Postadolescent acne in women
- Anetta Reszko, MD
Anetta Reszko, MD
- Assistant Professor of Dermatology
- Weill Cornell Medical Center
- Diane Berson, MD
Diane Berson, MD
- Assistant Clinical Professor of Dermatology
- Weill Medical College of Cornell University
Acne vulgaris is a skin disorder characterized by the presence of comedones and inflammatory lesions on the face, neck, shoulders, or trunk. Although the high prevalence of acne in the adolescent population has contributed to a perception that acne is a disorder of youth, acne remains a significant problem for many adults.
The unique features of postadolescent acne in women will be discussed here. General information on the pathogenesis, clinical features, diagnosis, and management of acne is reviewed separately. (See "Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris" and "Treatment of acne vulgaris" and "Hormonal therapy for women with acne vulgaris" and "Oral isotretinoin therapy for acne vulgaris" and "Light-based, adjunctive, and other therapies for acne vulgaris".)
Postadolescent acne is a common disorder that is often defined as acne that occurs in individuals aged 25 years or older. The disorder appears to occur more frequently in women than men [1-7]. As an example, in a population-based study of more than 17,000 individuals in China, acne was more common in men prior to the age of 30, but was more prevalent in women thereafter . Similarly, in a community-based study of 749 adults aged 25 years or older in the United Kingdom, clinically significant acne (defined as Leeds acne grade ≥1) was detected in 12 percent of women, but only 3 percent of men [7,8].
In addition, women may be more likely to visit healthcare providers for the evaluation and treatment of postadolescent acne [4,9]. In a retrospective study performed in the United Kingdom, 152 out of 200 patients over the age of 25 who were referred to a dermatology department for acne were female (75 percent) .
The prevalence of acne in women steadily decreases with age. This was evident in a prospective study of 2895 women (aged 10 to 70 years) performed in the United States, England, Italy, and Japan . Although acne was most prevalent at age 16 (present in almost 70 percent of subjects) and proceeded to decline after the age of 18, approximately one-half of women in their 20s, one-quarter of women in their 30s, and more than 10 percent of women in their 40s still had clinically significant acne (defined as more than four inflammatory lesions or comedones present on one side of the face). Acne occurred less frequently in post-menopausal women; among women aged 51 years and older, clinically significant acne was detected in less than 5 percent.
- Yentzer BA, Hick J, Reese EL, et al. Acne vulgaris in the United States: a descriptive epidemiology. Cutis 2010; 86:94.
- Shen Y, Wang T, Zhou C, et al. Prevalence of acne vulgaris in Chinese adolescents and adults: a community-based study of 17,345 subjects in six cities. Acta Derm Venereol 2012; 92:40.
- Poli F, Dreno B, Verschoore M. An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol 2001; 15:541.
- Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. Br J Dermatol 1997; 136:66.
- Preneau S, Dreno B. Female acne - a different subtype of teenager acne? J Eur Acad Dermatol Venereol 2012; 26:277.
- Seirafi H, Farnaghi F, Vasheghani-Farahani A, et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol 2007; 46:1188.
- Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol 1999; 41:577.
- Burke BM, Cunliffe WJ. The assessment of acne vulgaris--the Leeds technique. Br J Dermatol 1984; 111:83.
- Kane A, Niang SO, Diagne AC, et al. Epidemiologic, clinical, and therapeutic features of acne in Dakar, Senegal. Int J Dermatol 2007; 46 Suppl 1:36.
- Perkins AC, Maglione J, Hillebrand GG, et al. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt) 2012; 21:223.
- Perkins AC, Cheng CE, Hillebrand GG, et al. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. J Eur Acad Dermatol Venereol 2011; 25:1054.
- Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab 2006; 20:167.
- Timpatanapong P, Rojanasakul A. Hormonal profiles and prevalence of polycystic ovary syndrome in women with acne. J Dermatol 1997; 24:223.
- Skampardonis N, Kouskoukis A, Karpouzis A, Maroulis G. Marked hyperandrogenemia and acne associated with polycystic ovaries in Greek women with polycystic ovary syndrome. Clin Exp Obstet Gynecol 2011; 38:168.
- Chen W, Obermayer-Pietsch B, Hong JB, et al. Acne-associated syndromes: models for better understanding of acne pathogenesis. J Eur Acad Dermatol Venereol 2011; 25:637.
- George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan Med Surg 2008; 27:188.
- Shaw JC. Acne: effect of hormones on pathogenesis and management. Am J Clin Dermatol 2002; 3:571.
- Arora MK, Seth S, Dayal S. The relationship of lipid profile and menstrual cycle with acne vulgaris. Clin Biochem 2010; 43:1415.
- Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2003; 49:S1.
- Grossman Barr N. Managing adverse effects of hormonal contraceptives. Am Fam Physician 2010; 82:1499.
- Dréno B, Thiboutot D, Layton AM, et al. Large-scale international study enhances understanding of an emerging acne population: adult females. J Eur Acad Dermatol Venereol 2015; 29:1096.
- Knaggs HE, Wood EJ, Rizer RL, Mills OH. Post-adolescent acne. Int J Cosmet Sci 2004; 26:129.
- Williams C, Layton AM. Persistent acne in women : implications for the patient and for therapy. Am J Clin Dermatol 2006; 7:281.
- Lucky AW. Quantitative documentation of a premenstrual flare of facial acne in adult women. Arch Dermatol 2004; 140:423.
- Stoll S, Shalita AR, Webster GF, et al. The effect of the menstrual cycle on acne. J Am Acad Dermatol 2001; 45:957.
- Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol 2001; 137:1252.
- Addor FA, Schalka S. Acne in adult women: epidemiological, diagnostic and therapeutic aspects. An Bras Dermatol 2010; 85:789.
- Burton JL, Cartlidge M, Shuster S. Variations in sebum excretion during the menstrual cycle. Acta Derm Venereol 1973; 53:81.
- Williams M, Cunliffe WJ. Explanation for premenstrual acne. Lancet 1973; 2:1055.
- Capitanio B, Sinagra JL, Bordignon V, et al. Underestimated clinical features of postadolescent acne. J Am Acad Dermatol 2010; 63:782.
- Capitanio B, Sinagra JL, Ottaviani M, et al. Acne and smoking. Dermatoendocrinol 2009; 1:129.
- Schäfer T, Nienhaus A, Vieluf D, et al. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol 2001; 145:100.
- Ghodsi SZ, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol 2009; 129:2136.
- Mills CM, Peters TJ, Finlay AY. Does smoking influence acne? Clin Exp Dermatol 1993; 18:100.
- Klaz I, Kochba I, Shohat T, et al. Severe acne vulgaris and tobacco smoking in young men. J Invest Dermatol 2006; 126:1749.
- Rombouts S, Nijsten T, Lambert J. Cigarette smoking and acne in adolescents: results from a cross-sectional study. J Eur Acad Dermatol Venereol 2007; 21:326.
- Taylor SC, Cook-Bolden F, Rahman Z, Strachan D. Acne vulgaris in skin of color. J Am Acad Dermatol 2002; 46:S98.
- Plewig G, Fulton JE, Kligman AM. Pomade acne. Arch Dermatol 1970; 101:580.
- Kligman AM, Mills OH Jr. "Acne cosmetica". Arch Dermatol 1972; 106:843.
- Draelos ZD, DiNardo JC. A re-evaluation of the comedogenicity concept. J Am Acad Dermatol 2006; 54:507.
- Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol 1999; 141:297.
- Di Landro A, Cazzaniga S, Cusano F, et al. Adult female acne and associated risk factors: Results of a multicenter case-control study in Italy. J Am Acad Dermatol 2016.
- Marks R. Acne and its management beyond the age of 35 years. Am J Clin Dermatol 2004; 5:459.
- Dréno B, Thiboutot D, Gollnick H, et al. Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol 2010; 49:448.
- Lasek RJ, Chren MM. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol 1998; 134:454.
- Demircay Z, Seckin D, Senol A, Demir F. Patient's perspective: an important issue not to be overlooked in assessing acne severity. Eur J Dermatol 2008; 18:181.
- Cooper JS, Lee BT. Treatment of facial scarring: lasers, filler, and nonoperative techniques. Facial Plast Surg 2009; 25:311.
- Goodman G. Cleansing and moisturizing in acne patients. Am J Clin Dermatol 2009; 10 Suppl 1:1.
- PATHOGENESIS AND ASSOCIATED FACTORS
- Menstrual cycle
- Cosmetic products
- Other factors
- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS
- EVALUATION AND TREATMENT PRINCIPLES
- Preparing for treatment
- Approach to treatment
- Cosmetic concerns and skin care
- SUMMARY AND RECOMMENDATIONS