Journal of Clinical and Aesthetic Dermatology

OCT 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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18 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY October 2017 • Volume 10 • Number 10 O R I G I N A L R E S E A R C H A Acne is principally a disorder of adolescence. However, the prevalence of adult patients with acne is increasing. Acne tarda (adult acne) is defined as acne that develops (late-onset acne) or continues (persistent acne) after 25 years of age. 1 Earlier puberty onset for female individuals triggers a higher incidence of acne vulgaris in the younger age ranges when compared to male individuals, regardless of a country's economic level. 2 In an Indian study, acne prevalence was highest among younger men and older women. 3 Both types of adult acne are more common in women. Seventy-five percent of women with acne report a premenstrual flare. 4 Hormonal factors, stress, increased use of cosmetics, and exposure to hot and humid conditions (e.g., while cooking) might play a role in increased prevalence of adult acne in women. In cases of persistent acne, female patients report lesions on most days and might experience a premenstrual flare. Late-onset acne can be further subdivided into chin acne (i.e., acne that occurs around the chin and perioral area) and sporadic acne. Chin acne is inflammatory and flares premenstrually, while sporadic acne occurs suddenly in adult life with no distinguishing features. 5 The morphological characteristics of adult female acne are often distinct from adolescent acne (Figures 1 and 2). In adults, inflammatory lesions (particularly papules, pustules, and nodules) are generally more prominent on the lower chin, jawline, and neck, and comedones are closed (i.e., micro cysts). Adult acne is mainly mild-to- moderate in severity and might be refractory to treatment. 6 Use of cosmetics to hide lesions and post- acne pigmentation is higher in women, and the psychological effects of persistent adult acne might effect women at a higher rate than men, 7 especially among professional or working women. We explored associations that acne might have with certain clinical, hormonal, and biological factors among a local cohort of female patients who presented to our clinic for acne treatment. We also reviewed the current literature on acne to determine the prevalence of these associations. Here, we describe and discuss the results of our study and literature review, and we interpret how these findings might be used to improve treatment and optimize patient outcomes in dermatology. METHODS Thirty-six female subjects of reproductive age who had visited a private skin clinic in Western India between October 2016 and February 2017 for treatment of acne were A B S T R A C T ABSTRACT: Female acne is often associated with clinical signs of hyperandrogenism or metabolic syndrome. Various hormonal and biochemical factors as well as Vitamin D deficiency play a role in the etiopathogenesis of acne, and it is important to be able to detect the altered marker(s) indicative of certain abnormalities in order to diagnose and treat the cause. However, interpretation of these markers can be difficult, as there is ambiguity as to what is considered "normal" or "abnormal." The aim of this study was to explore the associations that acne might have with certain clinical, hormonal, and biological factors among female patients with acne. Additionally, the available literature was reviewed in order to determine the prevalence of these associations, discussion of which is provided. The author's investigations reveal a very high prevalence of abnormal metabolic and hormonal statuses among women with acne, indicating the need for dermatologists to maintain a high index of suspician for other disorders, especially metabolic disorders (and in particular, polycystic ovary syndrome), when treating female patients with acne. KEYWORDS: Female acne, clinical investigation, insulin, hormone, metabolic disorder, polycystic ovary syndrome, PCOS Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne: A Study and Literature Review by SUJATA MEHTA-AMBALAL, MD Dr. Mehta-Ambalal is a private practitioner and visiting dermatologist with Shalby Hospitals in Ahmedabad, Gujarat, India. J Clin Aesthet Dermatol. 2017;10(10):18–24 FUNDING: No funding was received for this study. DISCLOSURES: The author has no financial conflicts relating to the content of this article. CORRESPONDENCE: Sujata Mehta-Ambalal, MD; Email:

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