Acne vulgaris is a common, chronic, inflammatory dermato- sis among teenagers that regresses spontaneously during late adolescence or early adulthood. and may involve comedones, papules, pustules, nodules, and scarring or hyperpigmentation from resolved lesions .
A significant number of patients experience acne after adolescence, with three distinct sub-types of disease:
- Persistent acne (a continuation of the disease from adolescence into adulthood);
- Relapsing acne, with regression after adolescen- ce and recurrence in adulthood;
- and Late-onset acne, which first presents well after puberty (commonly in the early- to mid-twenties) .
The mean age at presentation for adult acne treatment is around 24 years, and 10 % of visits to a physician are by patients 35 to 44 years of age
Morphological Differences between acne in female adults and teenagers
Characteristics of adult acne
- Acne on the chin (deep-seated, long-lasting small nodules (< 0.5 cm)
- Cysts in the U-zone alone appears to be specific to women;
- Mixed presentations with inflammatory and non-inflammatory lesions involving multiple areas of the face
- Localization of acne on the lower face areas
- Acne of the trunk is less common in this population .
- Excessive oil production
- Mild to moderate acne
- Flare-ups before menstruation appear to be more common in older women,
Persistent, relapsing and new-onset types of adult female acne are frequently associated with inflammation (deep nodules), post-inflammatory pigmentation (PIH) and a high frequency of scarring, with a significant negative impact on the Quality of life (QOL).
Hyperpigmentation is more prevalent in women with dark skin or phototype IV, and may be of greater concern than for women with a lighter skin complexion
Characteristics of Adolescent acne
- Commonly located around the T-zone (forehead and nose) and ears
- Acne on chest and back area
- Numerous comedones (blackheads and white heads)and inflammatory lesions (papules, pustules and nodules) See post https://bareskinnaturals.com/helpful-tips/pimples-causes-and-treatment/ for in-depth explanation of the terms papules, pustules , nodules and cysts.
Adolescent acne that persists and is transformed to adult acne often involves frequent relapses, therefore requires even more maintenance therapy for an extended period than adolescent acne (in which the numerous pubertal lesions usually respond quickly to treatment).
Although no clear difference in pathogenesis between adult female acne and adolescent acne has been demonstrated, adult female acne is dominated by three main pathophysiological factors:
(a) resistant strains of Propionibacterium acnes may cause chronic stimulation of the innate immune system, initiating and exacerbating inflammatory lesions ;
(b) Hormonal imbalance
(c) Genetic predisposition