Acne, sexual orientation, and mental health among young adults in the United States: A population-based, cross-sectional study

Guidelines of care for the management of acne vulgaris

BACKGROUND

Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.

OBJECTIVE

The objective of this study was to provide evidence-based recommendations for the management of acne.

METHODS

A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.

RESULTS

This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.

LIMITATIONS

Analysis is based on the best available evidence at the time of the systematic review.

CONCLUSIONS

These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Treatment of acne and acne-related scarring with fixed combination clindamycin phosphate and benzoyl peroxide gel (1.2%/3.75%) and tretinoin gel microsphere 0.06% in an Asian American transgender female

Acne vulgaris is one of the most common skin diseases in the United States and can affect any gender or ethnic group. Post-inflammatory hyperpigmentation (PIH) and scarring from acne can have a negative psychosocial impact on patients. Skin of color patients are particularly prone to PIH, as the dark marks left from acne may take several months to resolve, far after the acne has cleared. Here, we report a case of moderate acne with associated scarring in a transgender, Asian American female who was successfully treated with fixed combination topical therapy with clindamycin phosphate and benzoyl peroxide gel 1.2%/3.75% and tretinoin gel microsphere 0.06%.

Acne vulgaris and risk of depression and anxiety: A meta-analytic review

BACKGROUND

Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted.

OBJECTIVE

We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety.

METHODS

A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region.

RESULTS

Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region.

LIMITATIONS

Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature.

CONCLUSIONS

Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.

Acne and the Lesbian, Gay, Bisexual, or Transgender Teenager

Although most teenagers experience acne, for sexual and gender minority teenagers, acne could be more challenging and require specific psychosocial considerations. Acne may be more strongly associated with mental health issues in sexual and gender minority adolescents. Acne development during puberty may trigger gender dysphoria in transgender patients. Transgender and gender nonbinary patients receiving testosterone therapy may experience new or worsening acne. Comprehensive care for moderate to severe acne in sexual and gender minority adolescents should include culturally competent discussions about sexual behaviors, contraception, and/or gender-affirmation treatment plans.

Dermatologic care of sexual and gender minority/LGBTQIA youth, Part 2: Recognition and management of the unique dermatologic needs of SGM adolescents

Sexual and gender minority (SGM) individuals, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) persons, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Part 2 of this two-part review will address unique concerns regarding acne, tanning behavior, sexually transmitted infections, and other health disparities among SGM adolescents. A more comprehensive understanding of the dermatologic needs of SGM youth will better allow pediatric dermatologists to actively and compassionately care for this health disparity population.

Dermatologic Conditions in Transgender Populations

Transgender persons receiving gender-affirming hormone therapy and procedures may face specific skin conditions. Skin diseases in transgender patients often are underdiagnosed and underrecognized despite their important impact on quality of life and mental health. This article discusses pathophysiology, diagnosis, and treatment of common skin diseases in the transgender populations. For transmasculine patients, conditions include acne vulgaris and male pattern hair loss. For transfeminine patients, conditions include hirsutism, pseudofolliculitis barbae, and melasma. Postprocedural keloids and other cutaneous complications are discussed. Unique aspects of skin health in transgender persons should be considered in the context of multidisciplinary gender-affirming care.

Prescribing isotretinoin for transgender youth: A pledge for more inclusive care

As the transgender community has become increasingly visible in public life, a greater awareness of this group's unique health needs and obstacles to optimal medical care has developed. Unfortunately, transgender youth face multiple barriers within the health care system, including access to equitable and gender-affirming care. As dermatologists who care for children and adolescents, we must be aware of the challenges facing transgender youth and work to correct the disparities that exist for this vulnerable group. An initial step in supporting our transgender patients is to advocate for changes to the iPLEDGE system for prescribing isotretinoin (and other Risk Evaluation and Mitigation Strategy systems), specifically requesting a change to its gender-binary categorization model that compromises an individual's right to self-identify. By promoting a gender-neutral patient categorization that is based instead upon reproductive potential, a simple change to the iPLEDGE program allows us to safely treat all of our patients requiring isotretinoin, while preserving our transgender patients' rights to self-determination and self-identification.

Acne: a side-effect of masculinizing hormonal therapy in transgender patients

BACKGROUND

Masculinizing hormonal treatment in transgender men has the potential to increase the level of androgens at end organs, including the pilosebaceous unit. Androgen-induced sebocyte growth and differentiation, sebum production and infundibular keratinization may underlie the development of acne vulgaris among patients receiving this therapy.

OBJECTIVES

The aim of this article is to familiarize dermatologists with the sensitivities and challenges of treating acne in transgender male individuals.

METHODS

This review article discusses the pathogenesis and treatment of acne in transgender men on testosterone therapy and highlights the unique considerations in treating this underserved patient population.

RESULTS

Despite the incidence of treatment-related acne and the unique considerations in treating transgender men, studies addressing this topic among this patient population are limited.

CONCLUSIONS

Generally, the standard guidelines for the treatment of acne can be followed in treating these patients; however, several medical, social and psychological factors should be considered.