Epidemiology and Management of Acne in Adult Women

Topical, Biological and Clinical Challenges in the Management of Patients with Acne Vulgaris

“…4 The significant role of androgens is also recognised. 2 The Gram-positive bacterium P. acnes, which is part of the normal skin microbiome, is present in the pilosebaceous units and uses lipid-rich sebum as a nutrient source; its growth is therefore increased in the presence of acne-associated excessive sebum production. 21 Lipid-rich sebum is hydrophobic in nature and it facilitates lubrication and protection of the skin while P. acnes hydrolyses triglycerides in the sebum, causing the release of free fatty acids which increase the chance of bacterial adherence.…”

“…In the absence of well-defined aetiological factors, the principle objective for optimal clinical management of acne vulgaris is to identify potential precipitating and/or aggravating factors and to prevent significant associated morbidities. 2 Additionally, it is important to prevent new acneiform lesions and associated scarring and hyperpigmentation [ Figure 3]. Most experts advocate the use of a stepwise treatment algorithm in accordance with the severity of the disorder, typically combining non-pharmacological and pharmacological agents concomitantly with counselling and support.…”

“…First introduced in 1934 for the treatment of papulopustular acne, BPO appears to have diverse mechanisms of action, including antibacterial mechanisms by virtue of its oxidative effect and sebostatic and comedolytic properties. 2,4 BPO is effective, rapid and substantially reduces P. acnes colonies while also reducing the risk of resistance when used in combination with topical antibiotics. 35 Adapalene has been in clinical use for over two decades; research has confirmed its efficacy and safety, both as a monotherapy and when combined with topical antibiotics.…”

“…1 It is associated with substantial morbidity and sometimes mortality due to associated disorders. 2 The term acne was introduced by the Greek philosopher Celsus in the second century C.E. to describe the presence of pustules/papules on the skin, although the ancient Roman physician Pliny had previously used the word 'varus' to describe similar pustules.…”

“…1 These lesions can evolve rapidly in some patients and are likely androgen-induced. 2 The current challenge in treating acne vulgaris is improving the understanding of its precise underlying cellular and molecular biology, identifying any potential candidate trigger factors and developing treatment guidelines within a regional and demographic context. The latter concept is of particular interest in view of several recent reports suggestive of diverse causal factors, such as seasonal variations, unique dietary and ethnic factors and comorbidities.…”