Post-adolescent Female Acne

  • Gillian HeineckeEmail author
  • Diane Berson


While acne has been traditionally considered an adolescent disorder, recent studies show a significant prevalence among adults. The mean age of presentation for acne treatment is 24 years with 21 % of acne office visits by patients 25–34 years old and 15 % of these visits by patients 35 years and older [1]. In adults, acne occurs more frequently among women than men [2]. The characteristic clinical picture is mild to moderate deep-seated inflammatory papules and nodules on the face, especially the chin, jawline, and neck. Most commonly, this is “persistent” acne, which began in adolescence and has continued to adulthood, although a “late-onset” form also occurs. Recognizing acne in this population and providing treatment is essential since acne scarring can be correlated with duration of disease [3].


Oral Contraceptive Sebaceous Gland Cyproterone Acetate Acanthosis Nigricans Acne Scarring 
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  1. 1.
    McConnell RC, Fleischer Jr AB, Willford PM, Feldman SR. Most topical tretinoin treatment is for acne vulgaris through the age of 44 years: an analysis of the national ambulatory medical care survey, 1990–1994. J Am Acad Dermatol. 1998;38:221–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999;41:577–80.PubMedGoogle Scholar
  3. 3.
    Layton AM, Henderson K, Cunliffe WJ. A clinical assessment of acne scarring. Clin Exp Dermatol. 1994;4:303–8.CrossRefGoogle Scholar
  4. 4.
    Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J. 1979;1:1109–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58:56–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. Br J Dermatol. 1997;136:66–70.PubMedCrossRefGoogle 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:S1–37.PubMedCrossRefGoogle Scholar
  8. 8.
    McGeown CH, Goulden V, Holland DB, et al. Sebum excretion rate in post-adolescent acne compared to controls and adolescence acne. J Invest Dermatol. 1997;108:386.Google Scholar
  9. 9.
    Aizawa H, Niimura M. Adrenal androgen abnormalities in women with late onset and persistent acne. Arch Dermatol Res. 1993;284:451–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Darley CR, Kirby JD, Besser GM et al. Circulating testosterone, sex hormone binding globulin and prolactin in women with late onset or persistent acne vulgarisGoogle Scholar
  11. 11.
    Seirafi H, Farnaghi F, Vasheghani-Farahani A, et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007;46:1188–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Cibula D, Hill M, Vohradnikova O, Kuzel D, Fanta M, Zivny J. The role of androgens in determining acne severity in adult women. Br J Dermatol. 2000;143:399–404.PubMedCrossRefGoogle Scholar
  13. 13.
    Lookingbill DP, Horton R, Demers LM, Egan N, Marks Jr JG, Santen RJ. Tissue production of androgens in women with acne. J Am Acad Dermatol. 1985;12:481–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Carmina E, Lobo RA. Evidence for increased androsterone metabolism in some normandrogenic women with acne. J Clin Endocrinol Metab. 1993;76:1111–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Carmina E, Godwin AJ, Stanczyk FZ, Lippman JS, Lobo RA. The association of serum androsterone glucuronide with inflammatory lesions in women with adult acne. J Endocrinol Invest. 2002;25:765–8.PubMedGoogle Scholar
  16. 16.
    Cunliffe WJ. Natural history of acne. In: Plewig G, Marks R, editors. Acne and related disorders. London: Martin Dunitz; 1989. p. 4–6.Google Scholar
  17. 17.
    Ballanger F, Baudry P, N’Guyen JM, Khammari A, Dréno B. Heredity: a prognostic factor for acne. Dermatology. 2006;212:145–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Schäfer T, Nienhaus A, Vieluf D, Berger J, Ring J. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001;145:100–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Mills CM, Peters TJ, Finlay AY. Does smoking influence acne? Clin Exp Dermatol. 1993;18:100–1.PubMedCrossRefGoogle Scholar
  20. 20.
    Capitanio B, Sinagra JL, Bordignon V, Cordiali Fei P, Picardo M, Zouboulis CC. Underestimated clinical features of post-adolescent acne. J Am Acad Dermatol. 2010;63:782–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Misery L. Nicotine effects on the skin: are they positive or negative? Exp Dermatol. 2004; 13:665–70.PubMedCrossRefGoogle Scholar
  22. 22.
    Ganceviciene R, Graziene V, Fimmel S, Zouboulis CC. Involvement of the corticotropin-releasing hormone system in the pathogenesis of acne vulgaris. Br J Dermatol. 2009;160:345–52.PubMedCrossRefGoogle Scholar
  23. 23.
    Till AE, Goulden V, Cunliffe WJ, Holland KT. The cutaneous microflora of adolescence, persistent and late-onset acne patients does not differ. Br J Dermatol. 2000;142:885–92.PubMedCrossRefGoogle Scholar
  24. 24.
    Kligman AM, Mills Jr OH. Acne Cosmetica. Arch Dermatol. 1975;106:843–50.CrossRefGoogle Scholar
  25. 25.
    Nelson FP, Rumsfield J. Cosmetics. Content and function. Int J Dermatol. 1988;27:665–72.PubMedCrossRefGoogle Scholar
  26. 26.
    Rivera AE. Acne scarring: a review and current treatment modalities. J Am Acad Dermatol. 2008;59:659–76.PubMedCrossRefGoogle Scholar
  27. 27.
    Marks R. Acne and its management beyond the age of 35 years. Am J Clin Dermatol. 2004; 5:459–62.PubMedCrossRefGoogle Scholar
  28. 28.
    Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56:651–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Goudas VT, Dumesic DA. Polycystic ovary syndrome. Endocrinol Metab Clin North Am. 1997;26:893–912.PubMedCrossRefGoogle Scholar
  30. 30.
    Ebede TL, Arch EL, Berson D. Hormonal treatment of acne in women. J Clin Aesthetic Dermatol. 2009;2:16–22.Google Scholar
  31. 31.
    Thiboutot D. Acne: hormonal concepts and therapy. Clin Dermatol. 2004;22:419–28.PubMedCrossRefGoogle Scholar
  32. 32.
    Lobo RA. Hyperandrogenism: physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive gynecology. 5th ed. Philadelphia, PA: Elsevier; 2007. p. 983–92.Google Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    Saint-Jean M, Ballanger F, Nguyen JM, Khammari A, Dreno B. Importance of spironolactone in the treatment of acne in adult women. J Eur Acad Dermatol Venereol. 2011;25:1480–1.PubMedCrossRefGoogle Scholar
  35. 35.
    George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan Med Surg. 2008; 27:188–96.PubMedCrossRefGoogle Scholar
  36. 36.
    Frangos JE, Alavian CN, Kimball AB. Acne and oral contraceptives: update on women’s health screening guidelines. J Am Acad Dermatol. 2008;58:781–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of DermatologyMount SinaiNew YorkUSA
  2. 2.Department of DermatologyWeill Cornell Medical CollegeNew YorkUSA

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