Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life

• Published in: Disease-a-month Vol. 67; no. 4; p. 101103
• Main Authors: Greydanus, Donald E., Azmeh, Roua, Cabral, Maria Demma, Dickson, Cheryl A., Patel, Dilip R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021
• Subjects: Acne; Acne conglobata; Acne excoriée; Acne fulminans; Acne neonatorum; Acne rosacea; Acne vulgaris; Acne Vulgaris - drug therapy; Acne Vulgaris - microbiology; Acne Vulgaris - pathology; Acne Vulgaris - psychology; Acneiform disorders; Acquired Hyperostosis Syndrome - epidemiology; Administration, Oral; Administration, Topical; Adolescent; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Awareness; Benzoyl Peroxide - administration & dosage; Benzoyl Peroxide - adverse effects; Benzoyl Peroxide - therapeutic use; Child; Contraceptives, Oral - therapeutic use; Dermatologic Agents - administration & dosage; Dermatologic Agents - adverse effects; Dermatologic Agents - therapeutic use; Diagnosis, Differential; Emotional sequelae; Female; Hidradenitis suppurativa; Hidradenitis Suppurativa - epidemiology; Humans; Isotretinoin; Isotretinoin - administration & dosage; Isotretinoin - adverse effects; Isotretinoin - therapeutic use; Male; Propionibacteriaceae - isolation & purification; Psychological Distress; SAPHO syndrome; Topical retinoids; Topical retinoids; Acne neonatorum; Acne conglobata; Acne; Acne fulminans; Acne vulgaris; Hidradenitis suppurativa; Emotional sequelae; Antibiotics; SAPHO syndrome; Acneiform disorders; Antibiotic resistance; Isotretinoin; Acne excoriée; Acne rosacea
• ISSN: 0011-5029; 1557-8194
• DOI: 10.1016/j.disamonth.2020.101103

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered.
Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular.
Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.