Acne in Women
Acne, usually, affects adult women over 25 at a rate ranging from 14% to 40%.
More specifically, in older women acne may occur during menopause or even later. In the majority of younger women with inflammatory acne, there is a link between facial hirsutism (abnormal growth of hair on a woman’s face and body), a presence of large pores and seborrhea (scales of greasy skin), whereas in smokers’ acne, it is more severe as compared to nonsmokers. Women are negatively affected in terms of psychology and self-esteem even in cases of mild or moderate acne, resulting in to significant consequences in their interpersonal and professional relationships. Thus, acne treatment should not be limited only to the physical aspect, but to the psychological impact too.
Acne and Hyperandrogenism
Among all women with acne, the possibility of hyperandrogenism should be examined especially when abnormal menstrual cycles, hypertrichosis or androgenetic alopecia coexist.
Characteristics of androgen excess in adult women are listed below:
- Late-onset acne
- Resistant acne
- Menstrual cycle abnormalities
- Female or Male alopecia
- Acanthosis nigricans (common skin pigmentation disorder)
- Truncal obesity (excess fat in the abdomen)
Acne and Polycystic Ovary Syndrome
Acne that originates or persists into adulthood and that is unresponsive to conventional therapies should raise suspicion for the diagnosis of underlying Polycystic Ovary Syndrome (PCOS). Compared with normal pubertal acne, women with PCOS have predominantly inflammatory lesions on the lower face, neck, chest, and upper part of the back. Women with moderate to severe acne should be examined for PCOS because 19% to 37% of patients with moderate to severe acne meet the criteria for this disorder.
Acne and Metabolic Syndrome
It is a common disorder with clinical characteristics associated with the Polycystic Ovary Syndrome. Metabolic Syndrome describes the clinical presentation of severe insulin resistance, obesity, hypertension, dyslipidemias, and microvascular angina. Occasionally, ovarian hyperandrogenism and polycystic ovaries may occur in this setting.
Acne and Pregnancy
During pregnancy, women’s faces look shiny and very healthy. However, some pregnant women show skin irritation caused by acne. The possible onset or exacerbation of acne is due to androgen increase, which leads to the stimulation of the sebaceous glands increased sebum production and obstruction of the pilosebaceous pores. On the contrary, acne which improves during pregnancy is a result of the increase of estrogen levels, which inhibit the production of sebum from the sebaceous gland.