Evaluating and treating the adult female patient with acne

Acne vulgaris is a common disease of the pilosebacous unit that affects an estimated 40-50 million Americans. Greater than 95% of teenage boys and between 83% and 85% of teenage girls suffer from acne. The condition frequently continues into adulthood. While boys more commonly suffer from acne in the teenage years, greater numbers of women suffer into adulthood. It is unclear if the number of post-adolescent women with acne is rising as compared to the past, or whether women are now seeking out treatment more than in the past. ⁴ Post-adolescent acne is a significant problem for women. One survey-based United States study found that approximately 50% of women continue to suffer from acne in their twenties, 35% in their thirties, 26% in their forties, and 15% in their fifties. The prevalence of acne was shown to be higher in women than in men in each of these age groups.⁷ A similar study from Europe showed that beyond the age of 23, acne is more prevalent in women than men. In their forties and fifties, 5% and 8% of women suffered from acne, respectively. Several other studies have provided similar data, showing that larger numbers of adult women suffer from acne as compared to age matched men. Acne is the number one reason that patients visit a dermatologist. While the mean age at which patients are seen for acne is 24 years old, 10% of visits occur in patients in their mid-thirties and forties. Approximately two thirds of dermatology visits for acne are made by women, and one-third of total acne office visits are made by women over 25 years old. Acne patients suffer from a significant psychological burden, which has been compared to that of patients with systemic diseases like diabetes, asthma, arthritis, or epilepsy. Up to 50% of adolescents with acne experience disturbances to their psyche, including issues with body image, anxiety, depression, poor self-esteem, social impairment, and thoughts of suicide. Moreover, acne treatment is expensive. The average total cost of care related to an acne patient's visit to the dermatologist is estimated to be $689.¹⁴