Evaluating and Treating the Adult Female Patient With Acne

December 2013 | Volume 12 | Issue 12 | Original Article | 1416 | Copyright © 2013

Joshua A. Zeichner MD

Mt. Sinai Medical Center, New York, NY

Abstract

Acne vulgaris is a common disease of the pilosebacous unit that affects an estimated 40-50 million Americans. Greater than 95% of teenage boys and between 83% and 85% of teenage girls suffer from acne. The condition frequently continues into adulthood. While boys more commonly suffer from acne in the teenage years, greater numbers of women suffer into adulthood. It is unclear if the number of post-adolescent women with acne is rising as compared to the past, or whether women are now seeking out treatment more than in the past.4 Post-adolescent acne is a significant problem for women. One survey-based United States study found that approximately 50% of women continue to suffer from acne in their twenties, 35% in their thirties, 26% in their forties, and 15% in their fifties. The prevalence of acne was shown to be higher in women than in men in each of these age groups.7 A similar study from Europe showed that beyond the age of 23, acne is more prevalent in women than men. In their forties and fifties, 5% and 8% of women suffered from acne, respectively. Several other studies have provided similar data, showing that larger numbers of adult women suffer from acne as compared to age matched men. Acne is the number one reason that patients visit a dermatologist. While the mean age at which patients are seen for acne is 24 years old, 10% of visits occur in patients in their mid-thirties and forties. Approximately two thirds of dermatology visits for acne are made by women, and one-third of total acne office visits are made by women over 25 years old. Acne patients suffer from a significant psychological burden, which has been compared to that of patients with systemic diseases like diabetes, asthma, arthritis, or epilepsy. Up to 50% of adolescents with acne experience disturbances to their psyche, including issues with body image, anxiety, depression, poor self-esteem, social impairment, and thoughts of suicide. Moreover, acne treatment is expensive. The average total cost of care related to an acne patient’s visit to the dermatologist is estimated to be $689.14

J Drugs Dermatol. 2013;12(12):1418-1427.

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INTRODUCTION

Acne vulgaris is a common disease of the pilosebacous unit that affects an estimated 40-50 million Americans.1,2 Greater than 95% of teenage boys and between 83% and 85% of teenage girls suffer from acne.3 The condition frequently continues into adulthood. While boys more commonly suffer from acne in the teenage years, greater numbers of women suffer into adulthood.4,5,6,7 It is unclear if the number of post-adolescent women with acne is rising as compared to the past, or whether women are now seeking out treatment more than in the past.4

Post-adolescent acne is a significant problem for women. One survey-based United States study found that approximately 50% of women continue to suffer from acne in their twenties, 35% in their thirties, 26% in their forties, and 15% in their fifties. The prevalence of acne was shown to be higher in women than in men in each of these age groups.7 A similar study from Europe showed that beyond the age of 23, acne is more prevalent in women than men. In their forties and fifties, 5% and 8% of women suffered from acne, respectively.8 Several other studies have provided similar data, showing that larger numbers of adult women suffer from acne as compared to age matched men.9,10,11

Acne is the number one reason that patients visit a dermatologist. 12 While the mean age at which patients are seen for acne is 24 years old, 10% of visits occur in patients in their mid-thirties and forties.13 Approximately two-thirds of dermatology visits for acne are made by women, and one-third of total acne office visits are made by women over 25 years old.14 Acne patients suffer from a significant psychologic burden, which has been compared to that of patients with systemic diseases like diabetes, asthma, arthritis, or epilepsy.15 Up to 50% of adolescents with acne experience disturbances to their psyche, including issues with body image, anxiety, depression, poor self-esteem, social impairment, and thoughts of suicide.16,17 Moreover, acne treatment is expensive. The average total cost of care related to an acne patient’s visit to the dermatologist is estimated to be $689.14

Review of Pathogenesis

Our current understanding of the pathogenesis of acne does not provide a clear distinction in what causes adolescent versus adult acne. Moreover, it is unclear why acne is more prevalent in adult women compared to age matched males. What we know is that acne vulgaris is caused by several major pathogenic factors, Table 1. These include abnormal follicular keratinization,18 sebum production,19 Propionibacterium acnes (P. acnes) bacteria, 20 and inflammation.20,21

Both hyperproliferation and cell retention lead to the hyperkeratinization observed in epithelium of the pilosebaceous follicle of acne patients. This bottle-neck effect, along with perifollicu-

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