Acne in Adults
Adult acne is an increasingly common phenomenon during the last decades, with increasing trends.
Adult acne either appears for the first time in adulthood or is related to cases of adolescent acne that does not alleviate and continues during adulthood. In particular, there is a fairly large number of women reporting that they never had acne during their teenage years, but first appeared in their 30s or 40s. There is also a relatively small percentage of women who may experience acne during or after menopause (postmenopausal acne).
Despite the fact that in most cases adult acne is mild or moderate, there is still the possibility that it will have an important negative psychological, social and emotional impact. Thus, it is of utmost importance to diagnose and identify the stages of acne in order to decide on the appropriate therapeutic regimen depending on each individual needs. For that, a detailed skin analysis using the complexion analysis system Canfield VISIA® is required to identify, determine and evaluate precisely the skin lesions as well as the regular monitoring of the treatment in order to modify accordingly the progress of the patient.
The following factors should be taken into consideration during diagnosis:
- Acne onset
- Use of inappropriate cleansing and sun protection products
- Skin picking (Dermatillomania) areas of acne
- Microscopy examination for the detection of Demodex folliculorum mite,
- Examination for Staphylococcal infection (a genus of Gram-positive bacteria) depending on each patient’s clinical condition, and in women, examination of their hormonal profile and laboratory examination to detect and exclude hyperandrogenism, particularly in the case where Polycystic Ovary Syndrome coexists. (PCOs).
Adult Acne forms and clinical condition
Adult acne can be categorised in two types depending on its onset:
- Persistent acne: onset is during puberty and continues into adulthood
- Late-onset acne: onset is during adulthood
Furthermore, depending on its clinical signs it can be categorised as follows:
- Papulopustular acne: usually mild to moderate severity with deep, inflammatory papules and cysts while a small number of comedones may also be present on the cheeks.
- Post-adolescent acne: comedones throughout the face along with a small number of inflammatory lesions.
As compared to adolescent acne, in adult acne inflammatory lesions (papules, pustules and nodules) occur to a greater extent in the lower part of the face, especially on the chin and/or around the jaw as well as in the neck, whereas comedones are mainly closed comedones.
Androgen Excess and Acne
Acne may be caused or aggravated due to the increased adrenal gland production in response to stress, adrenal tumors, gonadal dysgenesis, Cushing’s syndrome, and ovarian androgen excess, such as that which occurs in patients with polycystic ovarian syndrome (PCOS). More specifically, in women androgens are directly secreted by the adrenal glands and the ovarian follicles, whereas in men by the adrenal glands.
Causes of hyperandrogenism in women and men:
- Adrenal causes (women and men)
- Congenital adrenal hyperplasia
- Cushing’s syndrome
- Virilising adrenal tumors
- Ovarian causes (women only)
- Polycystic Ovary Syndrome
- Hyperreactio luteinalis (bilaterally enlarged ovaries)
- Virilising ovarian tumours
In patients with acne showing rapid development of virilising signs, such as voice deepening, increased muscle mass, or androgenetic alopecia, the evaluation should focus more on a search for a tumor rather than polycystic ovaries.
Prevalence of Acne in adult men and women
Among adults, acne is mainly a chronic condition. Approximately, one in ten (7-17%) people have acne after the age of 25, and a much lower percentage (1% of men and 5% of women) still have acne in their 40s.
Researchers conclude that women are more likely to suffer from acne when they are aged over 20 compared to men. In general, adult acne differs in terms of the following points as compared to adolescent acne:
- more profound burden on the quality of life
- possibility of particular clinical characteristics
- laboratory examination-hormonal testing is required
- more difficult to be treated effectively with usual treatments
- possible greater skin sensitivity on topical treatments
Adult acne treatment
One of the most safe and effective methods to treat adult acne is phototherapy (light therapy) which involves exposing the skin to ultraviolet light in order to:
- regenerate tissues
- control the pathogenic organisms promoting acne or its persistence
- improve skin texture