Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.

In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.

“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.

Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.

More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.

Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.

Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”

In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.

Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.

“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.

Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.

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