The Clinical and Epidemiological Profile of Adult Female Acne Vulgaris in Lagos, Nigeria

BACKGROUND AND AIMS

Studies of adult female acne vulgaris are few despite its increasing presentation in dermatology clinics. Adult female acne is classified as either late onset, persistent acne or return acne with a mixed pattern of inflammation in most females. The aim of this study was to document the socio-demographic characteristics (late onset, persistent acne, age, pre-menstrual flare) and clinical profile (severity, pattern, type of lesions, scarring and type of scars) of adult female acne patients.

METHODOLOGY

Cross sectional descriptive study of 56 adult female acne patients aged 25 years and above. Patients were clinically examined and severity of acne graded with the Comprehensive Acne Severity Scale. Socio-demographic data and clinical profile was documented using a questionnaire designed for the study. Data analysis was performed using the SPSS version 22. Level of significance of all tests was set at 5%.

RESULTS

Age range was 25-67 years with a mean age of 33.4 years. Prevalence of adult female acne was 19.3% amongst female patients seen in the clinic. Acne was persistent in 55.4%, late onset in 44.6%, only inflammatory in 5.4%, only non-inflammatory in 42.9%, and a mixed pattern of inflammation in 51.8%. Location of acne was facial only in 80.4% with extra facial involvement in 19.6%. Acne was severe, moderate and mild in 35.7%, 44.6%, and 19.6% respectively. Acne scar was present in 87.5%, post inflammatory hyperpigmentation in 65.3%.

CONCLUSION

Adult female acne is increasing in prevalence. Acne in adult females is mostly persistent in nature with mixed inflammatory pattern. It affects the whole face and it is associated with scarring.

A Prospective Study Examining Trigger Factors and Hormonal Abnormalities in Adult Female Acne

Background:

Numerous triggers have been implicated in adult female acne including endogenous (hormonal dysfunction and genetic predisposition) and exogenous causes (drugs, cosmetics, sunscreens, stress, and smoking).

Aims:

To evaluate the role of various trigger factors in adult female acne and to analyze the androgenic hormone pattern including anti-Mullerian hormone (AMH) in these patients.

Materials and Methods:

Patients having acne of age ≥25 years were analyzed using a pre devised proforma to elicit trigger factors while the severity was graded using the Global Acne Grading System (GAGS). A detailed hormonal assessment was undertaken that assessed total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), AMH, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin.

Results:

Out of the 165 cases seen and sub-analyzed for triggers, premenstrual flare, diet, cosmetics, and stress were the most commonly implicated causes. Among cosmetics, fairness creams and foundations were implicated. The hormonal analysis revealed deranged values of all hormones with the most common being 17-OHP and AMH. Almost 42.8% patients with DHEAS derangement and 58.75% females with raised 17-OHP suffered from moderate to severe stress.

Limitations:

A prospective cohort correlation study of the implicated triggers is needed to confirm the association with adult female acne.

Conclusions:

Adult female acne may be triggered by diet, stress, and cosmetics and there is a distinct hormonal milieu that accounts for hyperandrogenemia. We noted high levels of adrenal androgens which have been known to be associated with stress and sleep deprivation. Our study shows the value of counseling adult female acne patients about various acne triggers.

Efficacy and Tolerability of an Acne Treatment Regimen with Antiaging Benefits in Adult Women: A Pilot Study

Objective: The objective of this study was to assess clinical safety and efficacy of a novel acne treatment regimen in adult women. Methods: Participants in the study included an ethnically diverse group of adult women (n=24) with mild-to-moderate acne who were treated twice daily with a topical regimen (cleanser, acne cream, and rebalancing gel) for eight weeks. Following baseline assessments, subjects returned to clinic at Weeks 2, 4, and 8 for clinical assessments and self-assessment questionnaires. Results: Twenty-one of the 24 enrolled women completed the eight-week clinical trial. Statistically significant clinical improvements were seen in both acne and aging parameters over time. The product regimen was well tolerated without adverse reactions commonly seen with topical acne products. Conclusion: The regimen demonstrated efficacy and tolerability in adult women with acne and signs of skin aging.