Could adult female acne be associated with modern life?


In recent years, the prevalence of adult female acne has increased, but the reason for this increase remains unclear. Acne is one of the most common skin disorders. It can be triggered or worsened by endogenous and exogenous factors, including genetic predisposition, hormone concentrations, diet, smoke and stress; although the interaction with this last factor is not well understood. Modern life presents many stresses including urban noises, socioeconomic pressures and light stimuli. Women are especially affected by stress during daily routine. The recent insertion in the labor market is added to the duties of the mother and wife. Women also have a higher risk of developing psychiatric disorders such as depression and anxiety. Sleep restriction is added to these factors, with several negative consequences on health, including on hormonal secretion and the immune system. This is further complicated by the natural variation in sleep architecture across the menstrual cycle. Recent studies have brought new data about the mechanisms and possible factors involved. This review aims to establish a connection between stress, sleep deprivation and adult female acne.

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  1. 1.

    Ackermann K, Revell VL, Lao O, Rombouts EJ, Skene DJ, Kayser M (2012) Diurnal rhythms in blood cell populations and the effect of acute sleep deprivation in healthy young men. Sleep 35:933–940

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Adenekan B, Pandey A, McKenzie S, Zizi F, Casimir GJ, Jean-Louis G (2013) Sleep in America: role of racial/ethnic differences. Sleep Med Rev 17:255–262

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Agak GW, Qin M, Nobe J, Kim MH, Krutzik SR, Tristan GR, Elashoff D, Garbán HJ, Kim J (2014) Propionibacterium acnes Induces an IL-17 Response in Acne Vulgaris that Is Regulated by Vitamin A and Vitamin D. J Invest Dermatol 134:366–373

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  4. 4.

    Åkerstedt T, Orsini N, Petersen H, Axelsson J, Lekander M, Kecklund G (2012) Predicting sleep quality from stress and prior sleep–a study of day-to-day covariation across six weeks. Sleep Med 13:674–679

    PubMed  Article  Google Scholar 

  5. 5.

    Alestas T, Ganceviciene R, Fimmel S, Müller-Decker K, Zouboulis CC (2006) Enzymes involved in the biosynthesis of leukotriene B4 and prostaglandin E2 are active in sebaceous glands. J Mol Med (Berl) 84:75–87

    Article  CAS  Google Scholar 

  6. 6.

    Andersen ML, Alvarenga TF, Mazaro-Costa R, Hachul HC, Tufik S (2011) The association of testosterone, sleep, and sexual function in men and women. Brain Res 1416:80–104

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Andersen ML, Santos-Silva R, Bittencourt LR, Tufik S (2010) Prevalence of erectile dysfunction complaints associated with sleep disturbances in Sao Paulo, Brazil: a population-based survey. Sleep Med 11:1019–1024

    PubMed  Article  Google Scholar 

  8. 8.

    Bender BG, Ballard R, Canono B, Murphy JR, Leung DY (2008) Disease severity, scratching, and sleep quality in patients with atopic dermatitis. J Am Acad Dermatol 58:415–420

    PubMed  Article  Google Scholar 

  9. 9.

    Bin YS, Marshall NS, Glozier N (2013) Sleeping at the limits: the changing prevalence of short and long sleep durations in 10 countries. Am J Epidemiol 177:826–833

    PubMed  Article  Google Scholar 

  10. 10.

    Bittencourt LR, Santos-Silva R, Taddei JA, Andersen ML, de Mello MT, Tufik S (2009) Sleep complaints in the adult Brazilian population: a national survey based on screening questions. J Clin Sleep Med 5:459–463

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Born J, Hansen K, Marshall L, Mölle M, Fehm HL (1999) Timing the end of nocturnal sleep. Nature 397:29–30

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Buysse DJ (2014) Sleep health: can we define it? Does it matter? Sleep 37:9–17

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K (2010) Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev 14:359–369

    PubMed  Article  Google Scholar 

  15. 15.

    Capitanio B, Sinagra JL, Bordignon V, Cordiali Fei P, Picardo M, Zouboulis CC (2010) Underestimated clinical features of postadolescent acne. J Am Acad Dermatol 63:782–788

    PubMed  Article  Google Scholar 

  16. 16.

    Carskadon MA (2011) Sleep’s effects on cognition and learning in adolescence. Prog Brain Res 190:137–143

    PubMed  Article  Google Scholar 

  17. 17.

    Chiu A, Chon SY, Kimball AB (2003) The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol 139:897–900

    PubMed  Article  Google Scholar 

  18. 18.

    Chrousos GP, Peck GL, Gross EG, Cutler GB Jr, Loriaux DL (1982) Adrenal function in women with idiopathic acne. J Invest Dermatol 78:468–471

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Culebras A (2012) Sleep, stroke and poststroke. Neurol Clin 30:1275–1284

    PubMed  Article  Google Scholar 

  21. 21.

    Darling CA, Coccia C, Senatore N (2012) Women in midlife: stress, health and life satisfaction. Stress Health 28:31–40

    PubMed  Article  Google Scholar 

  22. 22.

    Denda M, Takei K, Denda S (2013) How does epidermal pathology interact with mental state? Med Hypotheses 80:194–196

    PubMed  Article  Google Scholar 

  23. 23.

    Dettoni JL, Consolim-Colombo FM, Drager LF, Rubira MC, Souza SB, Irigoyen MC, Mostarda C, Borile S, Krieger EM, Moreno H Jr, Lorenzi-Filho G (2012) Cardiovascular effects of partial sleep deprivation in healthy volunteers. J Appl Physiol (1985) 113:232–236

    Article  CAS  Google Scholar 

  24. 24.

    Dréno B, Layton A, Zouboulis CC, López-Estebaranz JL, Zalewska-Janowska A, Bagatin E, Zampeli VA, Yutskovskaya Y, Harper JC (2013) Adult female acne: a new paradigm. J Eur Acad Dermatol Venereol 27:1063–1070

    PubMed  Article  Google Scholar 

  25. 25.

    Dumont-Wallon G, Dréno B (2008) Specificity of acne in women older than 25 years. Presse Med 37:585–591

    PubMed  Article  Google Scholar 

  26. 26.

    Dunn JH, Koo J (2013) Psychological stress and skin aging: a review of possible mechanisms and potential therapies. Dermatol Online J 19:18561

    PubMed  Google Scholar 

  27. 27.

    Ganceviciene R, Böhm M, Fimmel S, Zouboulis CC (2009) The role of neuropeptides in the multifactorial pathogenesis of acne vulgaris. Dermatoendocrinol 1:170–176

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  28. 28.

    Ganceviciene R, Graziene V, Fimmel S, Zouboulis CC (2009) Involvement of the corticotropin-releasing hormone system in the pathogenesis of acne vulgaris. Br J Dermatol 160:345–352

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Garg A, Chren MM, Sands LP, Matsui MS, Marenus KD, Feingold KR, Elias PM (2001) Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol 137:53–59

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Goulden V, Clark SM, Cunliffe WJ (1997) Post-adolescent acne: a review of clinical features. Br J Dermatol 136:66–70

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    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 141:297–300

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Goulden V, Stables GI, Cunliffe WJ (1999) Prevalence of facial acne in adults. J Am Acad Dermatol 41:577–580

    PubMed  CAS  Google Scholar 

  33. 33.

    Hachul H, Andersen ML, Bittencourt LR, Santos-Silva R, Conway SG, Tufik S (2010) Does the reproductive cycle influence sleep patterns in women with sleep complaints? Climacteric 13:594–603

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Hall JM, Cruser D, Podawiltz A, Mummert DI, Jones H, Mummert ME (2012) Psychological stress and the cutaneous immune response: roles of the HPA Axis and the sympathetic nervous system in atopic dermatitis and psoriasis. Dermatol Res Pract 2012:403908

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Hirotsu C, Rydlewski M, Araújo MS, Tufik S, Andersen ML (2012) Sleep loss and cytokines levels in an experimental model of psoriasis. PLoS One 7:e51183

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  36. 36.

    Isard O, Knol AC, Castex-Rizzi N, Khammari A, Charveron M, Dréno B (2009) Cutaneous induction of corticotropin releasing hormone by Propionibacterium acnes extracts. Dermatoendocrinol 1:96–99

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  37. 37.

    Jafferany M (2007) Psychodermatology: a guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry 9:203–213

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ (2003) Inflammatory events are involved in acne lesion initiation. J Invest Dermatol 121:20–27

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  40. 40.

    Joo EY, Yoon CW, Koo DL, Kim D, Hong SB (2012) Adverse effects of 24 hours of sleep deprivation on cognition and stress hormones. J Clin Neurol 8:146–150

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Kahan V, Andersen ML, Tomimori J, Tufik S (2009) Stress, immunity and skin collagen integrity: evidence from animal models and clinical conditions. Brain Behav Immun 23:1089–1095

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Kawakami N, Takatsuka N, Shimizu H (2004) Sleep disturbance and onset of type 2 diabetes. Diabetes Care 27:282–283

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Khunger N, Kumar C (2012) A clinico-epidemiological study of adult acne: is it different from adolescent acne? Indian J Dermatol Venereol Leprol 78:335–341

    PubMed  Article  Google Scholar 

  44. 44.

    Killgore WD (2010) Effects of sleep deprivation on cognition. Prog Brain Res 185:105–129

    PubMed  Article  Google Scholar 

  45. 45.

    Kollar EJ, Slater GR, Palmer JO, Doctor RF, Mandell AJ (1966) Stress in subjects undergoing sleep deprivation. Psychosom Med 28:101–113

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Kraus SJ (1970) Stress, acne and skin surface free fatty acids. Psychosom Med 32:503–508

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Lattova Z, Keckeis M, Maurovich-Horvat E, Wetter TC, Wilde-Frenz J, Schuld A, Pollmächer T (2011) The stress hormone system in various sleep disorders. J Psychiatr Res 45:1223–1228

    PubMed  Google Scholar 

  48. 48.

    Lee WJ, Jung HD, Lee HJ, Kim BS, Lee SJ, Kim do W (2008) Influence of substance-P on cultured sebocytes. Arch Dermatol Res 300:311–316

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Leproult R, Van Cauter E (2010) Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev 17:11–21

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  50. 50.

    Leproult R, Van Cauter E (2011) Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 305:2173–2174

    PubMed  Article  Google Scholar 

  51. 51.

    McEwen BS (2012) Brain on stress: how the social environment gets under the skin. Proc Natl Acad Sci USA 109(Suppl 2):17180–17185

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  52. 52.

    Monti JM, Vignale R, Monti D (1989) Sleep and nighttime pruritus in children with atopic dermatitis. Sleep 12:309–314

    PubMed  CAS  Google Scholar 

  53. 53.

    Ohayon MM, Morselli PL, Guilleminault C (1997) Prevalence of nightmares and their relationship to psychopathology and daytime functioning in insomnia subjects. Sleep 20:340–348

    PubMed  CAS  Google Scholar 

  54. 54.

    Omisade A, Buxton OM, Rusak B (2010) Impact of acute sleep restriction on cortisol and leptin levels in young women. Physiol Behav 99:651–656

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Picardi A, Abeni D (2001) Stressful life events and skin diseases: disentangling evidence from myth. Psychother Psychosom 70:118–136

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    Poli F, Dreno B, Verschoore M (2001) An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol 15:541–545

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Preneau S, Dreno B (2012) Female acne—a different subtype of teenager acne? J Eur Acad Dermatol Venereol 26:277–282

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Raap U, Weißmantel S, Gehring M, Eisenberg AM, Kapp A, Fölster-Holst R (2012) IL-31 significantly correlates with disease activity and Th2 cytokine levels in children with atopic dermatitis. Pediatr Allergy Immunol 23:285–288

    PubMed  Article  Google Scholar 

  59. 59.

    Roberts RE, Duong HT (2014) The prospective association between sleep deprivation and depression among adolescents. Sleep 37:239–244

    PubMed  PubMed Central  Google Scholar 

  60. 60.

    Rosekind MR (2006) Sleep challenges of a 24/7 global society. Manag Care 15:15–6, 17

  61. 61.

    Ruiz FS, Andersen ML, Martins RC, Zager A, Lopes JD, Tufik S (2012) Immune alterations after selective rapid eye movement or total sleep deprivation in healthy male volunteers. Innate Immun 18:44–54

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Santos-Silva R, Bittencourt LR, Pires ML, de Mello MT, Taddei JA, Benedito-Silva AA, Pompeia C, Tufik S (2010) Increasing trends of sleep complaints in the city of Sao Paulo, Brazil. Sleep Med 11:520–524

    PubMed  Article  Google Scholar 

  63. 63.

    Scholzen T, Armstrong CA, Bunnett NW, Luger TA, Olerud JE, Ansel JC (1998) Neuropeptides in the skin: interactions between the neuroendocrine and the skin immune systems. Exp Dermatol 7:81–96

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    Shechter A, Boivin DB (2010) Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder. Int J Endocrinol 2010:259345

    PubMed  Article  PubMed Central  Google Scholar 

  65. 65.

    Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, Bixler EO (2012) Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med 13:346–353

    PubMed  Article  PubMed Central  Google Scholar 

  66. 66.

    Singh LK, Pang X, Alexacos N, Letourneau R, Theoharides TC (1999) Acute immobilization stress triggers skin mast cell degranulation via corticotropin releasing hormone, neurotensin, and substance P: a link to neurogenic skin disorders. Brain Behav Immun 13:225–239

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Soares CN (2005) Insomnia in women: an overlooked epidemic? Arch Womens Ment Health 8:205–213

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD (2014) Understanding the burden of adult female acne. J Clin Aesthet Dermatol 7:22–30

    PubMed  PubMed Central  Google Scholar 

  69. 69.

    Thayer ZM, Kuzawa CW (2014) Early origins of health disparities: material deprivation predicts maternal evening cortisol in pregnancy and offspring cortisol reactivity in the first few weeks of life. Am J Hum Biol. doi:10.1002/ajhb.22532

    Google Scholar 

  70. 70.

    Toyoda M, Morohashi M (2001) Pathogenesis of acne. Med Electron Microsc 34:29–40

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Toyoda M, Nakamura M, Makino T, Kagoura M, Morohashi M (2002) Sebaceous glands in acne patients express high levels of neutral endopeptidase. Exp Dermatol 11:241–247

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Tsigos C, Chrousos GP (2002) Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 53:865–871

    PubMed  Article  Google Scholar 

  73. 73.

    Van Leeuwen WM, Lehto M, Karisola P, Lindholm H, Luukkonen R, Sallinen M, Härmä M, Porkka-Heiskanen T, Alenius H (2009) Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL-17 and CRP. PLoS One 4:e4589

    PubMed  Article  PubMed Central  Google Scholar 

  74. 74.

    Yang YW, Kang JH, Lin HC (2012) Increased risk of psoriasis following obstructive sleep apnea: a longitudinal population-based study. Sleep Med 13:285–289

    PubMed  Article  Google Scholar 

  75. 75.

    Zouboulis CC (2000) Acne venenata und Acne cosmetica. In: Braun-Falco O, Gloor M, Korting HC (eds) Nutzen und Risiko von Kosmetika. Springer, Berlin, pp 116–123

    Google Scholar 

  76. 76.

    Zouboulis CC (2009) Acne vulgaris and rosacea. In: Granstein RD, Luger T (eds) Neuroimmunology of the skin—basic science to clinical practice. Springer, Berlin Heidelberg, pp 219–232

    Google Scholar 

  77. 77.

    Zouboulis CC, Böhm M (2004) Neuroendocrine regulation of sebocytes—a pathogenetic link between stress and acne. Exp Dermatol 13(Suppl 4):31–35

    PubMed  Article  CAS  Google Scholar 

  78. 78.

    Zouboulis CC, Seltmann H, Hiroi N, Chen W, Young M, Oeff M, Scherbaum WA, Orfanos CE, McCann SM, Bornstein SR (2002) Corticotropin-releasing hormone: an autocrine hormone that promotes lipogenesis in human sebocytes. Proc Natl Acad Sci USA 99:7148–7153

    PubMed  Article  CAS  PubMed Central  Google Scholar 

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  1. 79.

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We are indebted to Associação Fundo de Incentivo à Pesquisa (AFIP) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).

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Albuquerque, R.G.R., Rocha, M.A.D., Bagatin, E. et al. Could adult female acne be associated with modern life?. Arch Dermatol Res 306, 683–688 (2014).

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  • Adult female acne
  • Stress
  • Sleep
  • Skin
  • Immunity