Adult female acne: a guide to clinical practice

Abstract

BackgroundAcne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution.ObjectiveTo develop a guide for the clinical practice of adult female acne.MethodsA team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne.ResultsThe group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne.ConclusionDifferent from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.

A study comparing the clinical and hormonal profile of late onset and persistent acne in adult females

“…The “late onset” subtype appears for the first time after the age of 25 years. A third subtype is “recurrent acne” which occurs in adolescence and improves only to reappear after 25 years of age . Hormonal dysfunction, genetics, cosmetics use, diet, smoking, and stress are implicated as a trigger in adult female acne .…”

“…A third subtype is "recurrent acne" which occurs in adolescence and improves only to reappear after 25 years of age. 2 Hormonal dysfunction, genetics, cosmetics use, diet, smoking, and stress are implicated as a trigger in adult female acne. 3 Though some authors feel that the role of androgens in adult female acne is tenuous, clinical signs of hyperandrogenism (HA) like hirsutism, androgenetic alopecia, and seborrhea are routinely reported across studies even though corroborative biochemical hyperandrogenemia is not consistently seen.…”

Acne Protection: Measures & Miseries

“…Along with acne, having acne scars is a risk factor for suicide and also may be linked to poor selfesteem, depression, anxiety, altered social interactions, body image alterations, embarrassment, anger, lowered academic performance, and unemployment [137]. Studies have also shown that the psychological impact of acne appears to affect more females than males [35]. Facial appearance has an important role in self-perception, as well as in the interaction with others; face lesions cause a significant impact in women's quality of life [147].…”

“…Studies suggested that AEs at the application site occurred more often in Japanese patients than Western patients, most of the AEs were mild [172], [177]. It is most effective when used in combination with other acne vulgaris therapies [35]. BP is a bactericidal agent.…”

Topical 2% ketoconazole cream monotherapy significantly improves adult female acne: A double‐blind, randomized placebo‐controlled trial

“…Currently, treatment of AFA often includes adapalene with benzoyl peroxide, which is associated with skin irritation and does not address the Malassesia dysbiosis. Ketoconazole (KTZ) cream, one of the commonly used imidazole antifungal drugs, with anti‐inflammatory effect and antiandrogenic activity, is an effective treatment for Malassezia ‐related skin disorders such as seborrheic dermatitis which is a frequent comorbidity with acne .…”