As teenagers, we all have suffered from the most common, the most feared, and universally accepted as one of the ugliest looking conditions- pimples. As acne is usually prevalent in adolescents you may feel that as you grow up and grow out of the teen years you will be free of them. Imagine the plight of those, who as adults still have to face acne and more so if you are a female.
The important presentation coming up, a party you cannot avoid, or a get-together where you have decided to look your best. Adult female acne can play on your mind.
Let us, in this blog, address this condition and understand its causes and treatment.
What Is Adult Female Acne?
Acne or Acne vulgaris (AV) is a chronic condition of the pilosebaceous unit ( the hair follicle, shaft, and sebaceous gland) of the skin. It causes noninflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and varying degrees of scarring (1).
85% of people suffer from acne at least once in their lifetime. Although it is traditionally considered to be a disease that affects teenagers, it can persist into adulthood.
Recent research has shown that acne affects an increasing number of adults, particularly females. It is reported to have a 50.9% prevalence rate of acne in women ages 20 to 29 years versus 26.3% in women ages 40 to 49 years (2).
Based on the time of onset, two subtypes of adult female acne are recognized. ‘Persistent acne’ represents a continuation or a relapse of the disease from adolescence, while ‘late-onset acne’ presents for the first time well into adulthood (3).
More recently a third type has been suggested, called recurrent acne, that is present in adolescence, improves for a variable period, and returns in adulthood (4).
Difference In Adolescent And Adult Acne
Clinical features of adult female acne differ from adolescent acne. Inflammatory lesions ie. the papules and pustules are predominant in adults. Typical features are nodules that are usually painful. Duration is longer than in adolescents and this results in residual hyperpigmentation. It is localized typically on the U-zone: cheeks, peri-oral, and lower chin area.
This localization pattern of acne increases with age, after 40 years old.
Comedones may be clinically absent in adults. Involvement of non-facial skin is also very common in them. The different clinical presentation of acne in women suggests the involvement of a different mechanism than that observed in the adolescent group (5).
Causes of Adult Acne
Acne is a multifactorial disease. The four obvious factors typical of adolescent patients, which contribute to acne physiopathology are inflammation, colonization with Propionibacterium acnes bacteria, increased sebum production, and hyperkeratosis of the pilosebaceous duct.
However, the influence of these factors on the acne course may probably be somewhat different in adult female acne than in adolescent acne. Also, there are other factors involved in the causation of adult acne in addition (5). These are as follows
Internal Factors
Two main internal factors triggering or aggravating female acne are suggested
Hormones
The role of androgens in the pathogenesis of acne vulgaris is well established. Acne is probably a result of the exacerbated response of the pilosebaceous unit to the normal circulating androgens.
According to different studies, 39–85% of women have worsening acne in the days before menstruation. The premenstrual flare of acne is caused by an increase in the testosterone-to-estrogen ratio in the luteal phase. Progesterone and implanon coils used as contraceptives are also a source of acne outbreaks in females.
Furthermore, the study carried out by Goulden V in 2008 showed that 37% of women had at least one sign of hyperandrogenism. Adult female acne would then be one of the signs of an endocrine disease like PCOD/PCOS (5).
Genetics
Studies have shown that genetic factors play a strong role in the pathogenesis of adult female acne. It has been shown that a history of acne can be identified in at least one first-degree relative of 67% of adult females with acne.
Another study comparing 204 adults with persistent acne with 144 non-acne controls showed that relatives of patients with persistent adult acne had a significantly greater risk of adult acne than relatives of people without acne.
External Factors
Cosmetics
This factor remains controversial. Several studies have shown that cosmetics play an aggravating role. However, studies note that stopping using cosmetics is not associated with the regression of post-adolescent acne. The quality of cosmetic products is also important depending on the brand.
Stress
Stress is often reported as a factor triggering female acne. In the study of Poli et al., it was present in 50% of women. The link between stress and acne outbreaks of today is explained by the production of neuromodulators such as the substance P in sebaceous glands which are receptors that stimulate the sebaceous gland and thus the production of sebum.
Tobacco
Recent studies have highlighted the role of tobacco in female acne. It was noted that female smokers had more frequent and more severe acne than non-smokers and that there was a dose-dependent correlation. A strong correlation was seen between cigarettes and the type of non-inflammatory post-adolescent acne through an increase in the production of sebum induced by nicotine and a reduction in the production of vitamin E (6).
Other Factors.
The causes of adult female acne have not yet been fully elucidated. Several other factors have been postulated as triggers or aggravating factors, such as exposure to ultraviolet radiation, obesity, diet, sleep disorders, medications, excessive skin washing, and possible resistance to P. acnes bacteria but the level of proof remains low (6).
Treatment
A holistic approach to therapy should be taken that combines standard treatments with adjunct therapy and cosmetic use, and considers the specific characteristics of the adult female. Choice of therapy should also be determined by various other factors including the extent, severity, and duration of the disease, response to previous treatments, and predisposition to scarring, as well as patient preference and cost. Your physician or the dermatologist will be the best person to recommend you the treatment based on these factors.
Topical Therapy
Topical therapies alone are usually sufficient for the successful treatment of mild adult female acne. These include the use of retinoids, azelaic acid, antimicrobials like topical antibiotics and benzoyl peroxides, etc. in form of creams and gels
As no topical monotherapy can target all of the factors in acne causation, a combination of topical agents or topical plus systemic treatment may be required.
Systemic Therapy
It is usually required for moderate-to-severe acne, and also for milder forms associated with scarring, with a long duration of evolution and/or that have failed to respond to topical therapies. These include systemic antibiotics, hormone therapy, androgen receptor blockers, and inhibitors of ovarian and adrenal androgen production like isotretinoin and zinc salts (3).
Conclusion
Adult female acne may be considered a stubborn and chronic condition. Understanding its causes will help you in quick diagnosis and treatment for the same.
For more such informative articles keep checking out this space and do let us know your views on this topic in the comments section below.
Author: Dr Pooja Nilgar (Content writer and editor)
References
- Tan, A.U., Schlosser, B.J. and Paller, A.S., 2018. A review of diagnosis and treatment of acne in adult female patients. International journal of women’s dermatology, 4(2), pp.56-71.
- Dréno, B., 2015. Treatment of adult female acne: a new challenge. Journal of the European Academy of Dermatology and Venereology, 29, pp.14-19.
- Dréno, B., Layton, A., Zouboulis, C.C., López‐Estebaranz, J.L., Zalewska‐Janowska, A., Bagatin, E., Zampeli, V.A., Yutskovskaya, Y. and Harper, J.C., 2013. Adult female acne: a new paradigm. Journal of the European Academy of Dermatology and Venereology, 27(9), pp.1063-1070.
- Bagatin, E., Freitas, T.H.P.D., Rivitti-Machado, M.C., Ribeiro, B.M., Nunes, S. and Rocha, M.A.D.D., 2019. Adult female acne: a guide to clinical practice. Anais brasileiros de dermatologia, 94, pp.62-75.
- Romańska-Gocka, K., Woźniak, M., Kaczmarek-Skamira, E. and Zegarska, B., 2016. The possible role of diet in the pathogenesis of adult female acne. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 33(6), pp.416-420.
- Preneau, S. and Dreno, B., 2012. Female acne–a different subtype of teenager acne? Journal of the European Academy of Dermatology and Venereology, 26(3), pp.277-282.
