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Persistent Acne in Women

Implications for the Patient and for Therapy

  • Therapy in Practice
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Abstract

Acne is traditionally regarded as a skin disorder of the teenage years. However, recent epidemiologic studies have shown that a significant number of female patients aged >25 years experience acne. One recent community-based UK study estimated the prevalence of facial acne in adult women aged between 26 and 44 years to be 14%. It is not clear whether there is a true increase in acne in this age group or whether these patients are less tolerant of their acne and/or better informed of available therapies and so seek advice. The reasons for persistent acne are not fully understood. External factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered when managing these patients. Post-adolescent acne in females can be divided into ‘persistent acne’, which represents a continuation of acne from adolescence into adult life, and ‘late-onset’ acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The clinical picture of each of these forms of acne in adult females can differ slightly from conventional adolescent disease. The course of each form is more indolent. Because of these variations, the approach to investigation and management of these cases may have subtle differences when compared with that for teenage disease. Acne treatment should aim to reduce sebum, comedogenesis, propionibacteria population, and inflammation. Treatment selection will depend on the acne grade and site as well as the patient‘s preference and ability to comply with therapy. Maintenance therapy plays an important role in managing this group of patients. As the response to treatment is inevitably slow, patients must be encouraged to adhere to the chosen treatment regimen.

This article reviews the literature on persistent acne in women in terms of clinical presentation and possible etiologic factors, and outlines principles of therapy related to managing these cases.

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  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Burton JL, Cunliffe WJ, Stafford L, et al. The prevalence of acne vulgaris in adolescence. Br J Dermatol. 1971; 85: 119–26

    Article  PubMed  CAS  Google Scholar 

  2. Goulden V, Stables GI, Cunliffe WJ. The prevalence of facial acne in adults. J Am Acad Dermatol. 1999; 41: 577–80

    PubMed  CAS  Google Scholar 

  3. Shafer T, Nienhaus A, Vieluf D, et al. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001; 145: 100–4

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. Marks R. Acne and its management beyond the age of 35 years. Am J Clin Dermatol. 2004; 5 (6): 459–62

    Article  PubMed  Google Scholar 

  6. Gollnick MD, Cunliffe W, Berson D, et al. Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003; 49: S I–38

    Article  Google Scholar 

  7. McGeown CH, Goulden V, Holland D, et al. Sebum excretion in post adolescent acne compared to controls and adolescent acne [abstract]. J Invest Dermatol. 1997; 108: 386

    Google Scholar 

  8. Sheehan-Dare RA, Hughes BR, Cunliffe WJ. Clinical markers of androgenicity in acne vulgaris. Br J Dermatol. 1988 Dec; 119 (6): 723–30

    Article  PubMed  CAS  Google Scholar 

  9. Thiboutot D. Acne: hormonal concepts and therapy. Clin Dermatol 2004 Sep-Oct; 22 (5): 419–28

    Article  PubMed  Google Scholar 

  10. Vershoore M. Aspect hormonaux de l’acne. Ann Dermatol Venereol. 1987; 114: 439–54

    Google Scholar 

  11. Lawrence D, Shaw M, Katz M. Elevated free testosterone concentration in men and women with acne vulgaris. Clin Exp Dermatol. 1986; 11: 263–73

    Article  PubMed  CAS  Google Scholar 

  12. Lucky AW, McGuire J, Rosenfield RL, et al. Plasma androgens in women with acne vulgaris. J Invest Dermatol. 1983; 81: 70–4

    Article  PubMed  CAS  Google Scholar 

  13. Pochi PE, Comite H, Longcope C. Hormone blood levels in women with acne [abstract]. J Invest Dermatol. 1986; 86: 501

    Google Scholar 

  14. Sultan C, Oliel V, Audran F, et al. Free and total plasma testosterone in men and women with acne. Acta Derm Venereol (Stockh). 1986; 66: 301–4

    CAS  Google Scholar 

  15. Lookingbill DP, Horton R, Demers LM, et al. Tissue production of androgens in women with acne. J Am Acad Dermatol. 1985; 12: 481–7

    Article  PubMed  CAS  Google Scholar 

  16. Carmina E, Lobo RA. Evidence for increased androsterone metabolism in some normoandrogenic women with acne. J Clin Endocrinol Metab. 1993; 76: 1111–4

    Article  PubMed  CAS  Google Scholar 

  17. Thiboutot D, Gilliland K, Light J, et al. Androgen metabolism in sebaceous glands from subjects with and without acne. Arch Dermatol. 1999; 135: 1041–5

    Article  PubMed  CAS  Google Scholar 

  18. Allam SG. Acne vulgaris in the sixth decade and beyond [Master of Science thesis]. Cardiff: University of Wales, 1991

    Google Scholar 

  19. Eady EA, Gloor M, Lleyden JJ. Propionibacterium acnes resistance: a worldwide problem. Dermatology. 2003; 206: 54–6

    Article  PubMed  CAS  Google Scholar 

  20. Eady EA, Cove JH, Holland KT, et al. Erythromycin resistant propionibacteria in antibiotic treated acne patients: association with therapeutic failure. Br J Dermatol. 1989; 121: 51–7

    Article  PubMed  CAS  Google Scholar 

  21. Ozolins M, Eady EA, Avery A, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet. 2004; 364: 2188–95

    Article  PubMed  CAS  Google Scholar 

  22. Till AE, Goulden V, Cunliffe WJ, et al. The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ. Br J Dermatol. 2000; 142: 885–92

    Article  PubMed  CAS  Google Scholar 

  23. Mills OH, Kligman AM. Acne detergicans. Arch Dermatol. 1975 Jan; 111 (1): 65–8

    Article  PubMed  CAS  Google Scholar 

  24. Kligman AM, Mills Jr OH. ‘Acne cosmetica’. Arch Dermatol. 1972; 106 (6): 843–50

    Article  PubMed  CAS  Google Scholar 

  25. Khanna N, Gupta SD. Acneiform eruptions after facial beauty treatment. Int J Dermatol. 1999; 38 (3): 196–9

    Article  PubMed  CAS  Google Scholar 

  26. Cunliffe WJ. Clinical features of acne. In: Marks R, editor. Acne. London: Martin Dunitz, 1989: 11–75

    Google Scholar 

  27. Kligman AM. Post adolescent acne in women. Cutis. 1991; 48: 75–7

    PubMed  CAS  Google Scholar 

  28. Knaggs HE, Wood EJ, Rizer RL, et al. Post adolescent acne. Int J Cosmet Sci. 2004; 26: 129–38

    Article  PubMed  CAS  Google Scholar 

  29. Cunliffe WJ. Acne and unemployment [letter]. Br J Dermatol. 1986; 115: 386

    Article  PubMed  CAS  Google Scholar 

  30. Layton AM, Seukaran D, Cunliffe WJ. Scarred for life?. Dermatology. 1997; 195: 15–21

    Article  PubMed  Google Scholar 

  31. Myhill JE, Leichtmen SR, Bumett JW. Self-esteem and social assertiveness in patients receiving isotretinoin treatment for cystic acne. Cutis. 1988; 41: 171–3

    Google Scholar 

  32. Lasek RJ, Chren MM. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol. 1998; 134: 454–8

    Article  PubMed  CAS  Google Scholar 

  33. Derman RJ. Androgen excess in women. Int J Fertil Menopausal Stud. 1996 Mar–Apr; 41 (2): 172–6

    PubMed  CAS  Google Scholar 

  34. McLaughlin B, Barrett P, Finch T, et al. Late-onset adrenal hyperplasia in a group of Irish females who presented with hirsutism, irregular menses and/or cystic acne. Clin Endocrinol. 1990; 32: 57–64

    Article  CAS  Google Scholar 

  35. Leyden JJ. Antibiotic resistance in the topical treatment of acne vulgaris. Cutis. 2004 Jun; 73 (6 Suppl.): 6–10

    PubMed  Google Scholar 

  36. Griffiths CEM. Nicotinamide 4% gel for the treatment of inflammatory acne. J Dermatolog Treat. 1995; 6 Suppl. 1: S8–10

    Google Scholar 

  37. Dreno B, Bettoli V, Ochsendorf F. European recommendations on the use of oral antibiotics for acne. Ear J Dermatol. 2004; 14 (6): 391–9

    Google Scholar 

  38. Tan AW, Tan HH. Acne vulgaris: a review of antibiotic therapy. Expert Opin Pharmacother. 2005 Mar; 6 (3): 409–18

    Article  PubMed  CAS  Google Scholar 

  39. Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol. 2001; 137: 1252–3

    PubMed  CAS  Google Scholar 

  40. DeRossi SS, Hersh EV. Antibiotics and oral contraceptives. Dent Clin North Am. 2002; 46 (4): 653–4

    Article  PubMed  Google Scholar 

  41. Thiboutot D. Hormones and acne: pathophysiology, clinical evaluation, and therapies. Semin Cutan Med Surg. 2001; 20: 144–53

    Article  PubMed  CAS  Google Scholar 

  42. Huber J, Foidart JM, Wuttke W, et al. Efficacy and tolerability of a monophasic oral contraceptive containing ethinylestradiol and drospirenone. Eur J Contracept Reprod Health Care. 2000; 5: 25–34

    Article  PubMed  CAS  Google Scholar 

  43. Shaw JC. Hormonal therapy in dermatology. Dermatol Clin. 2001; 19: 169–78

    Article  PubMed  CAS  Google Scholar 

  44. Goodfellow A, Alaghband-Zadeh J, Carter G, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984; 111: 209–14

    Article  PubMed  CAS  Google Scholar 

  45. Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000; 43: 498–502

    Article  PubMed  CAS  Google Scholar 

  46. Yemisci A, Gorgulu A, Piskin S. Effects and side-effects of spironolactone therapy in women with acne. J Eur Acad Dermatol Venereol. 2005 Mar; 19 (2): 163–6

    Article  PubMed  CAS  Google Scholar 

  47. Cusan L, Dupont A, Belanger A, et al. Treatment of hirsutism with the pure antiandrogen flutamide. J Am Acad Dermatol. 1990; 23: 462–9

    Article  PubMed  CAS  Google Scholar 

  48. Manso G, Thole Z, Salquiero E, et al. Spontaneous reporting of hepatotoxicity associated with antiandrogens: data from the Spanish Pharmacovigilance System. Pharmacoepidemiol Drug Saf. 2006 Apr; 15 (4): 253–9

    Article  PubMed  CAS  Google Scholar 

  49. Shaw JC. Acne: effect of hormones on pathogenesis and management. Am J Clin Dermatol. 2002; 3 (8): 571–8

    Article  PubMed  Google Scholar 

  50. Ostlere LS, Rumsby G, Holownia P, et al. Carrier status for steroid 21-hydroxylase deficiency is only one factor in the variable phenotype of acne. Clin Endocrinol. 1998; 48: 209–15

    Article  CAS  Google Scholar 

  51. Saihan E, Burton J. Sebaceous gland suppression in female acne patients by combined glucocorticoid-oestrogen treatment. Br J Dermatol. 1981; 103: 139–42

    Article  Google Scholar 

  52. Pochi P, Strauss J. Sebaceous gland inhibition from combined glucocorticoid-estrogen treatment. Arch Dermatol. 1976; 112: 1108–9

    Article  PubMed  CAS  Google Scholar 

  53. Cunliffe WJ, van de Kerkhof PC, Caputo R, et al. Roaccutane treatment guidelines: results of an international survey. Dermatology. 1997; 194 (4): 351–7

    Article  PubMed  CAS  Google Scholar 

  54. Committee for Proprietary Medicinal Products (CPMP). Summary information on a referral opinion following an arbitration pursuant to article 30 of directive 2001/83/ED, for Roaccutane and associated names [online]. London: European Agency for the Evaluation of Medicinal Products, 2003. Available from URL: http://www.emea.eu.int/pdfs/human/referral/isotretinoin/281103en.pdf [Accessed 2006 Sep 13]

    Google Scholar 

  55. Committee for Proprietary Medicinal Products (CPMP). Annex III: amended summary of product characteristics of the reference member state [online]. London: European Agency for the Evaluation of Medicinal Products, 2003. Available from URL: http://www.emea.europa.eu/pdfs/human/referral/roaccutane/284603enl.pdf [Accessed 2006 Sep 13]

    Google Scholar 

  56. Committee for Proprietary Medicinal Products (CPMP). Annex II: scientific conclusions and grounds for amendment of the summary(ies) of product characteristics presented by the EMEA [online]. London: European Agency for the Evaluation of Medicinal Products, 2003. Available from URL: http://www.emea.europa.eu/pdfs/human/referral/roaccutane/284603enl.pdf [Accessed 2006 Sep 13]

    Google Scholar 

  57. US FDA Center for Drug Evaluation and Research. Alert for healthcare professionals: isotretinoin (marketed as Accutane) [online]. Rockville (MD): FDA, 2005. Available from URL: http://www.fda.gov/cder/drug/InfoSheets/HCP/IsotretinoinHCP.htm [Accessed 2006 Sep 13]

    Google Scholar 

  58. Marqueling AL, Zane LT. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review. Semin Cutan Med Surg. 2005 Jun; 24 (2): 92–102

    Article  PubMed  CAS  Google Scholar 

  59. Goulden V, Clark SM, McGeown C, et al. Treatment of acne with intermittent isotretinoin. Br J Dermatol. 1997 Jul; 137 (1): 106–8

    Article  PubMed  CAS  Google Scholar 

  60. Zane LT. Acne maintenance therapy: expanding the role of topical retinoids?. Arch Dermatol. 2006 May; 142 (5): 638–40

    Article  PubMed  Google Scholar 

  61. Goulden V, Clark SM, Cunliffe WJ. Treatment of adult acne with low-dose intermittent isotretinoin [abstract]. Br J Dermatol. 1996; 135: 20

    Article  Google Scholar 

  62. Cunliffe WJ. Treatment of acne. In: Cunliffe WJ, editor. Acne. London: Martin Dunitz Ltd, 1991: 252–87

    Google Scholar 

  63. Breathnach AS. Melanin hyperpigmentation of skin. Cutis. 1996; 57: 36–45

    PubMed  CAS  Google Scholar 

  64. Pepall LM, Cosgrove MP, Cunliffe WJ. Ablation of whiteheads by cautery under topical anaesthetic. Br J Dermatol. 1991; 125: 256–9

    Article  PubMed  CAS  Google Scholar 

  65. Atzori L, Brundu MA, Orru A. Glycolic acid peeling in the treatment of acne. J Eur Acad Dermatol Venereol. 1999; 12: 119–22

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This review paper was not supported by external commercial funding and there are no conflicts of interest to declare.

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Correspondence to Alison M. Layton.

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Williams, C., Layton, A.M. Persistent Acne in Women. Am J Clin Dermatol 7, 281–290 (2006). https://doi.org/10.2165/00128071-200607050-00002

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