ACNE – NOT JUST A TEENAGE CONDITION
One of the most common dermatological conditions, acne can be a chronic condition with a tendency for frequent recurrences and relapses. It is an ailment of the pilosebaceous unit presenting with noninflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, nodules and cysts).
Although most common in teenagers (prevalence of 70 to 87%), acne can also affect both children and adults with some subtle differences in how it presents across the different age groups and genders.
In females – hormonal changes occur with the onset of the menstrual cycle, during times of stress and during menopause with initial changes starting in puberty. For that reason, these hormonal changes can lead to acne persisting from teenage years into adulthood.
For males, there is a surge in the release of testosterone from the beginning of puberty that peaks between the ages of 18 – 19, thereafter declining throughout adulthood. Testosterone leads to enlarged sebaceous glands, increased secretion of sebum and therefore an increased likelihood of blocked pores leading to acne formation.
Dr Mathobela, a leading specialist dermatologist and OXY’s resident skincare expert, shares some insight on the presentation of acne across the varying ages.
Although possible to occur from birth to six weeks, neonatal acne is most common around two weeks of age and is estimated to affect approximately 20% of newborns. However, it can be difficult to differentiate neonatal acne from other acneiform papulopustular eruptions that are common in this age group.
Characterized mainly by papules, pustules and rarely comedones on the face (predominantly cheeks, nose and forehead), it can also occur on the head, back, shoulders, chin and chest. It is more common in boys and usually resolves on its own without scarring.
This begins at approximately six weeks and may last for six to twelve months – or longer. Again, more common in boys, it however only affects about 2% of babies but is associated with increased incidence and severity of adolescent acne.
Infantile acne presents with papules, pustules and comedones and, at times, nodules and cysts that have a tendency to cause acne scarring. Its distribution is similar to that of neonatal acne.
Presenting between the ages of 1-7 years, acne is rare in this age group and therefore all children experiencing it must be investigated for endocrine abnormalities. Lesions occur mainly on the face and are primarily a result of comedones, papules and pustules.
Acne is common in this age group and may be the first sign of pubertal maturation. Lesions occur mainly on the forehead and central parts of the face or the t-zone although, at times, may be present on the ears. Inflammatory lesions are very rare in pre-adolescents.
This is the age group affected most by acne, with a slight predominance and a slightly higher severity in boys. Approximately 50% of affected teenagers will have acne persisting into adulthood.
In early teenage years, acne presents mainly as comedones with an increase in papules, pustules and cysts in the late teenage years. The face is mostly affected, with lesions also common on the chest and back.
Interestingly, unlike some of the other ages, adult acne is more common in females than males.
It occurs mainly as a persistent acne from teenage years, affecting approximately 80% of individuals. Some adults do experience acne for the first time in their adult years – known as late-onset acne. These adults must be carefully examined for any endocrine abnormalities.
There are two main forms of acne occurring in adults.
The first presents mainly as papules, pustules, microcysts and a few comedones on the lower part of the face (jawline, chin and around the mouth and upper neck). There is an increased risk of scarring and tendency for acne to worsen with menstrual cycles.
The second type is known as the ‘mixed type’. This presents as comedones, papules and pustules. It affects most of the face including forehead and cheeks with lesions also sometimes appearing on the chest and back.