Challenges in Adult Acne and the Role of Skin Care in Managing the Condition

August 2024 | Volume 23 | Issue 8 | 8471 | Copyright © August 2024


Published online July 4, 2024

Hilary E. Baldwin MD FAADa, Glynis Ablon MD FAADb, Valerie Callender MD FAADc, Patricia K. Farris MD FAADd, Ted Lain MD FAAD MBAe, Evan A. Rieder MDf, Todd Schlesinger MD FAADg, Justin Marson MDh, Anneke Andriessen PhDi, Heather Woolery-Lloyd MD FAADj

aThe Acne Treatment and Research Center, Rutgers Robert Wood Johnson Medical Center, New York, NY
bAblon Skin Institute & Research Center, University of California, Los Angeles, Manhattan Beach, CA
cHoward University College of Medicine, Washington, DC; Callender Dermatology & Cosmetic Center, Glenn Dale, MD
dMetairie, Louisiana, Sanova Dermatology, Metairie, LA
eAustin Institute for Clinical Research, Sanova Dermatology, Austin, TX.
fPrivate Practice, New York, NY 
gClinical Research Center of the Carolinas, Charleston, SC 
hDepartment of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY
iRadboud UMC Nijmegen, Andriessen Consultants Nijmegen, The Netherlands 
jSkin of Color Division Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami,  Miller School of Medicine Miami FL 

Abstract
Background: Acne vulgaris is a complex, multifactorial, inflammatory skin condition. Although frequently presented at dermatology clinics, the literature on adult acne is scarce, particularly concerning skin barrier function and management. We aimed to provide insights into the role of skin barrier integrity in adult acne patients and the role of cleansers and moisturizers as adjunctive to treating and maintaining adult acne.  
Methods: A panel of eight dermatologists who treat adult patients with acne developed a consensus paper on the role of skin barrier function and skin care in adult acne management. The modified Delphi method comprised a face-to-face meeting and online follow-up to discuss the results of a scoping literature review. Drawing from their experience and opinions, they agreed on seven consensus statements.  
Results: Epidermal barrier dysfunction plays a vital role in acne pathogenesis and asymmetrically impacts adult female acne. Erythema, pruritus, peeling, and xerosis are common adverse effects of first-line acne treatment options and, if not appropriately counseled and managed, can exacerbate, leading to regimen nonadherence and poor patient experience and outcomes.
Conclusion: Improving patient knowledge of comprehensive acne treatments, including quality adjunctive cleansers and moisturizers, may maximize regimen efficacy and provide patients with personalized and successful acne treatment and maintenance tools.

J Drugs Dermatol. 2024;23(8):     doi:10.36849/JDD.8471

INTRODUCTION

Acne vulgaris (acne) is a multifactorial skin condition affecting the pilosebaceous unit1 and the most prevalent inflammatory dermatosis in the United States, affecting up to 50 million Americans.2  The four central factors in acne development affect the pilosebaceous unit: hyper-seborrhea and dysseborrhea, hyperkeratinization, Cutibacterium acnes colonization, and inflammation.3,4 Studies implicate skin barrier dysfunction as a material contributor to the pathophysiology of acne.4 

Acne can occur at any stage of life but primarily affects adolescents and young adults, with over 85% of 12- to 24-year-old individuals experiencing some manifestation or sequelae of acne.5-8 Adult acne is more prevalent among females and may have a unique presentation characterized by a predominance of inflammatory lesions on the jawline with few comedones.9

Acne can have significant social, psychological, and physical consequences, which can create feelings of embarrassment, humiliation, and self-consciousness.10-12 Longitudinal and population studies showed it can lead to psychiatric disturbances, including increased risk of depression and suicide.13-16 After the resolution of active lesions, individuals can be left with sequelae, including dyschromia and atrophic or hypertrophic scars, which can be compounded by potentially lifelong psychosocial scarring, further affecting the quality of 
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