Acne vulgaris and teenagers seem inextricably linked — both in the popular mind and in the dermatologist’s waiting room. Of course, acne vulgaris is largely a condition of adolescence; the prevalence of acne in adolescent boys and girls is so high as to be almost universal. However, adults suffer from acne, too. Even though many dermatologists report seeing increasing numbers of adult acne patients in their practices, the data on acne vulgaris in adults are surprisingly sparse. Much of the information on the pathophysiology and treatment of acne in adolescents also applies to adults, but there are subtle differences, and it is important to recognize these differences when treating adult patients.
Acne is a disease that can have considerable effects on self-image and psychological well-being, which may be even more profound in adult patients than in their teenage counterparts. In a survey of 111 people aged 16-39 years referred to dermatologists for acne, results showed that acne patients have levels of social, emotional, and psychological impairments as significant as those reported by patients with more “serious” diseases, such as chronic, disabling asthma, epilepsy, diabetes, back pain, or arthritis. Furthermore, both men and women appear to find the effects of acne on appearance to be the most bothersome aspect of the disease. In another study that revealed the significant impact of acne on quality of life, older adults were more affected psychologically by their disease than were younger acne patients, regardless of acne severity. Adults with acne have even been reported to have higher rates of unemployment than those without acne.
Adult acne is usually defined as acne after the age of 25 years. Two main forms of adult acne have been delineated: persistent acne, in which adolescent acne persists into adulthood, and late-onset acne, in which the disease erupts for the first time in adulthood. There are few data to establish which form is more common. In the prevalence study conducted by Conifer, 82% of subjects reported that their adult acne had persisted since adolescence. In contrast, 34% of subjects in the French study described above reported that they did not have acne as adolescents. Adult acne generally resolves by the age of 45, but so-called pensioner’s acne that persists into the sixth and seventh decades has been reported.
Adult acne appears to be more common in women than in men, although some speculate that this difference is just a reflection of the fact that more women than men seek treatment. In the Conifer prevalence study, however, only 3% of men but 12% of women had clinical acne.
Many physicians have noted that adult acne generally has a slightly different presentation compared with adolescent acne. The typical presentation of adult acne is clusters of inflammatory lesions on the lower cheek and along the jaw-line.
Researchers continue to investigate whether the pathogenesis of adolescent acne, persistent adult acne, and late-onset acne differ. As mentioned, no differences are apparent in the cutaneous and follicular micro-flora of adolescent acne patients, persistent acne patients, or late-onset acne patients. It has been proposed that the follicular duct might undergo cyclical changes that alternate between inflammation and repair, and that the duration of acne in an individual patient is determined by the number of follicles involved at any one time in the inflammation or repair cycle, as well as the number of times a follicle can complete each cycle. While this concept might explain persistent acne, it does not explain late-onset acne.
References:
- Ingentaconnect.com - Adult Acne
- NIH.gov - Adult Acne
- DermaGenex.com - Adult Acne
- Blackwell-Synergy.com - Adult Acne
- Karger.com - Adult Acne