Factors aggravating or precipitating acne in Indian adults: A hospital-based study of 110 cases

Abstract

Background:Although acne is principally a disorder of adolescence, the number of adult patients with acne is increasing. Adult acne is defined as the presence of acne beyond the age of 25 years. There is relatively few data on the prevalence and studies of acne in adult population.Aim and Objectives:To analyze the various factors that aggravate or precipitate acne vulgaris in Indian adults.Materials and methods:The study was done at the Department of Dermatology at a tertiary care center in Kerala for a period of 1 year. A total of 110 patients above the age of 25 year diagnosed clinically as acne vulgaris were included in the study. A detailed history regarding age of onset, duration, type of acne, family history, whether there was any exacerbation related to food, cosmetics, drugs, emotional stress, seasonal variation, sunlight, sweating, pregnancy, menstruation and smoking was taken.Results:Majority of patients with adult acne were in the age group 26-30 years and there was a clear female preponderance. Persistent acne was more common than late onset acne. Food items and cosmetics were attributed to exacerbation by 47.3% and 40% of patients respectively; 32.7% patients had exacerbations during stress, 26.4% following sun exposure and 23.6% after sweating. About 48% patients had first degree relatives with present or past history of acne. Most of the female patients had premenstrual flare of acne, which was much more common among patients with persistent acne. Pregnancy had no effect on acne in majority of patients. Seasonal variation was observed in 44.5% patients, most of them showing exacerbation in summer months.Conclusion:Acne as a disease lasts longer, persists into adulthood and requires treatment well into the forties. Unlike teenage acne, where males tend to be affected more commonly, post adolescent acne mainly affects females. It is therapeutically rewarding to identify the concerned triggers and aggravating factors and be able to deal with them.

A Review of Advancement on Influencing Factors of Acne: An Emphasis on Environment Characteristics

“…Dreno et al indicated individuals with acne suffered from significantly higher stress levels than in acne-free individuals ( 28 ). Epidemiological surveys in Japan ( 77 ), India ( 80 ), and South Korea ( 76 ) all found that stress was an aggravating factor for the cause of acne.…”

“…Sun exposure played a significant role in the incidence of acne. A survey of acne patients in India showed that 26.4% of them developed skin lesions after exposure to sunlight and seasonal variation was observed in 44.5% patients exacerbated, because of increased amount of sunshine exposure in summer months ( 80 ). Dreno et al found acne was significantly more frequent in individuals with moderate or intensive sun exposure due to their work or daily activities ( 28 ).…”

A prospective study examining trigger factors and hormonal abnormalities in adult female acne

“…It has been historically believed that low-grade persistent acne in females could occur majorly due to cosmetics use which lead to the use of the term “acne cosmetica” coined by Kligman. [ 24 ] A hospital-based study noted that 40% of adult acne patients experienced an aggravation of lesions after cosmetic use[ 21 ] which was supported by another study, which also concurred that a statistically significant difference in acne severity between “make-up” users and nonusers was seen. [ 18 ] Significantly, females with persistent acne were found to have a higher use of foundation.…”

“…also observed that oily foods and dairy products precipitated acne in 37.3% and 1.8% adult acne patients, respectively. [ 21 ] Diet has been propounded to cause acne via deranged nutrient signaling-induced hyperkeratosis and hyperseborrhea. [ 22 23 ] This with over-activation of mTORC1 by a high glycemic dietcan cause acne in conjunction with increased levels of androgens.…”

<p>Licochalcone A in Combination with Salicylic Acid as Fluid Based and Hydroxy-Complex 10% Cream for the Treatment of Mild Acne: A Multicenter Prospective Trial</p>

“…[1][2][3] Genetic predisposition, anxiety and depression, hyperglycemic diet, sunlight or artificial light, are additional factors known to be involved in the pathogenesis of acne. 4 Acne is clinically characterized by different clinical aspects and severity, spanning from mild forms, mainly characterized by retentional lesions (RTL) (open and closed comedones) with or without few inflammatory lesions (IFL) (papules/ pustules), to moderate or severe forms, with multiple IFL that seriously impact on patient's quality of life. 5,6 The treatment vary according to disease severity.…”