The clinical features of late onset acne compared with early onset acne in women.
Choi CW, Lee DH, Kim HS, Kim BY, Park KC, Youn SW.
J Eur Acad Dermatol Venereol. 2011. Apr;25(4):454-61.
Often, physicians are confronted with females with no onset of acne who present with new lesions as adults. Often topicals are ineffective and oral antibiotics are often necessary. Recalcitrant cases are often referred to a gynecologist to rule out hormonal imbalances most especially when androgenic features are present. Hormonal antiandrogen contraceptives are sometimes given at that time.
This article from Seoul, South Korea highlights differences between adult onset acne in that the number of lesions is lower and that comedones fewer. This highlights differences which can help understand the classification of acne vulgaris and maybe differentiate its pathogenesis in the adult only form.
85 patients with acne vulgaris for less than 5 years were prospectively enrolled and divided into 4 groups: onset age less than 16, between 16 and 20, 21 and 25 and over the age of 25. The age of the early onset group (less than 21, n=48) was 18.9 years old and the late onset group (21 and over) was 28.9 years old. In the late onset group, comedonal counts and total number of acne lesions in the T zone (forehead, nose and upper chin area) and the whole face were significantly less than in the early onset group. However, the proportion of lesions in the U zone (both cheeks, perioral and lower chin area) compared to the T zone was higher in the late onset group compared to the early onset group. No differences in sebum secretion were observed.
One area that is not addressed is early onset acne in patients extending beyond the 3rd decade. It might be interesting to compare females with late onset acne with those having had acne since adolescence to see if there is a difference in clinical presentation
In one of the reviewers personal experience in his common practice, acne vulgaris is more retentional (comedonal) in late onset acne in Asia whereas in Europe, late onset acne tends to be more inflammatory. It would be interesting to repeat the same study in other countries and races to see if differences could arise due to geographic and genetic factors.