Abstract

Acne vulgaris (AV) is a common condition with a lifetime prevalence of approximately 85% and occurs mostly during adolescence. AV can persist into adulthood, with a 50.9% prevalence rate of acne in women aged 20-29 years,and 26.3% in women aged 40-49 years. Nearly one-third of all dermatology office visits for acne are by women older than 25 years.

Here we are discussing a case of a 26-year-old woman, presented with persistent nodular skin papulesof the facial skin.The patient was diagnosed with AV.

Introduction

Acne vulgaris usually cause residual scarring and thus, significant morbidity due to psychological impacts such as poor self-image, depression and anxiety. Especially in women, scarring due to AV may result in depression and reduced quality of life. 

Acne vulgaris (AV) is characterized by non-inflammatory lesions with open and closed comedones; inflammatory lesions or inflammatory nodules, pustules or papules. It is common among adolescents and can be persistent in some. 

Factors contributing to acne occurrence include – genetics; family history; diet; and environmental factors – like occupational exposure, smoking and occlusive cosmetics. The pathogenesis underlying the formation of acne lesions involve – alteration of follicular keratinization that leads tocomedones; increased and altered sebum production under the influence of androgen; follicular colonization by Propionibacterium acnes; and complex inflammatory mechanisms that involve both innate and acquired immunity. In adult females, androgens play a major role of the pathogenesis of acne, for instance in cases with hyperandrogenism disorders –such as polycystic ovary syndrome (PCOS). Androgens stimulate sebum production via androgen receptors on the sebaceous glands and changes in these hormonal levels during premenarche or in PCOS may trigger acne.¹

Case report

A 26-year-old lady complained of persistent nodular skin papules on her face. 

On examination, multiple comedones were observed. Lesions resembles that of AV.

The patient wasprescribed 1% tretinoin gel for use after sunset.She was also advised to use a sunscreen, during the day, to prevent photodamage.

This therapy aided in achieving mean percent reduction in inflammatory and noninflammatory lesion counts. It also improved the severity of the lesions and quality of life of the patient. 

No adverse effect was reported apart from mild skin dryness at the site of application. Overall, the treatment was well-tolerated and rendered satisfactory results, as well as prevented acne recurrence. 

Conclusion

Topical therapy is recommended for treating mild, moderate and severe acne in women of reproductive potential. Systemic agents may lead to side-effects and are used as a last resort, in recalcitrant AV. Topical retinoids have been widely used for the treatment of AV and has shown good results with respect to attenuating symptoms and improving the scar and severity of acne.

This case study relates a successful treatment of persistent acne vulgaris in a 26-year-old woman with 1% tretinoin gel. The report demonstrates that the use oftretinoin gel at nighttime, along with daytime sunscreen application for 12-weeks can ameliorate symptoms of AV and improve the severity of the lesions, and may also prevent recurrence.

Source

1. Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol. 2017;4(2):56-71. Published 2017 Dec 23. doi:10.1016/j.ijwd.2017.10.006
2. Massa AF, Burmeister L, Bass D, Zouboulis CC. Acne Fulminans: Treatment Experience from 26 Patients. Dermatology. 2017;233(2-3):136-140. doi:10.1159/000473860
3. Harper JC, Baldwin H, Stein Gold L, Guenin E. Efficacy and Tolerability of a Novel Tretinoin 0.05% Lotion for the Once-Daily Treatment of Moderate or Severe Acne Vulgaris in Adult Females. J Drugs Dermatol. 2019;18(11):1147-1154.