Adult acne in women has increased by 10% worldwide over the past 10 years, according to a 2022 Adult Acne Study led by Brigitte Dreno, MD, PhD, chief of the hospital’s Department of Dermatology University of Nantes in France, and his colleagues. The review was published in the International Journal of Dermatology.1
“In adults, acne has serious consequences, including psychological impact, low self-esteem, social isolation, and depression,” the authors wrote. The condition affects more than 640 million people worldwide, with the biggest risk factor being heredity.1 However, there are factors within the patient’s control, such as diet, that can reduce the risk of acne.
Treatment approaches vary by gender, and new treatments are in the pipeline, including modulating the skin microbiome, which would be helpful in reducing antibiotic use and preventing microbial resistance.1
Anais Aurora Badia, MD, DO, adult and pediatric dermatologist and founder of Florida Skin Center, now part of Advanced Dermatology and Cosmetic Surgery in Fort Myers and Lehigh Acres, Fla., spoke with Dermatology Times® about the rates acne crescents in adults and how to treat it.
Factors contributing to acne in adults
Badia said adult acne and adolescent acne share similar causes, and acne is primarily caused by sebum production, inflammation and bacteria. “Stress, hormones and diet can increase inflammation,” she said. “As our stress levels increase, we produce higher levels of acne-causing androgens, which can stimulate the sebaceous glands and hair follicles that contribute to acne.”
In addition to stress – which has been significantly higher in recent years due to the pandemic – Badia said masks worn to protect against COVID-19 increase acne rates because they trap dirt and bacteria on the skin, which contributes to an increase in acne-causing bacteria Propionibacterium acnes.
Badia also noted gender differences in the prevalence of acne. “Increased hormone levels contribute to acne in both men and women. However, the types of hormones responsible for acne are different for everyone,” she explained. “Women have tend to see more hormonal fluctuations than men due to medications, menstrual cycles and menopause”, which is why women get more acne than men.2
Diet also plays a role in the development of acne. “Some small studies have shown a link between dairy consumption and an increased risk of acne,” Badia said. “Other studies have linked high glycemic index foods to acne. [because] these foods quickly raise our blood sugar, causing inflammation, which in turn leads to an increase in acne. Dreno and colleagues’ review also found that milk, sugar, sugary drinks and fatty foods were associated with acne in adults.1
Badia added that skin and hair products can also cause acne. She said dermatologists should advise patients to read labels and look for non-comedogenic or oil-free products.
“It’s also important to advise them to use products that contain physical sunscreens, such as zinc oxide or titanium dioxide,” she said.
Badia noted that each patient should be treated according to their needs and concerns. The Adult Acne Review by Dreno and colleagues contained a summary of the 2018 International Consensus Treatment Recommendations from the Global Alliance to Improve Outcomes in the Acne Group. The recommendations are as follows3:
Retinoids play a vital role in the treatment of acne, with topical retinoid and benzoyl peroxide as first-line treatment for inflammatory acne and/or comedonal acne.
Systemic and topical antibiotics should be avoided as monotherapy.
Very severe acne (cystic and conglobata) should be treated with oral isotretinoin.
Patients should take isotretinoin by mouth until their acne clears up. The total cumulative dose to keep acne in remission needs further study.
Use low-dose oral isotretinoin to minimize acne breakouts.
Maintenance treatment with a topical retinoid with or without benzoyl peroxide should be used in most patients. Avoid topical antibiotics for maintenance treatment.
Pregnant women and patients with acne and post-inflammatory hyperpigmentation should be prescribed 20% azelaic acid cream or 15% gel.
Do not use devices (laser, intense pulsed light, photodynamic therapy) as first-line treatment for inflammatory acne.
In a small number of women aged 25 and over, only the lower face is affected by acne. Topical retinoids with or without benzoyl peroxide should be used.
Starting treatment early minimizes the risk of scarring.
Recent New Treatments
Badia noted that acne therapies have come a long way.
“With concerns about antibacterial resistance on the rise, a new topical minocycline [Amzeeq] is the first of its kind to deliver antibiotic therapy with minimal systemic absorption,” she noted. “Another new acne medication is clascoterone cream 1% [Winlevi]. This drug is a dihydrotestosterone antagonist and prohibits the production of sebum. She explained that clascoterone is similar in structure to spironolactone but has minimal systemic antiandrogenic effects and is safe for both men and women.
She added that topical retinoids continue to be “the gold standard in acne treatment” and that “many new formulations…have come out recently with age indications as young as 9 years old.” .
Acne prevention: advice for patients
Badia recommended informing patients of the following:
- Protect their skin by using a daily SPF with zinc oxide and not actively tanning.
- Cleanse their face daily with a gentle cleanser.
- Avoid products that contain alcohol, harsh exfoliants, and astringents that can irritate skin and make acne worse.
- Avoid popping or picking acne lesions as this may lead to more acne and scarring.
- Dagnelie MA, Poinas A, Dréno B. What’s new in adult acne over the past 2 years: focus on the physiopathology and treatments of acne. Int J Dermatol. 2022;61(10):1205-1212. doi:10.1111/ijd.16220
- Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD. Understanding the burden of acne in adult women. 2014;7(2):22-30. Accessed September 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935648/
- Thiboutot DM, Dréno B, Abanmi A, et al. Practical Acne Management for Clinicians: An International Consensus from the Global Alliance to Improve Acne Outcomes. J Am Acad Dermatol. 2018;78(suppl 1):S1-S23.e1. doi:10.1016/j.jaad.2017.09.078