By Christine C. Dierickx, M.D., Khatri A. Khatri, M.D., Zeina S. Tannous, M.D., James J. Childs, PhD, Richard H. Cohen, PhD, Andrei Erofeev, PhD, David Tabatadze, PhD, Ilya V. Yaroslavsky, PhD, & Gregory B. Altshuler, DrSc
Published in Lasers Surg Med 2008, 40;2:113–23
Published in J Am Acad Dermatol 2008, 58;1:56–59
Background
Acne, one of the most common skin diseases, is often mistakenly thought to affect the teenaged population exclusively. A significant number of patients either continue to experience acne or develop new-onset acne after their teenage years.
Objective
A survey was designed to assess the prevalence of acne in the teenaged years, 20-29 years, 30 to 39 years, 40 to 49 years, and 50 years and older. The article discussed acne vulgaris as a common skin disease, affecting more than 85% of adolescents and often continuing into adulthood.
Current research indicates that the pathogenesis of acne involves 4 main processes: follicular hyperproliferation, excess sebum production, inflammation, and proliferation of Propionibacterium acnes. Clinically, acne is graded according to the types of lesions present: open and closed comedones, inflammatory papules, pustules, cysts, nodules, and even scarring may be seen in various forms of acne.
The degree to which both active acne and scars from previous acne may cause psychological or emotional harm varies with clinical severity. It has been shown that the impact of acne on a patient’s psychological and emotional well-being is comparable with that of systemic disease processes such as diabetes, asthma, arthritis, and epilepsy. A significant number of patients experience persistent acne or develop new-onset adult acne after adolescence.
The mean age for presentation for acne treatment is 24 years. The importance of providing treatment for these adults is heightened by the awareness that acne that persists for longer periods is more likely to lead to scarring.
Methods
Adults aged 20 years and older were asked to complete surveys distributed at various sites on a university campus and at a medical complex. The researchers of this article devised a 1-page questionnaire. It was designed to evaluate the prevalence of acne in various adult age groups. Both women and men aged 20 years or older were asked to participate by completing the questionnaire.
Results
After the teenaged years, women were more likely to report having acne than men, with the difference being statistically in all age groups. Of the 1013 included in the data analysis, the mean age of participants was 48 years. There were 540 females and 473 male participants; when asked, 73% affirmed to having either a pimple or acne.
Among the teenage population, acne was approximately evenly divided
between males and females. But once past the teenage years, acne reporting was shown to be significantly higher among women than men for all age groups.
The second portion of the survey contained questions pertinent only to women. Of pre-menopausal women, 62.2% noted that their acne got worse around the time of menstruation. Of the 86 women who reported using either hormone replacement therapy or over-the-counter medications for the side effects of menopause, 9 women reported improvement in their acne with the use of hormone therapy. Within this second part of the study, 87.2% of the women reported no change, whereas 2.3% reported worsening of their acne symptoms.
Limitations
The study results were based on the participant’s own perception of the presence or absence of acne rather than a clinical evaluation.
Conclusions
Acne continues to be a common skin problem past the teenaged years, with women being affected at higher rates than men in all age groups 20 years or older. The results of this study confirmed the findings of other previous studies: that acne remains a common disease throughout the adult years. The study results indicated that after the teenage years, women are more often affected by acne than men. However, the overall prevalence of acne does decline with age in both sexes.
There are significant numbers to indicate that individuals experience either a worsening of acne symptoms or fail to experience improvement after the teenaged years. Research continues to show more information concerning the pathogenesis of acne, and more specifically the role of hormones in the development of acne.
There are still questions that remain, such as why more adult women continue to experience acne than adult men. Other questions to be explored are, what is the pathophysiology of premenstrual flare and what role does menopause play?
Another question to explore concerns the main causal factors of adult-onset acne in men and women. Discovering these answers would allow for greater insight into improving the quality of life for adult patients with acne.
Reprint requests: : Dr. Boni E. Elewski, Department of Dermatology, University of Alabama at Birmingham School of Medicine, Eye Foundation Hospital 414, 1720 University Boulevard, Birmingham, AL 35294.
