Can We Define Acne as a Chronic Disease?

If So,How and When?


There is widespread misunderstanding of acne amongst both the medical and lay community, who often perceive the condition to be a simple, self-limited affliction of adolescents. Because many think that the disease “will go away on its own,” they do not feel an urgency to aggressively treat acne. However, very often the reality is that acne treatment can be quite difficult. Furthermore, acne can be a devastating disease for the patient, since it manifests on visible body parts and in children near puberty, who are vulnerable both socially and psychologically. Most typically, acne is not an acute disease but rather a condition that continuously changes in its distribution and severity. Usually, acne treatment is necessary for many months and sometimes years. Despite treatment, acne may cause scarring and associated negative psychological effects. It is important for both patients and physicians to be aware that very effective treatments are available. It is also important to realize that new studies have proven the benefit of maintenance therapy with topical retinoids; these agents can minimize the potential for relapse, which is part of the natural history of acne. This article reviews the evidence suggesting that acne is a chronic disease in at least a subset of individuals. The members of the Global Alliance to Improve Outcomes in Acne believe that acne should be recognized and investigated as a chronic disease. This will change expectations of clinical trial design and treatment and will highlight gaps in the knowledge of acne epidemiology. The result should be an improvement in patient outcomes.

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  1. 1.

    Centers for Disease Control. National Center for Health Statistics: classifications of diseases and functioning and disability [online]. Available from URL: [Accessed 2008 Apr 22]

  2. 2.

    O’Halloran J, Miller GC, Britt H.Defining chronic conditions for primary care with ICPC-2. Fam Pract 2004; 21: 381–6

    PubMed  Article  Google Scholar 

  3. 3.

    Bornman J. The World Health Organisation’s terminology and classification:application to severe disability. Disabil Rehab 2004; 26: 182–8

    Article  Google Scholar 

  4. 4.

    Cunliffe WJ. Acne. London: Martin Dunitz Ltd, 1989: 2–4

    Google Scholar 

  5. 5.

    Stern RS. Dermatologists and office-based care of dermatologic disease in the 21st century. J Invest Derm 2004; 9: 126–30

    Article  Google Scholar 

  6. 6.

    Neimeir V, Kupfer J, Demmelbauer-Ebner M,eaet al. Coping with acne vulgaris: evaluation of the chronic skin disorder questionnaire in patients with acne. Dermatology 1998; 196: 108–15

    Article  Google Scholar 

  7. 7.

    Gollnick H, 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 (1 Suppl.): S1–37

    PubMed  Article  Google Scholar 

  8. 8.

    Thiboutot DM, Shalita AR, Yamauchi PS, et al. Adapalene gel, 0.1%, as maintenance therapy for acne vulgaris: a randomized, controlled, investigator-blind follow-up of a recent combination study. Arch Dermatol 2006; 142: 597–602

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Leyden J, Thiboutot DM, Shalita AR, et al. Comparison of tazarotene and minocycline maintenance therapies in acne vulgaris: a multicenter, double-blind, randomized, parallel-group study. Arch Dermatol 2006; 142: 605–12

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Zhang ZJ, Li LF, Tu YT, et al. A successful maintenance approach in inflammatory acne with adapalene gel 0.1% after an initial treatment in combination with clindamycin topical solution 1% or after monotherapy with clindamycin topical solution 1%. J Dermatolog Treat 2004; 15: 372–8

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Alirezai M, George SA, Coutts I,et al. Daily treatment with adapalene gel 0.1% maintains initial improvement of acne vulgaris previously treated with oral lymecycline. Eur J Dermatol 2007; 17: 45–51

    PubMed  CAS  Google Scholar 

  12. 12.

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

    PubMed  Article  Google Scholar 

  13. 13.

    Thiboutot DM, Lookingbill DP. Acne: acute or chronic disease? J Am Acad Dermatol 1995; 32: 2–5

    Article  Google Scholar 

  14. 14.

    Kligman AM. An overview of acne. J Invest Dermatol 1974; 62: 268–87

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Chew EW, Bingham A, Burrow D. Incidence of acne vulgaris in patients with infantile acne. Clin Exp Dermatol 1990; 15: 376–7

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Dreno B, Poli F. Epidemiology of acne. Dermatology 2003; 206: 7–10

    PubMed  Article  Google Scholar 

  17. 17.

    Taylor SC, Cook-Bolden F, Rahman Z, et al. Acne vulgaris in skin of color. J Am Acad Dermatol 2002; 46: S98–106

    PubMed  Article  Google Scholar 

  18. 18.

    Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and adults. BMJ 1979; 166: 1109–10

    Article  Google Scholar 

  19. 19.

    Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol 1999; 141: 297–300

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Poli F, Dreno B, Verschoore M. An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol 2001; 15: 541–5

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Tan JKL. The Canadian Acne Epidemiological Survey: baseline demographics and interim analysis. J Am Acad Dermatol 2004; 50 Suppl. 2: P15

    Article  Google Scholar 

  22. 22.

    James WD. Acne. N Engl J Med 2005; 352: 1463–72

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol 1999; 140: 273–82

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Cunliffe WJ. Acne and unemployment. Br J Dermatol 1986; 115: 386

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Krowschuk DP, Stancin T, Keskinen R, et al. The psychoscial effects of acne on adolescents. Pediatr Dermatol 1991; 8 (4): 332–8

    Article  Google Scholar 

  26. 26.

    Kilkenny M, Merlin K, Plunkett A, et al. The prevalence of common skin conditions in Australian school students: 3. Acne vulgaris. Br J Dermatol 1998; 139: 840–5

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Kilkenny M, Stathakis V, Hibbert ME,et al. Acne in Victorian adolescents: associations with age, gender, puberty and psychiatric symptoms. J Paediatr Child Health 1997; 33: 430–3

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Baldwin HE. The interaction between acne vulgaris and the psyche. Cutis 2002; 70: 133–9

    PubMed  Google Scholar 

  29. 29.

    Kligman AM. Postadolescent acne in women. Cutis 1992; 48: 218–22

    Google Scholar 

  30. 30.

    Smith RN, Mann NJ, Braue A,et al. 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 2007; 57: 247–56

    PubMed  Article  Google Scholar 

  31. 31.

    Kaymak Y, Adisen E, Ilter N, et al. Dietary glycemic index and glucose, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein 3, and leptin levels in patients with acne. J Am Acad Dermatol 2007; 57: 819–23

    PubMed  Article  Google Scholar 

  32. 32.

    Treloar V, Logan AC, Danby FW,et al. Comment on acne and glycemic index. J Am Acad Dermatol 2008; 58: 175–7

    PubMed  Article  Google Scholar 

  33. 33.

    Schafer 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

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Till AE, Gouden 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

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Plewig G, Kligman AM. Acne and rosacea. 3rdz ed. New York: Springer, 2000

    Google Scholar 

  36. 36.

    Cunliffe WJ, Gollnick HPM. Acne: diagnosis and management. London: Taylor & Francis,2001

    Google Scholar 

  37. 37.

    Giannetti A, Girolomoni G. Atopic dermatitis. In: Fritsch P, Burgdorf W, editors. EDF-white book: skin diseases in Europe. 2nd ed. Berlin: ABW-Wissenschaftsverlag, 2005: 69–71

    Google Scholar 

  38. 38.

    Burgdorf W. Acne vulgaris. In: Fritsch P, Burgdorf W, editors. EDF-white book: skin diseases in Europe. 2nd ed. Berlin: ABW-Wissenschaftsverlag, 2005: 74–6

    Google Scholar 

  39. 39.

    Mallon E, Newton JN, Klassen A, et al. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol 1999; 140: 672–6

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Aktan S, Ozmen E, Sanli B. Anxiety, depression, and nature of acne vulgaris in adolescents. Int J Dermatol 2000; 39: 354–7

    PubMed  Article  CAS  Google Scholar 

  41. 41.

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

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Thielitz A, Helmdach M, R¨opke E-M, et al. Lipid analysis of follicular casts from cyanoacrylate strips as a new method for studying therapeutic effects of antiacne agents.Br J Dermatol 2001; 145: 19–27

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Thielitz A, Sidou F, Gollnick H. Control of microcomedone formation throughout a maintenance treatment with adapalene gel 0.1%. J Eur Acad Dermatol Venereol 2007; 21: 741–53

    Article  Google Scholar 

  44. 44.

    Cunliffe WJ, Holland DB, Clark SM,et al. Comedogenesis: some new aetiological, clinical and therapeutic strategies. Br J Dermatol 2000; 142: 1084–91

    PubMed  Article  CAS  Google Scholar 

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This work was supported by an unrestricted educational grant from Galderma Laboratories, L.P. A grant for editorial assistance was supplied for this article by Galderma Laboratories, L.P., and was used to pay for the services of Valerie Sanders, a professional medical writer.

The Global Alliance to Improve Outcomes in Acne is an international committee of physicians and researchers in the field of acne. Membership: Harald Gollnick, MD, Chair; Diane Thiboutot, MD, Co-Chair; Diane Berson, MD; Biigitte Dreno, MD, PhD; Andrew Finlay, MD; James J. Leyden, MD; Alan R. Shalita, MD. Steering Committee: Vincenzo Bettoli, MD; Alejandro Cordero, MD; Chee Leok Goh, MD, MRCP, FRCP, FAMS; Maria Isabel Herane, MD; Sewon Kang, MD, MPH; Raj Kubba, MD; Alison Layton, MD; Yoshiki Miyachi, MD, PhD; Montserrat Perez, MD; Jaime Piquero-Martin, MD; Marcia Ramos-e-Silva, MD, PhD; Jo Ann See, MD; Neil Shear, MD; Vicente Torres Lozada, MD; John Wolf Jr, MD.

All three authors have acted as consultants to Galderma Laboratories, L.P. Professor Finlay has also acted as a consultant to York Pharma UK, Strakan, and Pierre Fabre, and the Department of Dermatology, University of Cardiff School of Medicine, Cardiff, Wales has received royalties for use of the Dermatology Life Quality Index.

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Correspondence to Dr Harald P.M. Gollnick.

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Gollnick, H.P., Finlay, A.Y., Shear, N. et al. Can We Define Acne as a Chronic Disease?. Am J Clin Dermatol 9, 279–284 (2008).

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  • Atopic Dermatitis
  • Acne
  • Maintenance Therapy
  • Tazarotene
  • Psychosocial Impact