Conferencia sobre avances en acné mujer adulta

Adult Female Acne: a growing concern

Jose Luis López Estebaranz, MD PhD

Head of Dermatolgy Dept. University Hosptial Fundación Alcorcón, Madrid, Spain.

Although acne is widely perceived as a disease of adolescence, nowadays a significant and increasing number of adults present to dermatologists with acne. Around 13% to 17% of adult females suffer from clinical acne. Even rates as high as 41% have been reported. The prevalence of acne varies between women of different ethnicity. It is greater among women of African American and Hispanic origin than those of Asian, Caucasians or Continental Indian origin.

Adult female acne is a chronic condition with a substantial negative psychological, social and emotional impact. Based on time of onset, two types of adult female acne are recognized: persistent acne that represents a continuation of the disease from adolescence and late onset acne that can occur for the first time well into adulthood.

In adult females, acne is often mild to moderate in severity, with predominantly inflammatory lesions and scarring. There are some morphological differences in adolescent and adult female acne. In the adult female acne lesions are typically present in the U zone compared with the T zone in adolescents. Retentional lesions are uncommon and nodules can appear on the lower face without other inflammatory lesions.

Although current published evidence does not support clear differences in the pathogenesis of adolescent and adult acne, clinical evidence appears to indicate differences in some pathogenic factors (i.e. cigarette consumption, stress, diet and obesity, use of cosmetics, and exposure to UV light). Endocrine conditions, such as polycystic ovary syndrome, adrenal hyperplasia or virilising tumours should be rule out in those adult female acne that are resistant to therapy and are accompanied by signs of hyperandrogenaemia (irregular menstrual cycles, clitoral hypertrophy, hirsutism, alopecia,..). External factors that may be involved in hyperandrogenism, such as the use of oral contraceptives with partially androgenetic effect, anabolic steroids, corticosteroid or adrenocorticotropic hormone therapy, should also be considered.

An holistic approach to acne therapy in the adult female should be taken that combines standard treatments with adjunct and cosmetic use. Choice of therapy should also be determined by various factors including the extent, severity and duration of disease, response to previous treatments and predisposition to scarring and postinflammatory hyperpigmentation, as well as patient preference and cost.

Maintenance therapy is important in the management of adult female acne. Topical retinoids are recommended as first line maintenance therapy with azelaic acid as alternative.

We will also present data regarding a Spanish epidemiological survey conducted in adult females with acne.