Numerous triggers have been implicated in adult female acne including endogenous (hormonal dysfunction and genetic predisposition) and exogenous causes (drugs, cosmetics, sunscreens, stress, and smoking).

A new study published in the Indian Dermatology Online Journal evaluated the role of various trigger factors in adult female acne and analyzed the androgenic hormone pattern—including anti-Mullerian hormone (AMH)—in these patients.

In this prospective cohort correlation study, patients having acne and of age ≥25 years, were analyzed using a pre devised proforma to elicit trigger factors. Acne severity was graded using the Global Acne Grading System (GAGS). A detailed hormonal assessment was undertaken that assessed total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), AMH, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH) and prolactin.

Out of the 165 cases seen and sub-analyzed for triggers, premenstrual flare, diet, cosmetics and stress were the most commonly implicated causes. Among cosmetics, the use of fairness creams and foundations were the common etiological factors. The hormonal analysis revealed deranged values of all hormones with the most common being 17-OHP and AMH. Almost 42.8% patients with DHEAS derangement and 58.75% females with raised 17-OHP suffered from moderate to severe stress.

In inference, it was stated that adult female acne may be triggered by diet, stress and cosmetics, and there is a distinct hormonal milieu that accounts for hyperandrogenemia. In addition, high levels of adrenal androgens were detected, which have been known to be associated with stress and sleep deprivation.

Source: Indian Dermatology Online Journal. 2020 Jul-Aug; 11(4): 544–550. doi: 10.4103/idoj.IDOJ_500_19