Abstract

Acne vulgaris is one of the most common inflammatory skin diseases affecting pilosebaceous units. Primary etiological cause of adult onset acne is a hormonal imbalance, especially hyperandrogenemia. Biggest challenge is that most of the cases of adult onset acne are resistant to the therapy. Androgen suppression may be useful in treating acne. Patient selection and evaluation before treatment is administered as crucial. Reducing sebum production is a major goal of hormonal treatment. Oral contraceptives may act through several mechanisms to reduce acne.

Introduction

Adult onset acne (AOA) is known as the, “a chronic inflammatory disease of the pilosebaceous units, occurring at the age over 25 years.” The disease clinically presents itself in the form of comedones, papules, pustules, cysts, and nodules on the lower part of the face, chin and jaw line. Acne can be classified into two types; persistent and late onset acne.

The disease is usually mild to moderate in severity. The differential diagnosis involved in such cases includes AOA, cosmetic acne, pomade acne, perioral dermatitis and seborrheic dermatitis. In case of AOA, androgen suppression is a useful strategy in treatment.

Therapeutic approach involves treatment with antiandrogens and other hormones such as cyproterone acetate, spironolactone, oral contraceptives, finasteride) are given as concomitant treatment for adult acne in woman. One of the major goals in the treatment for adult acne in women is the reduction of sebum production. Oral contraceptives are also found to be effective in the reduction of lesions associated with acne.

Case presentation

The present case is of a 25-year old woman suffering from acne since the age of 15 years. She presented with complaints of painful acneiform eruptions, especially on the lower third of her face.

There was no history of menstrual disturbances, patient had no pregnancies. There was no family history of acne vulgaris. Patient informed that she experienced reported improvement of the cutaneous lesions from sun exposure in summer. She was previously treated with topical antibiotics and sunscreens without any significant benefit. She was diagnosed with hormonal abnormality after gynaecological examination but a six-month therapy with carbegoline 0.5 mg/daily did not lead to any benefits.

There were no abnormalities following physical examination. The patient’s Body Mass Index was 19.1. Dermatological examination revealed pathological skin lesions affecting the lower third of the face, cheeks and chin and the back. They were presented as painful papules, some pustules and a few comedones. Laboratory examination gave normal haematological, biochemistry and urine analysis results. Hormonal results showed no deviations except for increased level of total testosterone (0.81 ng/ml) and prolactin (47.16 ng/ml). DHEA-S, LH, FSH, TSH, TAT, T3 and T4 were all in normal ranges. There were no abnormalities detected in the insulin resistance. Microbiological examination showed a sterile culture. Polycystic ovary syndrome was also ruled out after consultation with a gynaecologist.

Based on the above examination, the patient was diagnosed with moderate adult acne. The patient was treated with clindamycin phosphate 10 mg/g and tretinoin 0.25 mg/g gel once a day. At the end of 6 months, the patient showed slight improvement with a reduction in the number of eruptions on the face and back.

Conclusion

The present case is that of a 25-year-old woman with adult acne and increased levels of testosterone and prolactine. The case has highlighted the clinical presentation of adult onset acne and the specific treatment modalities that are beneficial in such cases including suppression of androgens, reduction of sebum production and use of oral contraceptive pills to reduce acne lesions.

Suggested Reading

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