Differential Risk Factors And Outcomes In Patients With Classical, Persistent, And Adult-onset Acne

BackgroundIn the past, acne usually starts in adolescence but not in adult. But with the increase of the pace of life or work, life stress and life style and changes in diet, the incidence of acne in puberty is increased. Because women tend to pay more attention to their appearances and figures, they often apply cosmetics and other anti-acne and anti-aging agents. In addition, they have some more endocrine diseases, such as polycystic ovarysyndrome. Thus, acne is not limited to the adolescent. The incidence of adult acne is increasing especially in middle-aged professional women. Although acne does not cause mortality but it causes great psychological burden and morbidity. Thus it significantly impairs the quality of life in patients.PurposeThe aim of this study is to investigate the risk factors for three forms of acne, namely, classical, persistent, and late-onset acne. Thus, the results might optimize the individualized diagnosis, treatment and prevention for patients with acnes.Method904female patients were recruited (age10-48). Using age of25as cut point, patients were further grouped into patients with adolescent acne and adult acne patients. The disease severity were categorized by Pillsbury grading system. Venous blood were collected in the5th day after menstruation to measure dehydrogenation different male testosterone (DHEA), testosterone, estradiol, prolactin, Luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone, and cortisol. Patients were asked to fill out the questionnaires, including basic information, the status of current disease, the risk factors, endocrine hormone levels, Cardiff Disability Index questionnaire. The data were analyzed by SPSS16.0statistical analysis software.ResultLower body mass index(BMI), and higher testosterone/estradiol ratio is associated more in patients with adolescent acne than in patients with adult acne. When comparing patients with persistent and late-onset acne, patients with late-onset acne patients tends to develop their acne in lower face and flare up in autumn. On the other hand, patients with persistent acne tends to have higher education, develop scars afterwards, worsen during premenstrual period, have irregular menstrual period, and use of cosmetics, particularly the greasy ones.Conclusion1. Testosterone/estradiol ratio of endocrine levels in adolescent is much higher than the adult acne. The blood level of the other sex hormones do not differ in three acne groups.2. The average education level of the persistent acne group is higher. The tendence towards chronic stress may influence on endocrine level and cause irregular menstruation.3. The percentage of the persistent group applying greasy cosmetics is higher than that of late-onset group. The persistent group tend to apply cosmetics to cover acne, leading to a vicious circle.4. Doctors should inform patients to develop better diet habit, go to bed earlier and maintain a good hygiene habits.5. In addition to drug treatment, mitigating psychological problems, improving patients’attitude, and controlling the patient’s negative emotions, are helpful to manage acne diseases.