A clinico-epidemiological study of adult acne: is it different from adolescent acne?

Although acne is usually recognized as an adolescent skin disorder, the prevalence of adults with acne is increasing. There is surprisingly a paucity of data on the prevalence and clinical features of postadolescent acne in the adult Indian population.

The clinical and epidemiological data of adult acne were evaluated with a view to establishing possible contributing etiological factors and observing whether clinical features differ from adolescent acne.

Patients over the age of 25 years presenting with acne in a tertiary care hospital were included in the study. A detailed history and examination was carried out, with a stress on aggravating factors. Hormonal imbalances were investigated in females with alopecia, obesity, hirsutism and menstrual irregularity. Severity of acne and complications like scarring and psychological stress were included.

Out of 280 patients included in the study 82.1% were women and 17.9% were men. The mean age of the patients was 30.5 years. Persistent acne was observed in 73.2%, while it was late onset in 26.8%. Majority of the patients had inflammatory papular acne (55%), whereas comedonal acne was the least common (6%). Most common predominant site of involvement was cheek (81%), followed by chin (67%), and mandibular area (58.3%). Family history of acne was present in 38.6%. Premenstrual flare was seen in 11.7% of female patients, obesity in 6.4%, hirsutism in 5.7% and alopecia in 1.8%, but raised laboratory markers of hyperandrogenism were observed in only 3.08%. Scarring was observed in a majority of patients (76.4%) and psychological stress in 52.8% patients.

Adult acne is predominant in women, and as compared to adolescent acne is more inflammatory, with involvement of the cheeks and lower half of the face, while comedones are rare. Facial scarring occurs in a majority and stress is common, which emphasizes that adult acne should not be neglected.