Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment

Abstract Acne vulgaris is one of the most common chronic inflammatory diseases and is characterized by papules, pustules, comedones, and nodules. Although adolescence is the preferential age group, acne may affect various age groups. Acne shares different properties in adults and adolescents. These differences extend from epidemiology to treatments. Increased awareness of these two subtypes will allow for better management of the disease. In this review, the authors examined all aspects of acne in adults and adolescents under the light of current literature.

MIN Zhongsheng's Clinical Experience in Delayed Post-adolescent Acne / 浙江中医药大学学报

[Objective] To explore the clinical experience of Professor MIN Zhongsheng treatment in delayed post -adolescent acne. [Methods] Through studying with Professor MIN, collecting clinical medical cases, representing academic views of others, discussing clinical experience of Professor MIN, treatment in delayed post -adolescent acne from the pathogenesis, explanation of the prescription was presented, and a classic case was cited as an evidence. [Results] Ancient doctors considered that wind, cold, heat and wet were the external cause, while the weakness of vital Qi and blood heat were the internal cause. It led to stasis, when body was infected with wind-cold damp pathogen. Professor MIN considers that the etiology of this disease contains two aspects, one is endocrine disorder, the other is metal facts. He also thinks that deficiency of energy is the root cause and blood stagnation is the clinical manifestation. He also regards tonifying Yin of liver and kidney,cleating away heat and toxin, removing blood stasis as treatment. In the classic case, Professor MIN used Rubus idaeus L, Eclipta prostrata as monarch drugs to tonify Yin of liver and kidney; used Hedyotis diffusa, Taraxacum mongolicum, Citrus reticulata Blanco, Salvia miltiorrhiza as minister drugs to clear away heat and toxin, and remove blood stasis. The patient of delayed post-adolescent acne became much better after the treatment.[Conclusion]The therapeutic method put emphases on tonifying Yin of liver and kidney, then clearing away heat and toxin. Removing blood stasis is the key of the treatment.

Relationship between clinical types and related risk factors in female patients with post-adolescent acne / 中华皮肤科杂志

Objective To investigate the relationship between clinical types and related risk factors in female patients with post-adolescent acne.Methods Female outpatients with post-adolescent acne aged more than 25 years were enrolled from Department of Dermatology of Renji Hospital between January and October 2016.A questionnaire survey was conducted to investigate related risk factors for post-adolescent acne in the females.Skin lesions and clinical types were evaluated by dermatologists.Statistical analysis was carried out by t test for comparison of means between two groups and by chi-square test for comparison of ratios.Results A total of 312 female patients with post-adolescent acne completed the survey,including 268 (85.9％) with mild to moderate acne and 44 (14.1％) with severe acne,241 (77.2％) with persistent acne and 71 (22.8％) with late-onset acne,or 102 (32.7％) with comedonal post-adolescent acne (CPAA) and 210 (67.3％) with papular post-adolescent acne (PPAA).Survey on related risk factors showed that 121 patients reported seasonal factors and 59 (18.9％) patients became worse in summer,and spicy,sweet and fried foods can aggravate the condition in 131 (42％),93 (29.8％) and 85 (27.2％) patients respectively.Other risk factors such as premenstrual period (62.8％,196/312),psychological factors (51.6％,161/312) and exogenous chemical exposures (43.6％,136/312) were complained of by the patients.Furthermore,premenstrual period,diet and constipation were found to be more associated with PPAA compared with CPAA (x2 =4.523,4.068,3.910,respectively,all P ＜ 0.05).Exogenous chemical exposures,such as the use of cosmetics,exposure to polluted air environment and occupational hazards,were more associated with CPAA compared with PPAA,as well as with late-onset acne compared with persistent acne (x2 =6.579,9.057,both P ＜ 0.05).In addition,premenstrual exacerbation occurred more frequently in patients with persistent acne compared with those with late-onset ache (x2 =4.512,P ＜ 0.05).Conclusions The risk factors for the occurrence of female post-adolescent acne are very complex.Premenstrual exacerbation plays a major role in the aggravation of papular and persistent post-adolescent acne,diet and constipation are more associated with PPAA,and exogenous chemical exposures are still be considered in the aggravation of comedonal and late-onset post-adolescent acne.Thus,clinical types should be considered in the diagnosis and treatment of post-adolescent acne in females.

A Statistical Analysis of the Epidemiology, Clinical Features and Perceptions of Acne in Middle School Students in Seoul Seongdong Area / 대한피부과학회지

BACKGROUND: Acne is one of the most common dermatologic disorders of adolescence. Despite this, there have been few epidemiological studies conducted in Korea. OBJECTIVE: The purpose of this study was to evaluate the prevalence, severity, and clinical characteristics of acne. In addition, the perceptions regarding acne causation, exacerbating factors, treatments, and sources of information among middle school students were investigated. METHODS: In a middle school in Seoul, Korea, 629 students (all girls) in 2004 and 832 students (435 boys and 397 girls) in 2008 were asked to complete a questionnaire about the epidemiology, clinical features, and perceptions of acne. RESULTS: In 2004, the prevalence of acne was 66.1% for girls and in 2008, the prevalence was 57.9% and 67.8% for boys and girls respectively. The severity of acne was evaluated using the Korean Acne Grading System (KAGS) and the results showed severity rates of 38.2%, 38.2% and 49.1% for grade 1, 21.6%, 15.2% and 16.1% for grade 2, 5.7%, 4.1% and 2.3% for grade 3, 0.3%, 0.2% and 0.3% for grade 4 and 0.3%, 0.2% and 0% for grade 5 for girls in 2004, and for boys and girls in 2008, respectively. In 2008, the prevalence of acne was higher in girls than boys (p=0.004); however, overall KAGS grades were higher in boys than girls (p=0.034). Additionally, an earlier onset of clinical acne was observed in girls (age 12.08) than boys (age 12.78) (p<0.001). The onset of clinical acne tended to be at a younger age in girls with an earlier onset of the first menarche (p<0.01). In both 2004 and 2008, more than 98% of the students reported their first case of acne on the face alone; however, current sites tended to involve the trunk along with the face (p=0.009, p<0.001, respectively). In 2008, the most commonly involved first site for facial acne was the forehead that over 70% of boys and girls had acne on their foreheads. The students thought high stress (64.5%, 42.0%, 51.2%), lack of sleep (33.8%, 35.7%, 40.2%), and lack of cleansing (26.6%, 35.7%, 45.7%) were the most common aggravating factors of acne for the girls in 2004, and for the boys and girls in 2008, respectively. In both 2004 and 2008, only about 10% of all acne patients had any kind of treatment for acne. Additionally, the students responded that they received information about the treatment of acne mostly from the Internet. The survey showed that 'broadcasting' was the most important point to consider when choosing a hospital and 'efficacy' when choosing a treatment option. CONCLUSION: We evaluated the epidemiological and clinical features of acne in adolescents, and learned that despite the high prevalence of acne among adolescents, only a few had actually had any treatment. Therefore, it is worthwhile to better inform middle school students about acne and the necessity for treatment to reduce acne severity and its impact on those affected.

Clinical Manifestation and Elevated Serum Insulin-like Growth Factor-1 (IGF-1) Levels with Post-adolescent Acne / 대한피부과학회지

BACKGROUND: Acne has been recognized as a common disorder amongst adolescents but recent studies have documented increased prevalence of post-adolescent acne. OBJECTIVE: The purpose of this study was to demonstrate insulin resistance in post-adolescent acne by examining insulin, insulin like growth factor-1 (IGF-1), and insulin like growth factor binding protein-3 (IGFBP-3) compared to those in normal controls. METHODS: Twenty-eight patients with acne between 25 and 45 years and 10 control individuals were studied. We classified the post-adolescent acne into persistent and late-onset types according to onset ages. We compared clinical features and the levels of fasting insulin, IGF-1, and IGFBP-3 in persistent and late-onset type of post-adolescent acne. RESULTS: Among the post-adolescent group, there were few patients of metabolic syndrome. But, the mean serum levels of IGF-1 were significantly increased in post-adolescent acne compared to those in controls. Mean serum levels of IGFBP-3 were decreased in post-adolescent acne. Compared to persistent type, late-onset type showed more inflammatory acne lesions. Increased fasting insulin, IGF-1, and decreased IGFBP-3 in late-onset type compared to those in persistent type were observed. CONCLUSION: Results of this study indicate that insulin resistance could have a role in pathogenesis of post-adolescent acne.

The Study of Post-adolescent Acne in Nurses / 대한피부과학회지

BACKGROUND: Acne is usually considered a disorder of adolescence, and a number of studies have examined the prevalence of this condition in the adolescent population. However, prevalence of acnes in patients over the age of 25 years has significantly increased. There are relatively few data on the prevalence of acne in the adult population, especially in Korea. Also, although many researches have been conducted into the etiology of this disease, much substantial myth still abounds with the treatment and cause of this condition. OBJECTIVE: This study was carried out to investigate the prevalence of acne in adult women, and to compare adolescent acne with post-adolescent acne in nurses. METHODS: We analyzed the answers from 504 nurses, who work in the St. Mary's Hospital, to questions about the acne. RESULTS: 1. Prevalence of post-adolescent acne was 36% in nurses of above the age of 25. Their mean age of onset of acne was 17.4 years. 2. The forehead and cheeks were the most common predilection sites in both groups. However, the jaw and perioral area were more common in the post-adolescent group than the adolescent group (p<0.05). 3. Positive family history of acne was more common in the post-adolescent group than the adolescent group (p<0.05). 4. Stress was the most important factor to aggravate acne in both groups. Menstrual cycle was related to aggravation of acne in the majority of nurses. However, both stress and menstrual cycle were more related to the post-adolescent group than the adolescent group (p<0.05). 5. Nurses are occupied medical care. Nevertheless, a considerable percentage of them showed wrong actions and incorrect recognition about the acne. CONCLUSION: Prevalence of post-adolescent acne in nurses was relatively high compared with previous data and most of post-adolescent acne was persistent acne.

A Comparative Study between Adolescent Acne and Post-adolescent Acne

BACKGROUND: The prevalence of patients over the age of 25 years with acne has significantly increased over the past 10 years. Several etiologic factors such as genetic factor, hyperandrogenism, stress, and cosmetics have been studied. OBJECTIVES: The purpose of this study is to evaluate the differences between adolescent acne and post-adolescent acne, based on the clinical features, asoociated diseased and aggravating factors of 327 acne patients. METHODS: 327 consective patients, first visited to our hospital with clinical facial acne between March 2000 and February 2001, were enrolled. 220 adolescent patients(AP) were under the age of 25 and post-adolescent patients(PP) were over age of 25. RESULTS: 1. In the face, cheeks and forehead in adolescents, chin and cheeks in post-adolescents were predilection sites. The predominant type was a comedonal type in adolescents and a papulopustular type in post-adolescents(P<0.05). Severity of inflammatory type was not different between two groups. Familial factors were important in both groups, but more frequently found in post-adolescents with persistent acne(P<0.05). 2. Rosacea, chloasma, and hyperandrogenic features such as hirsutism and androgenetic alopecia were more frequently observed in post-adolescents. Seborrheic and atopic dermatitis were more frequent in adolescents. Four patients had all the features of chloasma, acne, rosacea, seborrheic dermatitis and hirsutism. 3. Aggravation by weason especially summer, sweating, stress, and cosmetics was more frequent in adolescents. In PP, acne was more frequently aggravated by sunlight, foods and menstrual period. CONCLUSION: Post-adolescent acne was mainly a papulopustular type predominantly located on the chin and cheeks with mild to moderated severity, and family history and hyperandrogenism were strong etiologic factors in persistent acne. Aggravating factors were not significantly different between two group, which suggested cosmetics and stress might not be important in post adolescent acne.

A Comparison of the Sebum excretion rate and the Density of Propionibacterium acnes between Adult acne and Adolescent acne / 대한피부과학회지

BACKGROUND: Acne is principally a disorder of adolescence. However, a number of observational studies have documented a significant degree of acne in adult women. One study found a difference in women between late-onset acne and acne that persisted from adolescence. There were significant higher sebum excretion rates among women whose acne originated during the teenage years compared with late-onset acne groups. OBJECTIVE: The purpose of this study was to examine the clinical features of patients with acne and to compare the sebum excretion rates and the density of P acnes in adult acne with that in adolescent acne. METHODS: Thirty nine patients with acne vulgaris were clinically evaluated. Sebum secretion rates were evaluated by Sebutape method. The density of P acnes counted by scrub method. RESULTS: 1. The severity grades were mild to moderate in adult acne groups, consisting with the lower acne lesion counts than that of adolescent acne groups. 2. Sebum secretion rates by Sebutape(R) method showed different patterns in two groups. The mean value in the adult acne groups was lower than that in adolescent acne groups, but not statistically significant. Chin area dominant pattern, shown in adult acne groups, were not apparent in adolescent acne groups. 3. The density of P acnes was a lower mean value in the adult acne groups, but not statistically significant. Only in adolescent acne groups, the severity grades are well correlated to the density of P acnes. CONCLUSION: Adult acne was mild to moderate in severity. Clinically, adult acne differs from adolescent acne in that the lesions are located most commonly around the chin. Sebum excretion rate was the highest in the chin area of patients with adult acne. But there was no significant difference in two groups. Also the density of P acnes was not significantly different in two groups.