Experience Sharing Paper - Adult Acne

My Story - Signs and Symptoms:

Unlike many of my peers, I did not experience acne during my adolescent years. However, when I reached the age of 22, I developed a case of adult acne. My symptoms consisted of cystic pimples around my jawline, chin and neck. The acne severely impacted my self-image and psychological well-being at this time, since I had just started my first job after graduating college and had to work with clients in person. After seeing a dermatologist, I was diagnosed with moderate-to-severe late-onset adult acne.

Anatomical Structure and Physiological Processes Affected by Adult Acne

Acne - General

Acne is a chronic skin disorder affecting both adolescents and adults. The birthplace of acne is the pore around the hair follicle. Each hair follicle contains sebaceous glands that produce a fatty oil called sebum which is meant to lubricate the hair and skin. Hair follicles become clogged with shedding cells from the lining of the follicle, and clump together blocking the sebum from traveling up from the hair shaft and out through the pore. When the excess dead skin cells and sebum are present, they solidify as a soft plug that may close the pore. This causes the follicle wall to bulge and a whitehead is formed. Blackheads are formed if the pore remains open and the top surface of the plug darkens. A pimple then develops when the wall of the hair follicle ruptures. An inflammatory response is stimulated by P. acnes (Propionibacterium acnes) and other microorganisms, resulting in a red pimple filled with pus (Howard).

Adult Acne in Females

There are two types of adult acne: persistent acne and late-onset adult acne. Persistent acne is a continuation of the disease from adolescence, while late-onset acne begins in adulthood. Both types are more common in women (Khunger et al.). “Gender-wise late onset adult acne is predominant in woman (97.3%) as compared to men (2.7%) (Kunger et al.)”. Adults experience inflammatory lesions prominently on the lower chin, jawline, and necks. (Dreno et al.)

While no specific cause of adult acne has been found, several predisposing factors can be identified. Adult women with acne may have excess levels of androgens in the skin and sebaceous gland which promotes sebum production (Geller et al.). Also, genetic predisposition is directly related to an increase in adult acne. 50% of patients report a first-degree family member with postadolescent acne. Studies have also a reported a relationship between acne and diet. Diets high in gluten and dairy may negatively impact the endocrine and immune systems, leading to an aggravation of an existing acne condition (Howard). Chronic stress, leading to an in increase in adrenal androgens, has also been suggested as a major cause of acne (Khunger et al.).

Differential Diagnosis

A helpful tool used in diagnosis of adult acne is the Global Acne Assessment Score (GAAS) which provides a rubric for determining the severity of the acne. Acne severity is categorized on a numerical scale of 0 to 4, correlating with the following categories: none, minimal, moderate, or severe acne (Howard). Based on the determined category, appropriate treatment can be administered.

Treatment

Many treatments are available for adult acne. The most successful treatment is an holistic approach to therapy which combines standard treatments with adjunct therapy and cosmetic use. This approach also considers the specific characteristics of the adult female, as well as response to previous treatments and the extent, severity, and duration of the condition (Dreno et al.). Acne therapy techniques are described below: Topical therapy Typically, patients try topical treatments before any other form of treatment. Topical therapies alone are usually not sufficient for the successful treatment of moderate-to-severe adult acne. Topical treatments include retinoids, azelaic acid, topical antibiotics, and benzoyl peroxide (Dreno et al.).

Systemic therapy

This therapy is usually required for moderate-to-severe adult acne. Systemic antibiotics are best used in combination with topical treatment. Tetracylines are usually the first recommended antibiotic therapy, in combination with BPO 2.5-5%. Another type of systemic therapy is hormonal therapy, which reduces excess sebum production. Hormonal treatments are usually combined with other treatments including antibiotics and BPO (Dreno et al.).

Adjunctive therapy

Adjunctive therapy includes light therapy and chemical peels. Current evidence suggest that light therapy is best used as an adjunct to standard therapy. Chemical peels are also best used as adjunctive therapy. Glycol acid, salicylic acid, and Jessner’s solutions are all recommended for the treatment of mild-to-moderate acne in adult females (Dreno et al.).

Maintenance therapy

This therapy is required to reduce the likelihood of relapse after treatment and where acne recurrences are frequent. Typically, topical retinoids such as adapalane 0.1% or tazarotene 0.1% are the prevalent maintenance therapy for adult acne (Dreno et al.).

Cosmetic use

The use of cleansers and moisturizers should be an essential component of any therapeutic regimen for adult female acne. Moisturizer should be used in the morning and the use of UVA/UVB sunscreen is recommended for all adults. It is important to note that all skin care products and cosmetics should be anti-comedonal and oil free (Dreno et al.).

Sources

Dréno, B., Layton, A., Zouboulis, C.C., López-Estebaranz, J.L., Zalewska-Janowska, A., Bagatin, E., Zampeli, V.A., Yutskovskaya, Y. and Harper, J.C. (2013), Adult female acne: a new paradigm. Journal of the European Academy of Dermatology and Venereology, 27: 1063–1070. doi: 10.1111/jdv.12061

Tanghetti, E. A., Kawata, A. K., Daniels, S. R., Yeomans, K., Burk, C. T., & Callender, V. D. (2014). Understanding the Burden of Adult Female Acne. The Journal of Clinical and Aesthetic Dermatology, 7(2), 22–30.

Geller, L., Rosen, J., Frankel, A., & Goldenberg, G. (2014). Perimenstrual Flare of Adult Acne. The Journal of Clinical and Aesthetic Dermatology, 7(8), 30–34.

Khunger N, Kumar C. A clinico-epidemiological study of adult acne: Is it different from adolescent acne?. Indian J Dermatol Venereol Leprol 2012;78:335-41

Howard DM. Adult acne: overview and case study. The Nurse Practitioner. 39: 12-5. (1313268) PMID: 25036245 DOI: 10.1097/01.NPR.0000451912.32803.ea