Adult-onset acne: prevalence, impact, and management challenges

Abstract

Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestation; hirsutism and acanthosis nigricans are often present. The majority of the normoandrogenic acne patients present a history since adolescence, but in many cases the lesion distribution and intensity change with time. There is often a typical localization of the lesions in the lower third of the face and lateral region of the neck. Another interesting feature is related to the impact on quality of life (QoL), which is always intense. Often there are signs of depression, even when the lesions are mild. As most adult patients are women, in addition to the conventional options, there is also hormone treatment. Combined oral contraceptives and spironolactone are good options. Knowing more about the particularities in etiopathogenesis, impact on QoL, and specific treatment options is important to all dermatologists who face the challenge of treating acne in adults.

Neuroendocrinology and neurobiology of sebaceous glands

“…Furthermore, several skin conditions exhibit SG abnormalities (Shi et al ., ). Acne vulgaris, or acne, is an exceedingly common skin disease (Tan & Bhate, ; Lynn et al ., ; Rocha & Bagatin, ), which is characterised by the formation of comedones (commonly called ‘blackheads’ or ‘whiteheads’). Comedones are cystic dilations of the distal hair follicle (HF) that are associated with atrophic SGs (Kligman, ).…”

Ultrasound Characteristics of the Hair Follicles and Tracts, Sebaceous Glands, Montgomery Glands, Apocrine Glands, and Arrector Pili Muscles

“…Skin conditions are among the leading causes of the global burden of disease . However, to date, common dermatologic disorders still present unclear points in their physiopathologic characteristics and management . The ability to noninvasively detect the normal morphologic characteristics of the hair and adnexal glands can allow identification of early subclinical abnormalities in many dermatologic conditions that affect millions of people worldwide, such as alopecia and acne …”

Acne Protection: Measures & Miseries

“…It is a valuable alternative in women with acne in whom oral isotretinoin has failed. Combined oral contraceptives and spironolactone are good options [265]. First and second-generation oral contraceptives decrease the efficacy of spironolactone, confirming the interest of using two third or fourth-generation oral contraceptives [263].…”

“…A study shows the effectiveness of spironolactone to treat acne in Asian women, with a 47% good response using an initial dose of 200 mg per day, then reducing the dose every 4 weeks. Spironolactone's side effects are dose-dependent, and the most frequent are increase of diuresis, headache, dizziness, menstrual irregularity, breast pain, fatigue, and hyperpotassemia [265].…”