...
Acne vulgaris is a skin condition characterized by the inflammation or hyperactivity of sebaceous glands on the skin, which results in the creation of comedones, lesions, nodules, and perifollicular hyperkeratinization. Increased sebum production, follicular blockage, and bacterial colonization may contribute to the disease etiology. Environmental factors, hormonal imbalance, and genetic predisposition can alter the severity of the disease. Its mental and monetary effects can be problematic for the society. In this study, we examined the role of isotretinoin in the treatment of acne vulgaris based on evidence from prior research. This review literature study compiled publications on the treatment of acne vulgaris from 1985 to 2022 based on PubMed and Google Scholar publications. Additional bioinformatics analyses were accompanied by GeneCards, STRING model, and DrugBank databases. These complementary analyses were designed to obtain a better perspective of personalized medicine which is highly required for dose-precise administrations of acne vulgaris treatment. Isotretinoin has been recognized as an effective treatment for acne vulgaris, particularly in cases that have been resistant to previous medications or have resulted in scarring, according to gathered data. Oral isotretinoin inhibits the proliferation of Propionibacterium acne, a critical factor in the development of acne lesions; also, it has been shown to be effective in reducing the number of Propionibacterium-resistant patients and regulating sebum production and reducing sebaceous gland size more effectively than other treatment options resulting in general improvements in skin clarity and acne severity and reduce inflammatory in 90% of patients. In addition to its efficacy, the majority of patients have shown that oral isotretinoin is well tolerated. This review highlights the use of oral retinoids, particularly isotretinoin, as an effective and well-tolerated treatment option for acne vulgaris. It has been proven that oral isotretinoin is useful for achieving long-lasting remission in patients with severe or resistant instances. Despite the fact that oral isotretinoin is related to a number of potential harmful effects, skin dryness was the most common side effect reported by patients that can be managed with the aid of suitable monitoring and drug administration against specific genes identified by genotyping of the susceptible variants of genes involved in TGFβ signaling pathway.
... Instagram, an image-based platform allowing users to digitally manipulate and share images, is growing in popularity (48% of adult social media users) [25]. Acne frequently affects adolescents [26], a group who are particularly engaged with social media [27]. ...
Background
The use of image-laden social media is hypothesized as being implicated in psychological distress in individuals with conditions affecting their appearance. However, relatively little is known about the mechanisms involved in this relationship.
Objective
This cross-sectional study examined the relationship between photo-orientated social media use and feelings of stigmatization in adults with acne, and tested whether upward skin comparisons mediate and self-compassion moderates this relationship.
Methods
Adults (N=650) with acne symptoms completed web-based measures of social media use (daily Facebook or Instagram use, Facebook function use), self-compassion, skin appearance comparisons, and internalized stigmatization.
Results
Moderated-mediation and mediation analyses indicated that there was a significant indirect effect of Facebook photo use on stigmatization, mediated by upward appearance comparisons (estimation of indirect effect 11.03, SE 5.11, 95% CI 1.19-21.12). There was no significant relationship between Instagram use and feelings of stigmatization (estimation of indirect effect 0.0002, SE 0.005, 95% CI −0.011 to 0.009), yet upward appearance comparisons predicted feelings of stigmatization (B=0.99, P<.001). Self-compassion did not moderate the indirect or direct relationships between photo-orientated social media use and stigma. However, self-compassion was negatively correlated with upward appearance comparisons and feelings of stigmatization in both Facebook and Instagram users.
Conclusions
The way that individuals engage with social media, and in particular make appearance comparisons, should be considered when working with individuals with skin-related distress. Interventions aimed at boosting self-compassion and reducing appearance comparisons may provide avenues for protecting against feelings of stigma.
... [18][19][20][21] In some studies reporting that it is associated with psychiatric disorders, it was argued that this fatsoluble drug crosses the blood-brain barrier affecting various parts of the central nervous system, including dopaminergic receptors, and causing depression and mood abnormalities. 22,23 When the controlled studies that argued the contrary were examined, Marqueling et al. examined a total of 9 studies, 6 prospective and 3 retrospectives, regarding the side effects of depression in patients using isotretinoin, published between 1984 and 2004, and concluded that there were no causal associations between isotretinoin and depression Webster et al. reported that the symptoms of secondary depression improved gradually even with the continuation of isotretinoin treatment. 24,25 Recently, in their meta-analysis, Li et al. showed that isotretinoin administration is associated with a reduction in depressive symptoms in patients suffering from acne. ...
... Similar to the present study, earlier studies report a higher prevalence of acne in younger males than females (24)(25)(26). In contrast, women older than 20 were more likely to report acne than men (24,27). ...
Background
Acne vulgaris (acne) is common among young persons (YPs). Clinical practice guidelines are available for acne management to minimize their physical and psychological impact. However, evidence of adherence to these guidelines is sparse in primary care practices. The study aimed to determine the demographic profile of YPs who sought primary care consultations for acne, their related prescriptions and referrals to specialists for further management.MethodA retrospective study was conducted using data from a cluster of eight public primary care clinics in Singapore. Demographic, clinical, prescription, and referral data were extracted from the electronic health records of YPs aged 10–29 years with a documented diagnosis of acne (ICD-10 classification) from 1st July 2018 to 30th June 2020. The data were reviewed, audited for eligibility criteria, and de-identified before analysis.ResultsComplete data from 2,700 YPs with acne were analyzed. Male (56.1%) YPs and those of Chinese ethnicity (73.8%) had the most frequent attendances for acne. The mean and median age at presentation was 19.2 (standard deviation = 4.3) and 19 (interquartile range = 16–22) years, respectively. Only 69.7% of YPs received an acne-related medication; 33.5% received antibiotic monotherapy; 53.0% were prescribed oral doxycycline, 35.0% acne cream (combination of sulfur, salicylic acid, and resorcinol), and 28.4% benzoyl peroxide 5% gel; 54.3% of those treated with antibiotics were prescribed with a shorter duration than recommended; 51.3% were referred to a dermatologist on their first visit, and 15.8% had more than one visit.Conclusion
Acne management for YPs can be enhanced with refresher training among primary care physicians for better adherence to its clinical practice guidelines.
... По данным разных источников, распространенность акне у взрослых женщин варьировала от 5,5 до 61,5%, при этом с возрастом она обычно снижается [6][7][8]. C.N. Collier et al. сообщили, что показатель распространенности акне среди женщин в возрасте от 20 до 29 лет составлял 50,9% по сравнению с 26,3% у женщин в возрасте от 40 до 49 лет [9]. A.C. Perkins et al. опубликовали данные по Северной Америке, показывающие, что акне страдают 12-22% взрослых женщин: 45% женщин в возрасте 21-30 лет и 12% женщин в возрасте 41-50 лет [8]. ...
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).
... Acne affects about 85% of adolescents and young adults [3]. It usually regresses by the age of 25 years, but persistence into adulthood is significant, with about 26% of women and 12% of men reporting acne in their 40s [4]. Acne severity varies widely, from mild to moderate up to severe forms in 10% of adolescents as well as young adults [1]. ...
Acne vulgaris is a common chronic skin disorder presenting with comedones, cystic structures forming within the distal hair follicle, and in most cases additionally with inflammatory skin lesions on the face and upper torso. We performed a genome-wide association study and meta-analysis of data from 34,422 individuals with acne and 364,991 controls from three independent European-ancestry cohorts. We replicated 19 previously implicated genome-wide significant risk loci and identified four novel loci [11q12.2 (FADS2), 12q21.1 (LGR5), 17q25.3 (FASN), and 22q12.1 (ZNRF3-KREMEN1)], bringing the total number of reported acne risk loci to 50. Our meta-analysis results explain 9.4% of the phenotypic variance of acne. A polygenic model of acne risk variants showed that individuals in the top 5% of the risk percentiles had a 1.62-fold (95% CI 1.47-1.78) increased acne risk relative to individuals with average risk (20-80% on the polygenic risk score distribution). Our findings highlight the Wnt and MAPK pathways as key factors in the genetic predisposition to acne vulgaris, together with the effects of genetic variation on the structure and maintenance of the hair follicle and pilosebaceous unit. Two novel loci, 11q12.2 and 17q25.3, contain genes encoding key enzymes involved in lipid biosynthesis pathways.
... Acne vulgaris is one of the most common inflammatory skin disorders, affecting nearly 85% of adolescents and young adults [1]. The current understanding of acne pathogenesis is continuously evolving. ...
Facial acne vulgaris with post-inflammatory erythema is one of the most common problems encountered in dermatologic clinics. It can leave hypertrophic scars and cause psychological problems. Thus, effective therapeutic interventions are needed. The aim of this study was to evaluate the efficacy and safety of a pulsed-type bipolar radiofrequency (RF) device for treating acne and post-inflammatory erythema. Eighteen patients who had been diagnosed with acne underwent three sessions of bipolar RF treatment at 4 week intervals. Efficacy was assessed based on the number of acne lesions and the total area of lesions. Acne lesion count and area were determined by color correction using the Viola–Jones algorithm after converting the photos into a CIELAB image and extracting the area higher than the erythema threshold from the A* channel. Most patients showed significant clinical improvement after the treatments. Acne lesion counts of the forehead, left malar, right malar, and total areas of the left malar and right malar were decreased significantly after sessions (all p < 0.05). Adverse effects such as pinpoint bleeding and pain were noted. However, they were transient and not severe enough to stop treatment. Thus, such pulsed-type bipolar radiofrequency microneedling is a safe and effective treatment for acne and post-inflammatory erythema.
... AV is an extremely common condition with a lifetime prevalence of approximately 85% and occurs mostly during adolescence [1]. AV can persist into adult-hood, with a 50.9% prevalence rate of acne in women ages 20 to 29 years versus 26.3% in women ages 40 to 49 years [2]. Female patients account for two thirds of visits made to dermatologists for acne, and one third of all dermatology office visits for acne are by women who are older than 25 years [3]. ...
Acne vulgaris (AV) is a chronic inflammatory disease rather than a natural part of the life cycle as colloquially viewed of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. Some of the key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. Grading of acne involves lesion counting and photographic methods. However, there is a lack of consensus on the exact grading criteria, which hampers the conduction and comparison of randomized controlled clinical trials evaluating treatments. Prevention of acne relies on the successful management of modifiable risk factors, such as underlying systemic diseases and lifestyle factors. Several treatments are available, but guidelines suffer from a lack of data to make evidence-based recommendations. In addition, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Acne commonly causes scarring and reduces the quality of life of patients. New treatment options with a shift towards targeting the early processes involved in acne development instead of suppressing the effects of end products will enhance our ability to improve the outcomes for patients with acne.
... After 25 years the frequency of acne decreases up to 25%. 1,2 Acne is thought to be caused by changes in hormones that are triggered during puberty and frequency of occurrence doesn't depend on gender. But women of secondary reproductive age suffer more from acne than men. ...
The objective: To identify, review and compare the pathological acne and the connection between other gynecological diseases in women of different ethnic groups.
Methods and materials: This study was carried out based on the World Health Organization database, hospital based acne incidence, different research materials and official websites
of medical committees.
Results: After analyzing the materials for 20 years, one in ten (7-17%) of people having acne after the age of twenty five. Women are far more likely to have acne during their early
adult years than men, with more than eight in ten of cases of adult acne occurring in women.Clinical acne was more prevalence in African American (37%) and Hispanic women (32%)
than in Continental Indian (23%), Caucasian (24%) and Asian women (30%).Among the women with acne 37.3% of women were diagnosed with polycystic ovarian syndrome where as 39.2% with abnormal menstruation. Other percentage of women diagnosed withpremenstrual dysphoric disorder and other gynecological disorders.
Conclusion: Many causes of adult acne are due to changes in hormone levels that womenexperience at certain points during their lives such as before menstrual periods, during pregnancy, starting or stopping birth control pills and polycystic ovarian syndrome and their prevalence percentage depend on their nationality. Importantly, public health initiatives that improve acne associated with gynecological diseases awareness address amenable risk factors and allow for the early detection will be essential in addressing the outcome inequalities that currently exist.
... Acne vulgaris is a common chronic skin disorder of the sebaceous follicles, which can affect up to 50.9% of women and 42.5% of men throughout their 20s and may continue to occur throughout adulthood [1]. The disease pathogenesis is complex and involves interplays between hyperplasia of the sebaceous glands, the subsequent formation of microcomedones associated with hyperkeratinisation of the follicular wall, and the induction of inflammatory reactions in keratinocytes and sebocytes [2,3]. ...
Introduction:
Patients with mild-to-moderate acne are frequently colonized by Staphylococcus aureus on their skin, which alters microenvironmental skin conditions and exacerbates disease symptoms. Bacteriocins produced by Bacillus subtilis may act as antimicrobial peptides against Gram-positive bacteria.
Aim:
To investigate whether topical application of bacteriocins from B. subtilis could serve as a potential strategy for promoting S. aureus decolonization from acneic skin.
Material and methods:
The research product was a cream formulation containing 1% bacteriocins from B. subtilis. First, we conducted a 60-day pilot study on the effect of topically applied bacteriocins from B. subtilis on the absolute abundance of S. aureus in 12 patients with mild-to-moderate acne. Second, we designed an 8-week, uncontrolled, open-label, multicentre clinical study to investigate whether the topical application of bacteriocins from B. subtilis reduces the number of inflammatory and non-inflammatory lesions, as well as Global Acne Grading Scale (GAGS) scores, in 373 patients with mild-to-moderate acne.
Results:
At the microbiological level, quantitative PCR showed a decrease in the absolute abundance of S. aureus in acne areas after topical application of the research product for 60 days (-38%, p < 0.001). In the clinical study, the number of inflammatory and non-inflammatory lesions was found to decrease at 8 weeks by 59% (p < 0.001) and 58% (p < 0.001), respectively, compared with baseline. A 56% decrease was observed for GAGS scores.
Conclusions:
Topical bacteriocins from B. subtilis can promote S. aureus decolonization in acneic skin, ultimately improving the clinical appearance of mild-to-moderate acne.
... There were 173 males and 135 females out of 308 patients of group-1, while Nagpal et al. [3] included 100 male cases with age matched 100 male control, while Munichandrappa et al. [7] included 45 age and sex matched cases and controls, in which 19 males and 26 females were included in each group. In the study by Collier et al., [8] acne is more frequent in women than men, probably due to earlier onset of puberty in the prior. However, no major gender disparity was noted in our study as female (176): male (173) ratio was -1.01:1 which contrasted with studies by Abdelmawla et al., [9] Munichandrappa et al., [7] and Lynn et al. [10] . ...
Background:
Despite being common and easy to treat conditions, acne and hirsutism may have a striking consequence on one's perception of self. Though understanding the pathogenesis of acne and hirsutism has undergone a major paradigm shift, one of them being insulin resistance (IR), extensive research is still underway. The purpose of the study is to establish causal relationship linking IR with acne vulgaris and hirsutism, as well as to assess severity of the two with increasing IR.
Materials and methods:
A cross-sectional observational study was conducted in the dermatology department. Patient's detailed clinical history and necessary parameters like height, weight, body mass index (BMI), etc., were recorded in predefined proforma, noting signs and symptoms of underlying IR, along with acne severity calculated by global acne grading system (GAGS) and hirsutism severity by modified Ferriman Gallwey score (mFG), then analyzing using Pearson's correlation test to establish correlation between IR and acne with/without hirsutism and hirsutism alone.
Results:
A total of 349 patients included in our study were divided into three groups, (i) Acne-only (N = 308) group showed statistically significant correlation of IR with acne severity (P < 0.0001) and recurrence (P < 0.0001). (ii) In hirsutism-only (N = 24) group, homeostatic model assessment for insulin resistance (HOMA-IR) was strongly associated with modified Ferriman-Gallwey score and recurrence suggesting raised insulin resistance with increased severity of hirsutism (P < 0.0001) and recurrence (P < 0.007). (iii) In acne + hirsutism (N = 17) group, raised BMI was found to be positively associated with IR but not with severity of both conditions.
Conclusion:
IR has emerged as an important contributory, if not, causative event in pathogenesis of severe, resistant acne, and hirsutism. These conditions have great deal of impact on the psychological health of those affected necessitating different approach to manage such cases.
... Acne over the age of 25 has traditionally been de ned as postadolescent acne, and it a ects about 14 percent of women aged 25 to 50. [1][2][3][4][5] The pathophysiology of post-adolescent acne remains unclear. The higher prevalence of acne in females with polycystic ovary syndrome (PCOS), a condition associated with insulin resistance (IR) and hyperandrogenism, lends credence to insulin's role in acne development as both insulin and insulin-like growth factor-1 (IGF-1) levels peak in late puberty and then eventually decrease until the third decade, and acne usually clears up by this point. ...
Background:
Post-adolescent acne is acne in patients aged older than 25 years. It is more common in women, suggesting an underlying hormonal imbalance. It has been postulated that insulin resistance (IR) may play a role in pathogenesis.
Objective:
To explore the relationship between fetuin-A, IR, and post-adolescent acne.
Methods:
Serum fetuin-A levels were assessed using an ELISA technique in 50 female patients with post-adolescent acne and 50 healthy controls, and IR was calculated using the Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR).
Results:
Studied patients had significantly higher HOMA-IR indices and serum fetuin-A levels than control subjects (P=0.001 and <0.001, respectively) and they were significantly increased in patients with severe lesions (P<0.001).
Conclusion:
We found that IR was more significantly prevalent among studied patients, especially those with more severe acne grades, and that could be attributed to higher serum fetuin-A levels. Fetuin -A might be a predictor for acne severity and associated metabolic comorbid conditions, such as IR. However, further large-scale studies will be needed.
... Many 7 8 developed countries in the world, like the USA, UK regularly conduct and report data on acne and its impact on QOL, and even developing countries like 9 Iran conduct studies on the subject but sadly data from Pakistan is reported less commonly. In our study, which was conducted on the medical students in Lahore, the prevalence was found to be 73.2 %, which is similar to the value of 73% of another 10 international research study in which participants had age group overlapping with this study and was also based on self-perception of acne. Similar, results were obtained in many studies. ...
Background: Acne Vulgaris is a rife and chronic dermal disorder, which commonly occurs in pubescent. This disease is characterized by the emergence of comedones, papules, pustules, nodules, or cysts which results from obstruction and inflammation of pilosebaceous units. Objective: To finding out the prevalence and psychological impact of acne on the quality of life in undergraduate medical students of Lahore, Pakistan. Methodology: A cross-sectional study was conducted during the month of October 2020, 291 among undergraduate medical students from eight medical colleges of Lahore, selected through simple random sampling, on both male and female undergraduate medical students. To assist them; they were given a simple grading criterion to self-diagnose their current acne severity and quality of life was evaluated by Cardiff Acne Disability Index. Data were analyzed by using SPSS version 22. Results: A total of 213 (73.2%) prevalence of acne was found among the participants who responded (291). No significant relation between acne severity and gender was found (p=0.151). There was no association between CADI score and gender (p=0.366). However, a significant correlation was found between CADI score and acne severity (p=0.000). In the population studied, 4.7% showed their acne severely impacting their quality of life, 27.7% have moderate, 58.7% have mild and 8.9% have no impact at all. Conclusion: High Prevalence rate of acne and its significant negative impact on QOL indicates that it is a very common dermatological disorder. Effective interventions can make substantial contributions to derogate the impact of acne severity on QOL.
... The reported prevalence of AV in women compared to men at the age 20 to 29 years, is 50.9% versus 42.5%. (Collier et al., 2008) Multiple factors can cause AV, such as psychological stress, age, race, genetics, hormonal, working condition, weather, seasons, and food. (Adhi, 2007), (Mansu et al., 2018) Hormones have a role in the occurrence of acne, and the menstrual cycle can affect acne, participants were asked whether their acne worsened before, during, or after their menstrual period and also asked whether it was not related with menstruation period. ...
Acne vulgaris (AV) is a chronic inflammation of pilosebaceous glands. The clinical presentation of AV can be described as an inflammatory lesion and non-inflammatory lesions. The diagnosis of AV is through clinical evaluations. AV was graded according to clinical severity using Lehmann’s criteria. AV predilection most commonly appears on the face, chest, and back. AV causes the greatest burden between 10 to 30 years old and can cause anxiety and decrease self-confidence, instigating decreased quality of life. Acupuncture is a non-pharmacological treatment modality that is performed using filiform needles at acupuncture points. An 18-year-old woman was diagnosed with a moderate degree of AV based on Lehmann's criteria. She received manual acupuncture acupoints with the needles retained for 30 minutes. The treatment was conducted 2 times a week for a total of 12 treatments. After 12 treatments of acupuncture therapy, the degree of AV was reduced from moderate to mild, with an 81.25% reduction in total lesions. Follow-up was carried out 1 month after the treatment, showing that the effect of acupuncture remained. The acupuncture mechanism works directly on acne lesions by improving microcirculation, reducing proinflammatory reactions, and increasing anti-inflammatory, as well as regulating the HPA axis which can reduce stress and improve hormones. Manual acupuncture can be considered a non-pharmacological therapeutic modality to treat AV with minimal side effects.
... Androgens are also linked with c-MYC expression via the Wnt/beta-catenin pathway for sebocyte differentiation [53,54]. ...
The skin harbors a huge number of different microorganisms such as bacteria, fungi and viruses, and it acts as a protective shield to prevent the invasion of pathogens and to maintain the health of the commensal microbiota. Several studies, in fact, have shown the importance of the skin microbiota for healthy skin. However, this balance can be altered by intrinsic and extrinsic factors, leading to the development of skin disease, such as acne vulgaris (AV), atopic dermatitis (AD) and rosacea(RS). Although these diseases are widespread and affect both adolescents and adults, the scientific correlation between these disorders and the skin microbiota and physiological parameters (TEWL, hydration and lipid composition) is still unclear. This review aims to investigate the current literature regarding the correlation between the skin microbiota and its imbalance underlying microbiological aspects, how the skin microbiota changes over the course of the disease and the current possible treatments. The following reported studies show a general imbalance of the bacterial flora. For this reason, more in-depth studies are necessary to explore the different subspecies and strains involved in all three diseases.
Amaç: Bu çalışma akne vulgarisin beslenme durumu ile ilişkisini değerlendirmek amacıyla planlanmış ve yürütülmüştür. Gereç ve Yöntem: Çalışmaya 34 aknesi olmayan, 34 aknesi olan kadın gönüllü dahil edilmiştir. Akne vulgaris şiddeti uzman dermatolog tarafından belirlenmiştir. Veriler sorumlu diyetisyen tarafından yüz-yüze görüşme yöntemiyle toplanmış, kadınların antropometrik ölçümleri yapılmış, bazı beslenme alışkanlıkları sorgulanmış, üç günlük besin tüketim kaydı alınmıştır. Bulgular: Akne vulgarisi olmayan kadınların sırasıyla beden kütle indeksi, vücut yağ yüzdesi 21,13±2,39 kg/m2, %22,44±6,16 iken aknesi olan kadınlarda sırasıyla 21,92±2,49 kg/m2, %24,36±5,13 olarak saptanmıştır. Akne vulgarisi olmayan kadınlardan %8,8’i, aknesi olan kadınların ise %17,6’sı hiç ara öğün tüketmemektedir. Çalışmaya katılan kadınların günlük enerji alım ortalamaları aknesi olmayan kadınlarda aknesi olan kadınlara göre daha düşük (sırasıyla 1260,04±371,83 kkal, 1586,04±416,14 kkal) bulunmuştur (p
Background:
Poor patient adherence with anti-acne medications is a common clinical challenge. DMT310, a natural topical product with a once-weekly application schedule, may alleviate this obstacle.
Objective:
Evaluate the safety, tolerability, and efficacy of DMT310 in treating moderate-to-severe acne.
Methods:
This 12-week, randomized, double-blind, placebo-controlled, multicenter clinical trial enrolled participants 12 years and older with moderate-to-severe acne.
Results:
The Intent to Treat (ITT) population included a total of 181 participants (DMT310, N = 91; Placebo, N = 90). Participants who received DMT310 versus participants treated with placebo demonstrated a statistically significant greater reduction in the number of inflammatory (IL) and noninflammatory (NIL) lesions at all timepoints: IL counts at Week 12(-15.64 vs -10.84, P < 0.001); NIL counts (at Week 12(-18.26 vs -12.41, P < 0.001). DMT310-treated participants also had higher rates of Investigator Global Assessment (IGA) treatment success than participants in the placebo group at all timepoints: IGA at Week 12(44.40% vs 17.78%; P < 0.001). No serious treatment related adverse events occurred.
Conclusions:
DMT310 once-weekly topical treatment significantly reduced both inflammatory and noninflammatory lesions and yielded a greater proportion of IGA treatment success at all timepoints in participants with moderate-to-severe acne.
Treatment of acne vulgaris with a long-pulsed ND-YAG laser: a prospective clinical trial
Acne vulgaris or “acne” is a prevalent and burdensome cutaneous condition that has been linked with unique mental health implications. Clinical (i.e., general and social anxiety, and major depression) and subclinical indicators (e.g., excessive worry, social self‐consciousness, and low self‐esteem) of internalizing disorders have been associated with acne across demographics (e.g., age groups and cultures). Considering the persistent burden of disease associated with these mental health outcomes, our primary aim was to concretely synthesize the relation between acne and internalizing symptoms. A secondary aim was to address the role that combined oral contraceptives and isotretinoin (e.g., Accutane), widely prescribed medical treatments for acne, may play in this relation as both have been linked to depression and anxiety. We discuss practical implications that may strengthen the effective biopsychosocial management of acne for suffering individuals. This review actively upholds and amplifies the call for longitudinal research that integrates the developmental psychology and dermatology literature to effectively treat acne in its entirety, including mental health.
The application of minerals and their derivatives in the pharmaceutical industries are many and varied, as shown in Fig. 4.1. As explained in the preceding chapters, the clay minerals are very useful for medicinal purposes owing to their distinctive internal structures, compositions, and the resulting antimicrobial and antitoxic properties, which include their abilities to adsorb a wide variety of viruses and toxins, to assist in the bactericidal actions of iron and some metals, and to combine with many antimicrobial cations and organic molecules.
Dysbiosis is characterized by a disruption of bacterial homeostasis and may be associated with various skin diseases. Acne is a multifactorial inflammatory disease with a robust microbial component and numerous correlations with dysbiosis states. Furthermore, various factors are recognized as triggers for skin dysbiosis, including the use of certain cosmetics. Based on these arguments, we hypothesized that the use of photoprotective formulations could trigger dysbiosis and the occurrence of acne manifestations. To verify this assumption, six volunteers between 19 and 23 years of age, meeting all the inclusion criteria, received two applications a day of a non-commercial sunscreen formulation developed with the sun filters ethylhexyl methoxycinnamate, ethylhexyl salicylate, methyl anthranilate, and octocrylene dispersed in a base gel, with an estimated protection factor of 28.8. The pure base gel was used as a control. The samples were applied to an area delimited by a standard template (15 cm ² ) in an amount corresponding to 30 mg (2 mg cm ² ) for ten days. At two points in time, pre- and post-sample applications, the facial skin surface was swabbed to collect extracted DNA and processed to verify divergent degrees of 16S RNA coding sequences. The data obtained allowed us to determine the abundance of different bacterial entities at the genus and species levels. The results showed that key species of the acne process, such as Cutibacterium acnes and Staphylococcus epidermidis , seem to tolerate the evaluated formulation well, not being significantly affected by the formulation, suggesting no interference of its use concerning dysbiosis induction.
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.
Acne vulgaris is a common chronic inflammatory skin disease of the pilosebaceous units. Four factors contribute to acne: hyperseborrhea and dysseborrhea, follicular hyperkeratinisation, skin microbiome dysbiosis and local immuno‐inflammation. Recent key studies have highlighted a better understanding of the important role of Cutibacterium acnes (C. acnes) in the development of acne. Three major findings in the last decade include: (1) the ability of C. acnes to self‐organize in a biofilm associated with a more virulent activity, (2) the loss of the C. acnes phylotype diversity and (3) the central role of the Th17 pathway in acne inflammation. Indeed, there is a close link between C. acnes and the activation of the Th17 immuno‐inflammatory pathway at the initiation of acne development. These mechanisms are directly linked to the loss of C. acnes phylotype diversity during acne, with a predominance of the pro‐pathogenic phylotype IA1. This specifically contributes to the induction of the Th17‐mediated immuno‐inflammatory response involving skin cells, such as keratinocytes, monocytes and sebocytes. These advancements have led to new insights into the underlying mechanisms which can be harnessed to develop novel treatments and diagnostic biomarkers. A major disadvantage of traditional treatment with topical antibiotics is that they induce cutaneous dysbiosis and antimicrobial resistance. Thus, future treatments would no longer aim to ‘kill’ C. acnes, but to maintain the skin microbiota balance allowing for tissue homeostasis, specifically, the restoration of C. acnes phylotype diversity. Here, we provide an overview of some of the key processes involved in the pathogenesis of acne, with a focus on the prominent role of C. acnes and the Th17‐inflammatory pathways involved.
Objective:
A healthy and stable microbiome has many beneficial effects on the host, while an unbalanced or disordered microbiome can lead to various skin diseases. Hyaluronic acid is widely used in the cosmetics and pharmaceutical industries; however, specific reports on its effect on the skin microflora of healthy people have not been published. This study aimed to determine the effect of sodium hyaluronate on the facial microflora of healthy individuals.
Methods:
Face of 20 healthy female volunteers between 18 and 24 years was smeared with sodium hyaluronate solution once per day. Cotton swabs were used to retrieve samples on days 0, 14, and 28, high-throughput sequencing of 16S rRNA was used to determine the changes in bacterial community composition.
Results:
Facial application of HA can reduce the abundance of pathogenic bacteria, such as Cutibacterium and S. aureus, and increase the colonization of beneficial-bacteria.
Conclusion:
This is the first intuitive report to demonstrate the effect of hyaluronic acid on facial microflora in healthy people. Accordingly, sodium hyaluronate was found to have a positive effect on facial skin health.
Objective. To evaluate clinical and laboratory changes in patients with acne tarda. Acne is a common chronic inflammatory disease that develops on the seborrheic areas of the skin in the form of comedones, follicular papules and pustules, as well as nodes. Acne is mainly formed at puberty, but can also be observed at an older age, later acne (acne tarda), as a rule, occurs in women. At the age of 25, 45 % of women suffer from acne, at the age of 3140 acne, is observed in 26 % of women, premenstrual acne periodically occurs in 78 % of women of different ages. Materials and methods. The study involved 62 women aged 3045 years, who formed two groups: group I included 30 patients with acne tarda, group II consisted of 32 women without acne acne tarda. The study included the investigation of complaints and anamnesis of disease and life, assessment of general and dermatological status, general blood and urine tests, biochemical blood analysis with indicators of lipid spectrum, carbohydrate metabolism, liver enzymes, pituitary hormones (LH, FSH, prolactin, TSH) and sex hormones. The methods of parametric and nonparametric statistics were used to analyze the data obtained, standard error (m) was used in the calculations, the level of statistical significance was noted at p 0.05. Results. Most of the patients with acne tarda had a history of pubertal acne and acne in relatives. Among them changes in lipid metabolism were detected significantly more often, primarily an increase in the level of leptin (46.7 9.1 %) (p 0.05), as well as hyperlipidemia and elevated atherogenicity index. Ovarian pathology was also significantly more often observed in patients with acne tarda, mainly in the form of functional cysts (53.3 9.1 %) (p 0.05), and an increase in progesterone levels (80.0 7.3 %) (p 0.05). There were no significant differences in other sex hormones and pituitary hormones, indicators of carbohydrate metabolism and the function of hepatobiliary system in patients with acne tarda and without it. Conclusions. Acne tarda develops mainly in women with a pubertal acne in anamnesis and a burdened heredity of acne. The disease is accompanied by a change in lipid metabolism, especially an increase in the blood leptin level, and proceeds against the background of hormonal homeostasis disorders in the form of hyperprogesteronemia with the formation of functional ovarian cysts.
Background:
COVID-19 pandemic has caused mask-related skin problems on health-care professions, yet very few studies have investigated the prevalence in oriental general population.
Objective:
To investigate the prevalence of mask-related adverse skin reactions in Orientals, to explore psychological influence, to identify risk factors for mask-related acne exacerbation.
Methods:
We performed a survey through social media. Participant demographics, skin condition before and after COVID-19, and the influence of adverse skin on social-psychological conditions were collected. We compared characteristics between individuals with or without acne exacerbation, and we performed a logistic regression to identify risk factors.
Results:
Six hundred and six participants (62.3%) responded the survey and 23.3% complained their facial acnes become exacerbated since COVID-19. The social-psychological impact of acnes is more prevalent in women. Risk factors for mask-related acne exacerbation were occupation as health-care workers (OR = 1.861, p = 0.027), prolonged wearing of N95 masks (OR = 3.167, p = 0.001), and touching of acnes (OR = 2.65, p = 0.002). Sex, pre-existed acnes, and prolonged wearing time per day are also associated with acne exacerbation.
Conclusions:
Mask-related adverse skin reactions are common in Orientals, and could lead to negative social-psychological effects.
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
Introduction: Acne is a chronic inflammatory disease that affects the pilosebaceous unit, and there are conflicting evidences regarding its association with metabolic syndrome (MS) and insulin resistance (IR). Methods: A cross-sectional study was performed with 162 acne patients, over 20 years of age, matched for age and sex with 78 healthy controls without acne. The measured parameters included waist circumference (WC), body mass index (BMI), systolic blood pressure, diastolic blood pressure, fasting blood glucose, fasting insulin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and total cholesterol. Acne severity was determined according to the Global Acne Grading System. The criteria used for the diagnosis of MS were those of the Harmonizing the Metabolic Syndrome Statement, adjusted for South Americans, and the IR was calculated using the HOMA-IR. Results: The prevalence of MS was significantly higher in cases, compared to controls (12.3% vs. 2.6%, P = 0.014), as was the prevalence of IR (11.7% vs. 3.8%, P = 0.047). In addition, MS and IR showed a positive correlation with the degree of acne severity (P = 0.011 and P = 0.021, respectively). HDL levels were significantly lower in cases (P = 0.012) and showed an association with acne severity (P = 0.038). In the logistic regression model, the risk factor that independently influenced both MS and IR in patients with acne was the WC (P = 0.001). Conclusions: Adults with acne, especially the most severe cases, are significantly more likely to have MS, IR, and lower HDL levels, compared to controls without acne.
Background: The current mainstay treatment of perimenstrual acne consists of systemic hormonal therapies, which can be problematic due to their side effects, stigma, or pill burden. Topical treatments are often used as well; however, data on their efficacy in treating this type of hormonal acne are limited.
Objective. We sought to evaluate the efficacy and tolerability of clindamycin phosphate and benzoyl peroxide 1.2%/3.75% combination gel in treating perimenstrual acne in adult women.
Methods. The single-group interventional pilot study was performed on 22 adult female subjects with perimenstrual acne. The subjects applied the investigational drug daily and were assessed every 14 days for a total of 99 days. Treatment success was evaluated by the investigators using the acne physician global assessment (PGA) scoring system. Drug tolerability assessment was based on the subject-reported adverse events, as well as physician-evaluated erythema, scaling, and dryness.
Results. The study demonstrated a significant improvement in PGA score and lesion count, as well as patient-reported outcomes. The medication was well-tolerated in all subjects.
Limitations. Limited sample size; lack of concurrent comparison group.
Conclusion. Clindamycin phosphate and benzoyl peroxide 1.2%/3.75% combination gel presents an important topical option for perimenstrual acne.
The prevalence of metabolic syndrome is increasing day by day, owing to the sedentary lifestyle, unhealthy food habits, genetic factors, environmental influences and many other conspicuous variables. Skin, aptly considered to be a mirror of internal organs, often manifests with certain signs and symptoms, suggestive of a diagnosis of metabolic syndrome. In this chapter, we have attempted to touch upon the dermatological manifestations (both common and uncommon) of metabolic syndrome.KeywordsMetabolic syndromeDiagnosisSkin manifestations
Across all ages and genders, how acne vulgaris has been described as a chronic inflammatory disorder of the pilosebaceous units has been known. There might be a shift in the paradigm of acne etiopathogenesis, but the four major factors affecting its course remain the same. The acne lesions and the sequalae remain a great concern. All of these are and have been the foci of a multitude of researches. The female gender is much affected by acne. Added to this frustrating skin disorder are conditions specific to women: the menstrual cycle and pregnancy. What is hopefully an adolescent affliction now extends even up to the postmenopausal years. What may be simply managed becomes complicated. This chapter focuses on Adult Female Acne and how polycystic ovary syndrome and pregnancy alter the course of its management. Relevant hormonal therapies and isotretinoin usage are reviewed. Adult female acne is now a part of many investigative works, yet much has to be uncovered. The desperation that builds up must be halted at the very beginning of management. As dermatologists, all efforts to become instrumental in improving the patient’s quality of life is imperative. The reciprocal relationship of doctor–patient should be developed.
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.
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.
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.
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.
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.
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.
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
- A M Layton
- K Henderson
- W J Cunliffe
Layton AM, Henderson K, Cunliffe WJ. A clinical assessment of
acne scarring. Clin Exp Dermatol 1994;4:303-8.
The prevalence of acne on the basis of physical examination
- Stern
Stern R. The prevalence of acne on the basis of physical
examination. J Am Acad Dermatol 1992;26:931-5.
Post-adolescent acne: a review of clinical features
- Goulden
A clinical assessment of acne scarring
- Layton
Prevalence of facial acne vulgaris in late adolescence and in adults
- Cunliffe