Adult acne could be more traumatizing than teen acne

The presence of adult acne, especially among women, is increasing, shows an Italian study that points to job stress for exasperating the condition in adults who are harder hit by the psychological, social and emotional effects of the condition as compared to teens.

“Adult acne in women has been associated with depression, anxiety, psychological stress, and suicidal ideation. Moreover, Tan et al18 observed that other factors such as increased age and longer acne duration (greater than five years) are related with a greater impairment in quality of life in females,” wrote researchers in the January issue of the Journal of Clinical and Aesthetic Dermatology.

This was a retrospective study of 1,167 patients who were treated from January 2008 to March 2015 at a clinic in Rome. The objective was to compare acne prevalence, patient sex, acne severity, and quality of life to adult (25 years or older) and adolescent patients (12-25 years). The study included 385 adult females; 69 adult male; 378 female adolescents and 335 male adolescents. In this study, acne was more common in female patients in general with most participants having mild acne (adolescent males, 77%), adolescent females, 89%), female adults, 92%, and adult males, 82%).

The least frequent form of acne was severe acne:  adolescent males (1%), adolescent females (1%), female adults (1%) and adult males (3%).  Moderate acne was observed more frequently than severe acne, but much less often than mild acne: adolescent males (22%), adolescent females (10%), female adults (7%) and adult males (15%).

In this study, 321 (70.7%) patients (72.2% females, 62.3% males) showed persistent forms of acne, while 133 (29.3%) presented with late onset adult acne (37.7% males, 27.8% females).

Acne affects approximately 95 percent of teens - both males and females equally - and although there may be little data to support this claim, it is increasing in the adults, particularly in females, the authors wrote.

Because the condition distinctly effects adults differently than teens, dermatologists, should be prepared to meet the unique needs of this growing patient population.

“Treating adult acne demands a different approach to diagnosis and a tailored management plan that considers all of the variables involved,” wrote Nevena Skroza, M.D., and colleagues in the article.

Adult acne lesions are clinically different from lesions in adolescents.  Adult acne primarily presents in women as seborrhea, comedones and inflammatory lesions most. The classical presentation of adult acne consists of inflammatory papulopustular lesions on the lower half of the face. It presents gradually most often as mild to moderate.

Adolescent acne and acne in adult females share a trait in that they both involve excess sebum production, abnormal keratinization within the follicle, and bacterial colonization of the pilosebaceous duct by Proponibacterium acnes.

The impact of acne on quality of life was determined by patients filling out the Assessment of Quality of Life questionnaire: a six-point scale (the higher the number, the less deterioration in quality of life) for 19 questions totaling a potential 114 points.

Acne had a significantly negative impact on quality of life: adolescent males (60/114 points), adolescent females (45/114 points), female adults (35/114 points) and adult males (70/114 points).

Job stress has also been linked to more severe forms of acne in women and that those with localized acne are more likely to report higher stress levels.

In 2014, the traditional description of adult acne was revised to reflect that post-adolescent acne is comparable in severity to adolescent acne in up to 90% of women, involving multiple areas of the face, including mandibles, temples and cheeks.

Acne has also been shown to be more present in women of darker skin types than in women of lighter skin.

However, the study found that the prevalence of acne decreased after the age of 45, but not between the ages of 24 to 44.

Two limitations of the study are that it is retrospective and confined to one treatment center. Also, the clinical evaluation did not account for the lesions and distribution patterns of acne, which can differ between sexes.

REFERENCE

Nevana Skroza MD, Ersilia Tolina MD, Alessandra Mambrin MD, et al. “Adult Acne Versus Adolescent Acne: A Retrospective Study of 1,167 Patients,” Journal of Clinical and Aesthetic Dermatology, January 2018.