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Der Hautarzt

, Volume 64, Issue 4, pp 241–251 | Cite as

Acne tarda

Akne im Erwachsenenalter
  • T. JansenEmail author
  • O.E. Janßen
  • G. Plewig
Leitthema

Zusammenfassung

Die Akne ist eine der häufigsten Hauterkrankungen in der Bevölkerung und speziell bei Jugendlichen. Wenn die Akne nach dem 25. Lebensjahr fortbesteht (persistierende Akne) oder sich erst entwickelt (Spätbeginnakne), spricht man von einer Acne tarda (Acne adultorum). Die Erkrankung wird bevorzugt bei Frauen beobachtet. Der klinische Befund ist relativ spezifisch und besteht in entzündlichen Läsionen im unteren Gesichtsabschnitt oder über das Gesicht verteilten Makrokomedonen (Mikrozysten). Dagegen zeigen erwachsene Männer bevorzugt einen Stammbefall. Die Pathogenese der Acne tarda ist weitgehend ungeklärt, wobei Kosmetika, Medikamente, Rauchen, Stress, Ernährung und Hormonstörungen verantwortlich gemacht werden. Erwachsene Frauen mit Akne und anderen Symptomen der Androgenisierung haben mit großer Wahrscheinlichkeit endokrine Störungen, insbesondere ein polyzystisches Ovarialsyndrom. Die Aknetherapie bei Erwachsenen und Jugendlichen weicht in einigen Punkten voneinander ab. Bei Erwachsenen ist in der Regel eine Langzeittherapie über Jahre oder Jahrzehnte erforderlich.

Schlüsselwörter

Acne adultorum Persistierende Akne Spätbeginnakne Polyzystisches Ovarialsyndrom Makrokomedonen 

Acne tarda

Acne in adults

Abstract

Acne is one of the most common skin diseases in the general population, especially among adolescents. Acne tarda (adult acne) is defined as acne that develops (late-onset acne) or continues (persistent acne) after 25 years of age. The disease is more common in women. The clinical features are quite specific: inflammatory acne in the lower facial region or macrocomedones (microcysts) spread over the face. Involvement of the trunk is much more common in men. The etiology of acne tarda is still controversial, as cosmetics, drugs, smoking, stress, diet, and endocrine abnormalities have been implicated. Women with acne tarda and other symptoms of hyperandrogenism have a high probability of endocrine abnormalities such as polycystic ovary syndrome. Treatment is similar to that of acne in adolescence. Long-term treatment over years or decades may be required.

Keywords

Acne adultorum Persistent acne Late-onset acne Polycystic ovary syndrome Macrocomedones 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Aizawa H, Niimura M (1993) Adrenal androgen abnormalities in women with late onset and persistent acne. Arch Dermatol Res 284:451–455PubMedCrossRefGoogle Scholar
  2. 2.
    Capitanio B, Sinagra JL, Ottaviani M et al (2007) „Smoker’s acne“: a new clinical entity? Br J Dermatol 157:1070–1071PubMedCrossRefGoogle Scholar
  3. 3.
    Capitanio B, Sinagra JL, Ottaviani M et al (2009) Acne and smoking. Dermatoendocrinol 1:129–135PubMedCrossRefGoogle Scholar
  4. 4.
    Capitanio B, Sinagra JL, Bordignon V et al (2010) Underestimated clinical features of postadolescent acne. J Am Acad Dermatol 63:782–788PubMedCrossRefGoogle Scholar
  5. 5.
    Cappel M, Mauger D, Thiboutot D (2005) Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women. Arch Dermatol 141:333–338PubMedCrossRefGoogle Scholar
  6. 6.
    Caputo V, Fiorella S, Curiale S et al (2010) Refractory acne and 21-hydroxylase deficiency in a selected group of female patients. Dermatology 220:121–127PubMedCrossRefGoogle Scholar
  7. 7.
    Carmina E, Godwin AJ, Stanczyk FZ et al (2002) The association of serum androsterone glucuronide with inflammatory lesions in women with adult acne. J Endocrinol Invest 25:765–768PubMedGoogle Scholar
  8. 8.
    Carmina E, Lobo RA (1993) Evidence for increased androsterone metabolism in some normoandrogenic women with acne. J Clin Endocrinol Metab 76:1111–1114PubMedCrossRefGoogle Scholar
  9. 9.
    Chen W, Obermayer-Pietsch B, Hong JB et al (2011) Acne associated with syndromes: models for better understanding of acne pathogenesis. J Eur Acad Dermatol Venereol 25:637–646PubMedCrossRefGoogle Scholar
  10. 10.
    Choi CW, Lee DH, Kim HS et al (2011) The clinical features of late onset acne compared with early onset acne in women. J Eur Acad Dermatol Venereol 25:454–461PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen EL (1945) The incidence and localization of acne. Br J Dermatol 57:10–14CrossRefGoogle Scholar
  12. 12.
    Collier CN, Harper JC, Cantrell WC et al (2008) The prevalence of acne in adults 20 years and older. J Am Acad Dermatol 58:56–59PubMedCrossRefGoogle Scholar
  13. 13.
    Cordain L, Lindeberg S, Hurtado M et al (2002) Acne vulgaris: a disease of Western civilization. Arch Dermatol 138:1584–1590PubMedCrossRefGoogle Scholar
  14. 14.
    Cunliffe WJ, Gould DJ (1979) Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J 1:1109–1110PubMedCrossRefGoogle Scholar
  15. 15.
    Darley CR, Kirby JD, Besser GM et al (1982) Circulating testosterone, sex hormone binding globulin and prolactin in women with late onset or persistent acne vulgaris. Br J Dermatol 106:517–522PubMedCrossRefGoogle Scholar
  16. 16.
    Darley CR, Moore JW, Besser GM et al (1984) Androgen status in women with late onset or persistent acne vulgaris. Clin Exp Dermatol 9:28–35PubMedCrossRefGoogle Scholar
  17. 17.
    Dréno B, Layton A, Zouboulis CC et al (2013) Adult female acne: a new paradigm. J Eur Acad Dermatol Venereol 27 (im Druck)Google Scholar
  18. 18.
    Dréno B, Thiboutot D, Gollnick H et al (2010) Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol 49:448–456PubMedCrossRefGoogle Scholar
  19. 19.
    Dumont-Wallon G, Dréno B (2008) Acné de la femme de plus de 25 ans: spécifique par sa clinique et les facteurs favorisants: étude rétrospective de 79 femmes. Presse Med 37:585–591PubMedCrossRefGoogle Scholar
  20. 20.
    Du-Thanh A, Kluger N, Bensalleh H et al (2011) Drug-induced acneiform eruption. Am J Clin Dermatol 12:233–245PubMedCrossRefGoogle Scholar
  21. 21.
    Eady EA, Jones CE, Cove JH et al (1995) Carriage of antibiotic resistant propionibacteria is not an explanation for acne tarda. J Invest Dermatol 105:497 (Abstract P-218)Google Scholar
  22. 22.
    Ganceviciene R, Böhm M, Fimmel S et al (2009) Involvement of the corticotropin-releasing hormone system in the pathogenesis of acne vulgaris. Br J Dermatol 160:345–352PubMedCrossRefGoogle Scholar
  23. 23.
    Goulden V, Clark SM, Cunliffe WJ (1997) Post-adolescent acne: a review of clinical features. Br J Dermatol 136:66–70PubMedCrossRefGoogle Scholar
  24. 24.
    Goulden V, Clark SM, McGeown CH et al (1997) Treatment of acne with intermittent isotretinoin. Br J Dermatol 137:106–108PubMedCrossRefGoogle Scholar
  25. 25.
    Goulden V, McGeown CH, Cunliffe WJ (1999) The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol 141:297–300PubMedCrossRefGoogle Scholar
  26. 26.
    Goulden V, Stables GI, Cunliffe WJ (1999) Prevalence of facial acne in adults. J Am Acad Dermatol 41:577–580PubMedGoogle Scholar
  27. 27.
    Harper JC (2008) Evaluating hyperandrogenism: a challenge in acne management. J Drugs Dermatol 7:527–530PubMedGoogle Scholar
  28. 28.
    Jansen T, Grabbe S, Plewig G (2005) Klinische Formen der Akne. Hautarzt 56:1018–1026PubMedCrossRefGoogle Scholar
  29. 29.
    Kamangar F, Shinkai K (2012) Acne in the adult female patient: a practical approach. Int J Dermatol 51:1162–1174PubMedCrossRefGoogle Scholar
  30. 30.
    Kane A, Niang SO, Diagne AC et al (2007) Epidemiologic, clinical, and therapeutic features of acne in Dakar, Senegal. Int J Dermatol 46(Suppl 1):36–38PubMedCrossRefGoogle Scholar
  31. 31.
    Kelekci KH, Kelekci S, Incki K et al (2010) Ovarian morphology and prevalence of polycystic ovary syndrome in reproductive aged women with or without mild acne. Int J Dematol 49:775–779Google Scholar
  32. 32.
    Kligman AM (1988/1989) A critical look at acne cosmetica. J Cutan Aging Cosmetol 1:109–114Google Scholar
  33. 33.
    Kligman AM, Mills OH Jr (1972) Acne cosmetica. Arch Dermatol 106:843–850PubMedCrossRefGoogle Scholar
  34. 34.
    Lasek RJ, Chren MM (1998) Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol 134:454–458PubMedCrossRefGoogle Scholar
  35. 35.
    Laue L, Peck GL, Loriaux DL et al (1991) Adrenal androgen secretion in postadolescent acne: increased adrenocortical function without hypersensitivity to adrenocorticotropin. J Clin Endocrinol Metab 73:380–384PubMedCrossRefGoogle Scholar
  36. 36.
    Lookingbill DP, Horton R, Demers LM et al (1985) Tissue production of androgens in women with acne. J Am Acad Dermatol 12:481–487PubMedCrossRefGoogle Scholar
  37. 37.
    Lucky AW (2004) Quantitative documentation of a premenstrual flare of facial acne in adult women. Arch Dermatol 140:423–424PubMedCrossRefGoogle Scholar
  38. 38.
    Lucky AW, McGuire J, Rosenfield RL et al (1983) Plasma androgens in women with acne vulgaris. J Invest Dermatol 81:70–74PubMedCrossRefGoogle Scholar
  39. 39.
    Maluki AH (2010) The frequency of polycystic ovary syndrome in females with resistant acne vulgaris. J Cosmet Dermatol 9:142–148PubMedCrossRefGoogle Scholar
  40. 40.
    McGeown CH, Goulden V, Holland DB et al (1997) Sebum excretion rate in post-adolescent acne compared to controls and adolescent acne. J Invest Dermatol 108:386 (Abstract 86)Google Scholar
  41. 41.
    Melnik B (2010) Acne vulgaris: Rolle der Diät. Hautarzt 61:115–125PubMedCrossRefGoogle Scholar
  42. 42.
    Nast A, Dréno B, Bettoli V et al (2012) European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol 26(Suppl 1):1–29PubMedCrossRefGoogle Scholar
  43. 43.
    Nelson AM, Gilliland KL, Cong Z et al (2006) 13-cis retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes. J Invest Dermatol 126:2178–2189PubMedCrossRefGoogle Scholar
  44. 44.
    Ostlere LS, Richardson T, Caine S (1993) The prevalence of late onset congenital adrenal hyperplasia in females with post-adolescent acne. Br J Dermatol 129(Suppl 42):25 (Abstract)Google Scholar
  45. 45.
    Pariser DM, Westmoreland P, Morris A et al (2007) Long-term safety and efficacy of a unique fixed-dose combination gel of adapalene 0.1 % and benzoyl peroxide 2.5 % for the treatment of acne vulgaris. J Drugs Dermatol 6:899–905PubMedGoogle Scholar
  46. 46.
    Plunkett A, Merlin K, Gill D et al (1999) The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia. Int J Dermatol 38:901–908PubMedCrossRefGoogle Scholar
  47. 47.
    Poli F, Dréno B, Verschoore M (2001) An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol 15:541–545PubMedCrossRefGoogle Scholar
  48. 48.
    Preneau S, Dréno B (2012) Female acne – a different subtype of teenager acne? J Eur Acad Dermatol Venereol 26:277–282PubMedCrossRefGoogle Scholar
  49. 49.
    Reynolds RC, Lee S, Choi JY et al (2010) Effect of the glycemic index of carbohydrates on acne vulgaris. Nutrients 2:1060–1072PubMedCrossRefGoogle Scholar
  50. 50.
    The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47CrossRefGoogle Scholar
  51. 51.
    Schäfer T, Nienhaus A, Vieluf D et al (2001) Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol 145:100–104PubMedCrossRefGoogle Scholar
  52. 52.
    Schlosser R, Schäfer J, Kaufmann R et al (2012) Heterozygoter 21-Hydroxylase-Mangel als Ursache eines Hyperandrogenismus. J Dtsch Dermatol Ges 10:841–842PubMedGoogle Scholar
  53. 53.
    Schmitt JV, Masuda PY, Miot HA (2009) Acne in women: clinical patterns in different age-groups. An Bras Dermatol 84:349–354PubMedCrossRefGoogle Scholar
  54. 54.
    Seirafi H, Farnaghi F, Vasheghani-Farahani A et al (2007) Assessment of androgens in women with adult-onset acne. Int J Dermatol 46:1188–1191PubMedCrossRefGoogle Scholar
  55. 55.
    Shaw JC, White LE (2001) Persistent acne in adult women. Arch Dermatol 137:1252–1253PubMedGoogle Scholar
  56. 56.
    Smith RN, Mann NJ, Braue A et al (2007) The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol 57:247–256PubMedCrossRefGoogle Scholar
  57. 57.
    Smith RN, Braue A, Varigos GA et al (2008) The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci 50:41–52PubMedCrossRefGoogle Scholar
  58. 58.
    Smith RN, Mann N, Makelainen H et al (2008) A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: a nonrandomized, parallel controlled feeding trial. Mol Nutr Food Res 52:718–726PubMedCrossRefGoogle Scholar
  59. 59.
    Spencer EH, Ferdowsian HR, Barnard ND (2009) Diet and acne: a review of the evidence. J Am Acad Dermatol 48:339–347Google Scholar
  60. 60.
    Thiboutot D (2001) Hormones and acne: pathophysiology, clinical evaluation, and therapies. Semin Cutan Med Surg 20:144–153PubMedCrossRefGoogle Scholar
  61. 61.
    Thiboutot D, Gilland K, Light J et al (1999) Androgen metabolism in sebaceous glands from subjects with and without acne. Arch Dermatol 135:1041–1045PubMedCrossRefGoogle Scholar
  62. 62.
    Thiboutot D, Knaggs HE, Gilland K et al (1998) Activity of 5α-reductase and 17β-hydroxysteroid dehydrogenase in the infrainfundibulum of subjects with and without acne vulgaris. Dermatology 196:38–42PubMedCrossRefGoogle Scholar
  63. 63.
    Till AE, Goulden V, Cunliffe WJ et al (2000) The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ. Br J Dermatol 142:885–892PubMedCrossRefGoogle Scholar
  64. 64.
    Williams C, Layton AM (2006) Persistent acne in women: implications for the patient and for therapy. Am J Clin Dermatol 7:281–290PubMedCrossRefGoogle Scholar
  65. 65.
    Yentzer BA, Hick J, Reese EL et al (2010) Acne vulgaris in the United States: a descriptive epidemiology. Cutis 86:94–99PubMedGoogle Scholar
  66. 66.
    Youn SW, Park ES, Lee DH et al (2005) Does facial sebum excretion really affect the development of acne? Br J Dermatol 153:919–924PubMedCrossRefGoogle Scholar
  67. 67.
    Yu YS, Cheng YW, Chen WC (2008) Lifetime course of acne: a retrospective questionnaire study in school teachers. Dermatol Sinica 26:10–15Google Scholar
  68. 68.
    Zouboulis CC, Rabe T (2010) Hormonelle Antiandrogene in der Aknetherapie. J Dtsch Dermatol Ges 8(Suppl 1):S60–S74PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Dermatologische PraxisKölnDeutschland
  2. 2.Dermatologische PrivatpraxisDüsseldorfDeutschland
  3. 3.EndokrinologikumHamburgDeutschland
  4. 4.Klinik und Poliklinik für Dermatologie und AllergologieLudwig-Maximilians-Universität MünchenMünchenDeutschland

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