Acne Vulgaris in Adults
Abstract
Introduction: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, of multifactorial etiology. It is one of the most common dermatological diseases. It affects more than 85% of teenagers, especially of the male gender. Despite being infrequent in adulthood, recent epidemiological data show a growing prevalence, around 40%, mainly in the female gender, with a negative impact on quality of life. Acne in adulthood or late acne is present after the age of 25 and is classified as late onset acne or persistent acne. The persistent type, which is the most common, represents 70% - 80% of all cases, and is characterised by the persistence of the teenage acne, while late onset acne is defined by the onset after the age of 25, with a prevalence of about 20% to 30%.
Objective: To review current scientific literature, especially focused on the pathophysiology of late acne, triggering and aggravating factors, as well as particularities of the therapeutic approach.
Methodology: The MEDLINE-PubMed database was used to select original and review articles published between 2001 and 2017.
Discussion: Acne can be a clinical sign of systemic disease, mainly with endocrinological abnormalities, as polycystic ovary syndrome, adrenal hyperplasia and virilising tumours. It is important to consider these etiologies into account, especially in women and in the presence of other signs of hyperandrogenism. Several studies point to other triggering or aggravating factors, namely genetic factors, stress, smoking, exposure to ultraviolet radiation, obesity, hyperglycaemic diet, drugs, cosmetics and colonisation by resistant strains of Propionibacterium acnes.
Conclusion: In most cases, adult acne affects the face, has mild to moderate clinical severity and is associated with normal hormonal levels. The exclusive location on the lower third of the face is most often associated with other signs of hyperandrogenism and endocrinological disease, as well as with a predominance of inflammatory lesions. Late acne is described as potentially refractory to the conventional therapy and is very relapsing. Thus, it is a therapeutic challenge, which requires an individualized approach.
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