The Question of Adolescent and Postadolescent Acne: The Nigerian Experience.

Introduction: Differences between adolescent and postadolescent acne are increasingly being recognized. This study aimed to document the clinical profile of facial acne vulgaris and, additionally, to compare adolescent to postadolescent acne and any gender-based differences. Methods: Cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted from February 2021 to March 2022 at three dermatology clinics. Patients had their anthropometric measurements, type of acne lesions, and severity and scarring assessed. Results: A total of 261 patients (75.5% females) with a mean age of 24.5 (±7.4) years were diagnosed to have facial acne vulgaris. The severity of acne was mild in 44.8%, moderate in 48.3%, and severe in 6.9%. Acne was noninflammatory in 69.7%, inflammatory in 13.0%, and mixed in 17.2%. Adolescent and postadolescent acne significantly differed in the type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences included BMI, lesions of acne, and severity. Conclusion: There is an increasing prevalence of postadolescent acne with persistent being the most common category. There are significant differences between adolescent and postadolescent acne: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and postadolescent acne.

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.

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

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.

Serum Fetuin-A: A Novel Potential Link Between Post-adolescent Acne and Insulin Resistance.

Background: Post-adolescent acne is acne in patients aged older than 25 years. It is more common in women, suggesting an underlying hormonal imbalance. It has been postulated that insulin resistance (IR) may play a role in pathogenesis. Objective: To explore the relationship between fetuin-A, IR, and post-adolescent acne. Methods: Serum fetuin-A levels were assessed using an ELISA technique in 50 female patients with post-adolescent acne and 50 healthy controls, and IR was calculated using the Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR). Results: Studied patients had significantly higher HOMA-IR indices and serum fetuin-A levels than control subjects (P=0.001 and <0.001, respectively) and they were significantly increased in patients with severe lesions (P<0.001). Conclusion: We found that IR was more significantly prevalent among studied patients, especially those with more severe acne grades, and that could be attributed to higher serum fetuin-A levels. Fetuin -A might be a predictor for acne severity and associated metabolic comorbid conditions, such as IR. However, further large-scale studies will be needed.

Clinical evaluation of efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Neodymium:YAG laser in the treatment of inflammatory acne vulgaris in adolescent and post-adolescent patients: a prospective randomized split-face comparative study.

Large numbers of local and systemic therapies are available for acne treatment. Common oral or topical retinoids, antibiotics, or keratolytics are used but sometimes are inconvenient, and side effects caused by these conventional therapies prompted a search for effective and safe treatments. This study aimed to evaluate the efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Nd:YAG laser in the treatment of moderate inflammatory acne vulgaris in both adolescents and post-adolescent patients. This split-face comparative study was carried out on thirty patients who suffered from moderate inflammatory and non-inflammatory acne vulgaris. The patients were classified into two groups: group I: adolescent (≤ 25 years) and group II: post-adolescent (< 25 years). Each group received four sessions of intralesional PRP injection on one side of the face and a long-pulsed Nd:YAG (1064 nm) laser on the other side with 2 weeks interval. Evaluation was done by blinded dermatologists using photographs and lesions counting and by patient satisfaction. Side effects were also noted. Both groups (adolescents and post-adolescent) showed a high statistically significant improvement of inflammatory as well as non-inflammatory lesions either in PRP or Nd:YAG laser-treated side with no significant difference between the two sides. The intralesional PRP injection and 1064 nm long-pulsed Nd:YAG laser are safe and effective methods for controlling inflammatory as well as non-inflammatory acne vulgaris in both adolescents and post-adolescent patients.

The Association Between Short-Term Air Pollution Exposure and Post-Adolescent Acne: The Evidence from a Time Series Analysis in Xi'an, China.

BACKGROUND: Post-adolescent acne is a common skin disease faced by adults. However, whether air pollution (AP) serves as a risk factor for post-adolescent acne remains elusive. AIM: To determine the relationship between short-term AP exposure (within 7 days) and outpatient visits for post-adolescent acne. METHODS: Daily outpatient visit data for post-adolescent acne and routinely AP data between 2010 and 2013 were collected from Xi'an, China. A generalized additive regression model was used to analyze the relationship between outpatient visits for post-adolescent acne and short-term ambient AP exposure. The gender-specific analyses were conducted as well. RESULTS: Totally, 27,190 outpatient visits for post-adolescent acne were included. The results revealed that a 10 µg/m3 increase in PM10, SO2, and NO2 at lag 0-7 day was associated with the increase of outpatient visits for post-adolescent acne at 0.84% (95% CI: 0.53%, 1.16%), 1.61% (95% CI: 0.12%, 3.10%), and 3.50% (95% CI: 1.60%, 5.40%), respectively. The significant positive associations of PM10, SO2, and NO2 were found at both single-lag models and moving average models. The gender-specific analyses showed that the effect estimates of PM10 was stronger for females than for males, while there was no observed gender difference in the effects of SO2 and NO2. CONCLUSION: Short-term exposure to AP was associated with increased outpatient visits for post-adolescent acne, especially for females in the effects of PM10.

Spironolactone in adolescent acne vulgaris.

Acne vulgaris (AV) is the most common skin condition affecting adolescents, most likely due to elevated androgen levels during puberty. Androgens stimulate and enlarge the sebaceous glands and keratinocytes, resulting in increased production of sebum and abnormal hyperproliferation of keratinocytes which lead to the formation of acne lesions. Current standard of care for AV includes topical therapies for mild cases and antibiotics or oral retinoids for severe cases. In recent years, spironolactone, an aldosterone antagonist and diuretic, has been applied to the treatment of AV due to its anti-androgen effects. Spironolactone is currently recommended in women who use oral contraceptives, are refractory to or contraindicated for standard treatment, show clinical signs of hyperandrogenism, or present with late-onset or persistent-recurrent AV past the teenage years. It is not prescribed to adolescents due to potential side effects; however, current data studying adults indicate that most side effects are mild, and that potential associations with hyperkalemia and increased risk of cancer are not sufficiently supported. Hence, we believe that spironolactone may be a safe and effective therapy for adolescent AV.

Efficacy and tolerability of low-dose spironolactone and topical benzoyl peroxide in adult female acne: A randomized, double-blind, placebo-controlled trial.

Effective therapies for adult female acne (AFA) are limited. Oral spironolactone (SPL), 100-200 mg/day, is currently used off-label to treat AFA. However, high-dose SPL results in clinically significant side-effects which prevent widespread use in clinical practice. The efficacy of low-dose spironolactone in AFA is unknown. We examined the efficacy and tolerability of low-dose (25-50 mg/day) oral SPL in Thai women with moderate AFA. A randomized, double-blind, placebo-controlled trial was conducted for 12 weeks. Moderate AFA patients aged between 25 and 45 years received a combination of daily topical benzoyl peroxide (BP) 2.5% plus either SPL 25 mg (SPL25 group), SPL 50 mg (SPL50 group) or placebo. We performed total acne counts and Adult Female Acne Scoring Tool (AFAST) grading at 4-week intervals. The success rate, defined as the proportion of participants achieving a "clear/almost clear" AFAST grade by the end of week 12, was considered as the main outcome. Treatment-related adverse events (TRAE) were recorded. We enrolled 63 participants in the study. The total acne counts decreased significantly in all three groups (P < 0.05) as compared with baseline. Participants in the SPL50 group had a significantly higher success rate than those in the placebo group (P < 0.05). Serum potassium and creatinine levels showed no significant changes with treatment or between groups. A small number of participants in SPL25 and SPL50 reported mild and temporary TRAE, such as menstrual irregularities, breast tenderness and dizziness. The combination of SPL 50 mg/day and topical BP proved effective in improving moderate AFA in Thai women, with an acceptable side-effect profile. We propose this regimen as an option for treating moderate AFA.

Skin surface lipidomics revealed the correlation between lipidomic profile and grade in adolescent acne.

BACKGROUND: Acne is a multifactorial skin disorder frequently observed during adolescence with different grades of severity. The crucial factors of acne are the increase of lipids secretion and the change of composition on the skin surface lipid (SSL). However, there are no studies on the changes of lipid composition and content between different grades of adolescent acne in lesional skin and nonlesionsal skin. AIMS: This study was to investigate correlation in the composition of SSL and different grades in order to understand the tendency of SSL alterations in this disease for successful acne management and prevention. METHODS: A powerful analytical technique, UPLC-QTOF-MS, and multivariate data analysis were used to investigate SSL variations of lipid main classes, subclasses, and species. RESULTS: The results indicated that sphinganine, triradylglycerols (TG), and phytosphingosine were important in adolescent acne development. The average fatty acids (FAs) chain length in patients with acne showed significantly shortened trend from mild to moderate adolescent acne. Additionally, the relative average content of TG, diglyceride (DG), FA, ceramides (Cers), and the level of unsaturated FAs significantly increased from mild to moderate adolescent acne. Interestingly, our results demonstrated that the phytosphingosine and sphinganine showed an increasing trend in mild acne groups, but decreasing trend in lesional skin of moderate group. CONCLUSIONS: Lipidomics analysis suggested that the variation of TG, phytosphingosine, and sphinganine was closely related to the occurrence severity of acne in adolescent.

Topical 2% ketoconazole cream monotherapy significantly improves adult female acne: A double-blind, randomized placebo-controlled trial.

The emergence of bacterial resistance is a global crisis. Prolonged use of antibiotics especially in acne is one issue of concern among dermatologists. Ketoconazole (KTZ) cream, a topical antifungal with anti-inflammatory and antiandrogenic actions, can decrease lipase activity of Cutibacterium acnes in vitro. We evaluated the efficacy and safety of KTZ cream in mild adult female acne (AFA) by conducting a randomized, double-blind, placebo-controlled trial using KTZ 2% and placebo cream twice daily for 10 weeks. We assessed the improvement of clinical severity, measured by AFA score graded by investigators and participants, and the change of acne count. Forty-one participants enrolled in our study. The proportion of participants with acne improvement from baseline (42.9% vs 9.5%, P = 0.015) and the success rate (45.0% vs 14.3%, P = 0.043) in the KTZ group were significantly higher than that of the placebo group. The most common adverse events were dryness and itching. The percentage change of acne count decreased significantly compared with baseline but did not differ statistically between the two groups (P = 0.268). We concluded that the KTZ monotherapy showed a plausible effect in improving AFA with excellent safety profile. It should be considered as a viable option for mild AFA treatment.