Original article
Adult female acne and associated risk factors: Results of a multicenter case-control study in Italy

https://doi.org/10.1016/j.jaad.2016.06.060Get rights and content

Background

The reasons for the appearance of acne in adulthood are largely unknown.

Objective

We explored the role of personal and environmental factors in adult female acne.

Methods

We conducted a multicenter case-control study in the outpatient departments of 12 Italian cities. Cases (n = 248) were consecutive women ≥25 years of age with newly diagnosed acne of any grade. Controls (n = 270) were females diagnosed with conditions other than acne.

Results

In multivariate analysis, a history of acne in parents (odds ratio [OR] = 3.02) or siblings (OR = 2.40), history of acne during adolescence (OR = 5.44), having no previous pregnancies (OR = 1.71), having hirsutism (OR = 3.50), being an office worker versus being unemployed or being a housewife (OR = 2.24), and having a high level of reported psychological stress (OR = 2.95) were all associated with acne. A low weekly intake of fruits or vegetables (OR = 2.33) and low consumption of fresh fish (OR = 2.76) were also associated with acne.

Limitations

We did not establish an onset date for acne. Some of our associations may reflect consequences of established acne.

Conclusion

Lifestyle factors may play an important role for acne development in adulthood, but their role should be further assessed in prospective studies.

Introduction

Acne is one of the most common diseases in adolescence, affecting >80% of young people.1 The disease usually resolves after 20 years of age, although it also affects 20% to 40% of adults. A study of people 40 to 49 years of age conducted in 1979 showed a prevalence of acne of about 3% in men and 11% to 12% in women, with a significant decrease after 45 years of age.2 Over the last decades, the average age of people with acne has increased from 20.5 to 26.5 years.3 In a 2001 study of 3305 women 25 to 40 years of age, the prevalence of acne was 41%,4 and in a second study of 2895 women 10 to 70 years of age acne peaked during the teenage years, but >25% of women suffered from acne after 21 years of age, with a peak of 45% in women between 21 and 30 years of age.5

When the disease is present after the age of 25 years in women, it is usually named adult female acne (AFA), which is comprised of 2 variants: “persistent” acne continues after adolescence, while “late onset” acne starts after 25 years of age.3 The latter seems to occur less frequently than the former.6 The reasons for its increase in adulthood are unknown: endogenous and exogenous factors, such as smoking and psychological stress, can combine and contribute to its clinical expression.7, 8, 9

To analyze the roles played by different factors, including family history, smoking habits, occupation, comorbidities, psychological stress, and dietary factors, we conducted a case-control study of adult women who were clinically diagnosed with acne at several dermatologic outpatient clinics in Italy.

Section snippets

Methods

This multicenter case-control study assessed factors associated with AFA in a consecutive group of women ≥25 years of age who attended a dermatologic outpatient department in 1 of 12 Italian cities distributed across Italy. The patients were diagnosed with acne of any grade (ranging from mild to severe), as assessed by dermatologists during the visit, while the controls were women ≥25 years of age who visited a dermatologic outpatient clinic for a condition other than acne and who were not

Demographics and clinical characteristics

From February 2013 to January 2015, 518 women (248 cases and 270 controls) were included in the study. Table I shows the demographic distribution and general characteristics of the subjects according to their case or control status. Overall, the mean age was 32.2 ± 5.2 and 36.4 ± 7.0 years (mean ± SD) for cases and controls, respectively (P < .001), and the mean body mass index (BMI) was 22.5 ± 3.9 kg/m2. A total of 24.5% of the women were current smokers, and 62.3% were regular or occasional

Discussion

Few formal epidemiologic studies have evaluated risk factors for the presence of AFA. Our case-control study indicated that having a personal history of acne in adolescence, a family history of acne in first-degree relatives, no previous pregnancies, having hirsutism, working as an office worker, reporting a higher level of psychological stress, and having some dietetic factors, including a low consumption of vegetables or fruit and fish, were all associated with AFA. We did not establish an

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Funding sources: None.

Conflicts of interest: None declared.

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© 2016 by the American Academy of Dermatology, Inc.