Adult-onset acne: prevalence, impact, and management challenges

Marco A Rocha, Ediléia Bagatin, Marco A Rocha, Ediléia Bagatin

Abstract

Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestation; hirsutism and acanthosis nigricans are often present. The majority of the normoandrogenic acne patients present a history since adolescence, but in many cases the lesion distribution and intensity change with time. There is often a typical localization of the lesions in the lower third of the face and lateral region of the neck. Another interesting feature is related to the impact on quality of life (QoL), which is always intense. Often there are signs of depression, even when the lesions are mild. As most adult patients are women, in addition to the conventional options, there is also hormone treatment. Combined oral contraceptives and spironolactone are good options. Knowing more about the particularities in etiopathogenesis, impact on QoL, and specific treatment options is important to all dermatologists who face the challenge of treating acne in adults.

Keywords: acne; adult; female; hormonal.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Pilosebaceous unit synthesis of androgens directly from cholesterol or by the conversion of weak blood androgens into powerful androgens. Abbreviations: DHEA, dehydroepiandrosterone; DHT, dihydrotestosterone.

References

    1. Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(Suppl 1):3–12.
    1. Burton JL, Cunliffe WJ, Stafford L. The prevalence of acne vulgaris in adolescence. Br J Dermatol. 1971;85(2):119–126.
    1. White GM. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. J Am Acad Dermatol. 1998;39(2):S34–S37.
    1. Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999;41(4):577–580.
    1. Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58(1):56–59.
    1. Perkins AC, Maglione J, Hillebrand GG, Miyamoto K, Kimball AB. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt) 2012;21(2):223–230.
    1. Poli F, Dréno B, Verschoore M. An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol. 2001;15(6):541–545.
    1. Yentzer BA, Hick J, Reese EL, Uhas A, Feldman SR, Balkrishnan R. Acne vulgaris in the United States: a descriptive epidemiology. Cutis. 2010;86(2):94–99.
    1. Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. Br J Dermatol. 1997;136(1):66–70.
    1. Willians C, Layton AM. Persistent acne in women. Am J Clin Dermatol. 2006;7(5):281–290.
    1. Dumont-Wallon G, Dréno B. Acné de la femme de plus de 25 ans: spécifique par sa clinique et les facteurs favorisants [Specificity of acne in women older than 25 years] Presse Med. 2008;37(4):585–591. French.
    1. Preneau S, Dreno B. Female acne – a different subtype of teenager acne? J Eur Acad Dermatol Venereol. 2012;26(3):277–282.
    1. Ozdemir S, Ozdemir M, Görkemli H, Kiyici A, Bodur S. Specific dermatologic features of the polycystic ovary syndrome and its association with biochemical markers of the metabolic syndrome and hyperandrogenism. Acta Obstet Gynecol Scand. 2010;89(2):199–204.
    1. Choi CW, Lee DH, Kim HS, Kim BY, Park KC, Youn SW. The clinical features of late onset acne compared with early onset acne in women. J Eur Acad Dermatol Venereol. 2011;25(4):454–461.
    1. Cunliffe WJ. The sebaceous gland and acne – 40 years on. Dermatology. 1998;196(1):9–15.
    1. Gollnick HP. Current concepts of pathogenesis of acne – implications for drug treatment. Drugs. 2003;63(15):1579–1596.
    1. Thiboutot D. Acne: hormonal concepts and therapy. Clin Dermatol. 2004;22(5):419–428.
    1. Kurokawa I, Danby WJ, Ju Q, et al. New developments in our understanding of acne pathogenesis and treatment. Exp Dermatol. 2009;18(10):821–832.
    1. Kim J, Ochoa MT, Krutzic SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine response. J Immunol. 2002;169(3):1535–1541.
    1. Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003;12(1):20–27.
    1. McInturff JE, Modlin RL, Kim J. The role of toll-like receptors in the pathogenesis and treatment of dermatological disease. J Invest Dermatol. 2005;125(1):1–8.
    1. Holland DB, Jeremy AH. The role of inflammation in the pathogenesis of acne and acne scarring. Semin Cutan Med Surg. 2005;24(2):79–83.
    1. Krishna S, Kim C, Kim J. Innate immunity in the pathogenesis of acne vulgaris. In: Shalita AR, Del Rosso JQ, Webster GF, editors. Acne Vulgaris. 1st ed. London: Informa Healthcare; 2011. pp. 12–27.
    1. Bellew S, Thiboutot D, Del Rosso JQ. Pathogenesis of acne vulgaris: what’s new, what’s interesting and what may be clinically relevant. J Drugs Dermatol. 2011;10(6):582–585.
    1. Heughebaert C, Shalita AR. Comedogenesis. In: Shalita AR, Del Rosso JQ, Webster GF, editors. Acne Vulgaris. 1st ed. London: Informa Healthcare; 2011. pp. 28–42.
    1. Taylor M, Gonzalez M, Porter R. Pathways to inflammation: acne pathophysiology. Eur J Dermatol. 2011;21(3):323–333.
    1. Norris JF, Cunliff WJ. A histological and immunohistochemical study of early acne lesions. Br J Dermatol. 1988;118(5):651–659.
    1. Layton AM, Morris C, Cunliff WJ, Ingham E. Immunohistochemical investigation of evolving inflammation in lesions of acne vulgaris. Exp Dermatol. 1998;7(4):191–197.
    1. Kadowaki N, Ho S, Antonenko S, et al. Subsets of human dendritic cell precursors express different toll-like receptors and respond to different microbial antigens. J Exp Med. 2001;194(6):863–869.
    1. Jugeau S, Tenaud I, Knol AC, et al. Induction of toll-like receptor by Propionibacterium acnes. Br J Dermatol. 2005;153(6):1105–1113.
    1. Kim J. Review of the innate response in acne vulgaris: activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. Dermatology. 2005;211(3):193–198.
    1. Marco Rocha AD, Lilia Guadanhim RS, Sanudo A, Bagatin E. Modulation of Toll like receptor-2 on sebaceous gland by the treatment of adult female acne. Dermatoendocrinol. 2017 Oct 4; Epub.
    1. Lee SE, Jeong SK, Lee SH. Protease and protease-activated receptor-2 signaling in the pathogenesis of atopic dermatitis. Yonsei Med J. 2010;51(6):808–822.
    1. Tenaud I, Khammari A, Dréno B. In vitro modulation of TLR-2, CD1d and IL-10 by adapalene on normal human skin and acne inflammatory lesions. Exp Dermatol. 2007;16(6):500–506.
    1. Leyden JJ, McGinley KJ, Mills OH, Kligman AM. Propionibacterium levels in patients with and without acne vulgaris. J Invest Dermatol. 1975;65(4):382–384.
    1. Leeming JP, Holland KT, Cunliff WJ. The microbial colonization of inflamed acne vulgaris lesions. Br J Dermatol. 1988;118(2):203–208.
    1. Youn SW, Park ES, Lee DH, Huh CH, Park KC. Does facial sebum excretion really affect the development of acne? Br J Dermatol. 2005;153(5):919–924.
    1. Carmina E, Godwin AJ, Stanczyc FZ, Lippman JS, Lobo RA. The association of serum androsterone glucuronide with inflammatory lesions in women with adult acne. J Endocrinol Invest. 2002;25(9):765–768.
    1. Seirafi H, Farnaghi F, Vasheghani-Farahani A, et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007;46(11):1188–1191.
    1. Aizawa H, Niimura M. Elevated serum insulin-like growth factor-1 (IGF-1) levels in women with postadolescent acne. J Dermatol. 1995;22(4):249–252.
    1. Thiboutot D, Gilliland K, Light J, Lookingbill D. Androgen metabolism in sebaceous glands from subjects with and without acne. Arch Dermatol. 1999;135(9):1041–1045.
    1. Summerly R, Yardley HJ, Raymond M, Tabiowo A, Ilderton E. The lipid composition of sebaceous glands as a reflection of gland size. Br J Dermatol. 1976;94(1):45–53.
    1. Pye RJ, Meyrick G, Burton JL. Free fatty acids in the early inflammatory papule of acne vulgaris. Clin Exp Dermatol. 1977;2(4):355–359.
    1. Rosenfield RL, Deplewski D, Kentsis A, Ciletti N. Mechanisms of androgen induction of sebocyte differentiation. Dermatology. 1998;196(1):43–46.
    1. Rosenfield RL, Kentsis A, Deplewski D, Ciletti N. Rat preputial sebocyte differentiation involves peroxisome proliferator-activated receptors. J Invest Dermatol. 1999;112(2):226–232.
    1. Rosenf ield RL, Deplewski D, Greene ME. Peroxisome proliferator- activated receptors and skin development. Horm Res. 2000;54(5–6):269–274.
    1. Zouboulis CC, Xia L, Akamatsu H, et al. The human sebocyte culture model provides new insights into development and management of seborrhoea and acne. Dermatology. 1998;196(1):21–31.
    1. Ingham E, Eady EA, Goodwin CE, Cove JH, Cunliffe WJ. Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris. J Invest Dermatol. 1992;98(6):895–901.
    1. Thiboutot DM, Layton AM, Eady EA. IL-17: a key player in the P. acnes inflammatory cascade? J Invest Dermatol. 2014;134(2):307–310.
    1. Cappel M, Mauger D, Thiboutot D. Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women. Arch Dermatol. 2005;141(3):333–338.
    1. Ludwig DS. The glycemic index: physiological mechanism relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002;287(18):2414–2423.
    1. Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52(2):207–214.
    1. Adebamowo CA, Spiegelman D, Berekey CS, et al. Milk consumption and acne in adolescents girls. Dermatol Online J. 2006;12(4):1.
    1. Kane A, Niang SO, Diagne AC, Ly F, Ndiaye B. Epidemiologic, clinical and therapeutic features of acne in Dakar, Senegal. Int J Dermatol. 2007;46(Suppl 1):36–38.
    1. Dall’oglio F, Tedeschi A, Fabbrocini G, Veraldi S, Picardo M, Micali G. Cosmetics for acne: indications and recommendations for an evidence-based approach. G Ital Dermatol Venereol. 2015;150(1):1–11.
    1. Rivera R, Guerra A. Management of acne in women over 25 years of age. Actas Dermosifiliogr. 2009;100(1):33–37.
    1. Capitanio B, Sinagra JL, Ottaviani M, Bordignon V, Amantea A, Picardo M. Acne and smoking. Dermatoendocrinol. 2009;1(3):129–135.
    1. Lucky AW, McGuire J, Rossenfield RL, Lucky PA. Plasma androgens in women with acne vulgaris. J Invest Dermatol. 1983;81(1):70–74.
    1. Lookingbill DP, Horton R, Demers RM. Tissue production of androgens in women with acne. J Am Acad Dermatol. 1985;12(3):481–487.
    1. Derman RJ. Androgen excess in women. Int J Fertil Menopausal Stud. 1996;41(2):172–176.
    1. Yarak S, Bagatin E, Hassun KM, Parada MO, Talarico Filho S. Hiperandrogenismo e pele: síndrome do ovário policístico e resistência periférica à insulina. An Bras Dermatol. 2005;80(4):395–410. Portuguese.
    1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.
    1. Archer JS, Chang RJ. Hirsutism and acne in polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18(5):737–754.
    1. Carmina E, Lobo RA. Evidence for increased androsterone metabolism in some normoandrogenic women with acne. J Clin Endocrinol Metab. 1993;76(5):1111–1114.
    1. Slayden SM, Moran C, Sams WM, Jr, Boots LR, Azziz R. Hyperandrogenemia in patients presenting with acne. Fertil Steril. 2001;75(5):889–892.
    1. Baxendale PM, Jacobs HS, James VH. Plasma and salivary androstenedione and dihydrotestosterone in women with hyperandrogenism. Clin Endocrinol. 1983;18(5):447–457.
    1. Wang C, Wakelin K, White J, Wood PJ. Salivary androgens in hirsutism: are they of use in routine evaluation? Ann Clin Biochem. 1986;23(Pt 5):590–595.
    1. Menon GK, Feingold KR, Moser AH, Brown BE, Elias PM. De novo sterologenesis in the skin. II. Regulation by cutaneous barrier requirements. J Lipid Res. 1985;26(4):418–427.
    1. Smythe CD, Greenall M, Kealey T. The activity of HMG-CoA reductase and acetyl-CoA carboxylase in human apocrine sweat glands, sebaceous glands, and hair follicles is regulated by phosphorylation and by exogenous cholesterol. J Invest Dermatol. 1998;111(1):139–148.
    1. Chen W, Thiboutot D, Zouboulis CC. Cutaneous androgen metabolism: basic research and clinical perspectives. J Invest Dermatol. 2002;119(5):992–1007.
    1. Fritsch M, Orfanos CE, Zouboulis CC. Sebocytes are the key regulators of androgen homeostasis in human skin. J Invest Dermatol. 2001;116(5):793–800.
    1. Harris G, Azzolina B, Baginsky W, et al. Identification and selective inhibition of an isozyme of steroid 5 alpha-reductase in human scalp. Proc Natl Acad Sci U S A. 1992;89(22):10787–10791.
    1. Thiboutot D, Harris G, Iles V, Cimis G, Gilliland K, Hagari S. Activity of the type 1 5 alpha-reductase exhibits regional differences in isolated sebaceous glands and whole skin. J Invest Dermatol. 1995;105(2):209–214.
    1. Zouboulis CC. Human skin: an independent peripheral endocrine organ. Horm Res. 2000;54(5–6):230–242.
    1. Azzouni F, Godoy A, Li Y, Mohler J. The 5 alpha-reductase isozyme family: a review of basic biology and their role in human diseases. Adv Urol. 2012;2012:530121.
    1. Carmina E, Stanczyc FZ, Matteri RK, Lobo RA. Serum androsterone conjugates differentiate between acne and hirsutism in hyperandrogenic women. Fertil Steril. 1991;55(5):872–876.
    1. Poortman J, Thijssen JH, Von Landeghem AA, Wiegerinck MA, Alsbach GP. Subcellular distribution of androgens and oestrogens in target tissue. J Steroid Biochem. 1983;19(1C):939–945.
    1. Labrie F, Dupont A, Belanger A. Complete androgen blockade for the treatment of prostate cancer. Important Adv Oncol. 1985:193–217.
    1. Bélanger B, Bélanger A, Labrie F, Dupont A, Cusan L, Monfette G. Comparison of residual C-19 steroids in plasma and prostatic tissue of human, rat and guinea pig after castration: unique importance of extra-testicular androgens in men. J Steroid Biochem. 1989;32(5):695–698.
    1. Coffman BL, Tephly TR, Irshaid YM, et al. Characterization and primary sequence of a human hepatic microsomal estriol UDP glucuronosyltransferase. Arch Biochem Biophys. 1990;281(1):170–175.
    1. Beaulieu M, Lévesque E, Hum DW, Bélanger A. Isolation and characterization of a novel cDNA encoding a human UDP-glucuronosyltransferase active on C19 steroids. J Biol Chem. 1996;271(37):22855–22862.
    1. Beaulieu M, Lévesque E, Barbier O, et al. Isolation and characterization of a simian UDP-glucuronosyltransferase UGT2B18 active on 3-hydroxyandrogens. J Mol Biol. 1998;275(5):785–794.
    1. Carrier JS, Turgeon D, Journault K, Hum DW, Bélanger A. Isolation and characterization of the human UGT2B7 gene. Biochem Biophys Res Commun. 2000;272(2):616–621.
    1. Turgeon D, Carrier JS, Lévesque E, Beatty BG, Bélanger A, Hum DW. Isolation and characterization of the human UGT2B15 gene, localized within a cluster of UGT2B genes and pseudogenes on chromosome 4. J Mol Biol. 2000;295(3):489–504.
    1. Labrie F, Luu-The V, Bélanger A, et al. Is dehydroepiandrosterone a hormone? J Endocrinol. 2005;187(2):169–196.
    1. Rocha M, Karina Cardozo HM, Carvalho VM, Bagatin E. ADT-G as a promising biomarker for peripheral hyperandrogenism in adult female acne. Dermatoendocrinol. 2017 Oct 13; Epub.
    1. Toscano V, Balducci R, Bianchi P, et al. Two different pathogenetic mechanisms may play a role in acne and in hirsutism. Clin Endocrinol (Oxf) 1993;39(5):551–556.
    1. Joura EA, Geusau A, Schneider B, Söregi G, Huber JC. Serum 3 alpha-androstanediol-glucuronide is decreased in nonhirsute women with acne vulgaris. Fertil Steril. 1996;66(6):1033–1035.
    1. Labrie F, Bélanger A, Bélanger P, et al. Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. J Steroid Biochem Mol Biol. 2006;99(4–5):182–188.
    1. Knaggs HE, Wood EJ, Rizer RL, Mills OH. Post-adolescent acne. Int J Cosmet Sci. 2004;26(3):129–138.
    1. Marks R. Acne and its management beyond the age of 35 years. Am J Clin Dermatol. 2004;5(6):459–462.
    1. Schmitt JV, Masuda PY, Miot HA. Padrões clínicos da acne em mulheres de diferentes faixas etaŕias. An Bras Dermatol. 2009;84(4):349–354. Portuguese.
    1. Addor FA, Schalka S. Acne da mulher adulta: aspectos epidemiológicos, diagnósticos e terapeûticos. An Bras Dermatol. 2010;85(6):789–795. Portuguese.
    1. Dréno B, Layton A, Zouboulis CC, et al. Adult female acne: a new paradigm. J Eur Acad Dermatol Venereol. 2013;27(9):1063–1070.
    1. Capitanio B, Sinagra JL, Bordignon V, Cordiali Fei P, Picardo M, Zouboulis CC. Underestimated clinical features of postadolescent acne. J Am Acad Dermatol. 2010;63(5):782–788.
    1. Dréno B, Thiboutot D, Layton AM, Berson D, Perez M, Kang S, Global Alliance to Improve Outcomes in Acne Large-scale international study enhances understanding of an emerging acne population: adult females. J Eur Acad Dermatol Venereol. 2015;29(6):1096–1106.
    1. Yazici K, Baz K, Yazici AE, et al. Disease-specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol. 2004;18(4):435–439.
    1. Gollnick HP, Cunliffe W, Berson D, et al. Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003;49(Suppl 1):S1–S38.
    1. Berlim MT, Fleck MPA. “Quality of life”: a brand new concept for research and practice in psychiatry. Rev Bras Psiquiatr. 2003;25(4):249–252.
    1. Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. 1999;140(2):273–282.
    1. Rapp DA, Brenes GA, Feldman SR, et al. Anger and acne: implications for quality of life, patient satisfaction and clinical care. Br J Dermatol. 2004;151(1):183–189.
    1. Dalgard F, Gieler U, Holm J, Bjertness E, Hauser S. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey. J Am Acad Dermatol. 2008;59(5):746–751.
    1. Kamamoto CSL, Hassun KM, Bagatin E, Tomimori J. Questionaŕio de qualidade de vida específico para acne (Acne-QoL): tradução, adaptação cultural e validação para lińgua portuguesa usada no Brasil. An Bras Dermatol. 2014;89(1):83–90. Portuguese.
    1. Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care. 1989;27(Suppl 3):S217–S232.
    1. Klassen AF, Newton JN, Mallon E. Measuring quality of life in people referred for specialist care of acne: comparing generic and disease-specific measures. J Am Acad Dermatol. 2000;43(2):229–233.
    1. Martin AR, Lookingbill DP, Batek A, Light J, Thiboutot D, Girman CJ. Health-related quality of life among patients with facial acne – assessment of a new acne-specific questionnaire. Clin Exp Dermatol. 2001;26(5):380–385.
    1. Rocha M, Sanudo A, Bagatin E. The effect on acne quality of life of topical azelaic acid 15% gel versus a combined oral contraceptive in adult female acne: a randomized trial. Dermatoendocrinol. 2017 Oct 13; Epub.
    1. Savage LJ, Layton AM. Treating acne vulgaris: systemic, local and combination therapy. Expert Rev Clin Pharmacol. 2010;3(4):563–580.
    1. Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol. 2001;137(9):1252–1253.
    1. Cunliffe WJ, Caputo R. Roaccutane treatment guidelines: results of an international survey. Dermatology. 1997;194(4):351–357.
    1. Seukeran DC, Cunliffe WJ. Acne vulgaris in the elderly: the response to low dose isotretinoin. Br J Dermatol. 1998;139(1):99–101.
    1. Rademaker M, Wishart JM, Birchall NM. Isotretinoin 5 mg daily for low-grade adult acne vulgaris – a placebo-controlled, randomized double-blind study. J Eur Acad Dermatol Venereol. 2014;28(6):747–754.
    1. Rademaker M, Wishart J, Birchall N. Long term remission of persistent adult acne following very low-dose (5 mg/day) isotretinoin. Australas J Dermatol. 2017;58(1):69.
    1. George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan Med Surg. 2008;27(3):992–1007.
    1. Redmond GP, Olson WH, Lippman JS, Kafrissen ME, Jones TM, Jorizzo JL. Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: a randomized, placebo-controlled trial. Obstet Gynecol. 1997;89(4):615–622.
    1. Van Vloten WA, Van Haselen CW, Van Zuuren EJ, Gerlinger C, Heithecker R. The effect of 2 combined oral contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea. Cutis. 2002;69(4):2–15.
    1. Maloney JM, Dietze P, Jr, Watson D, et al. Treatment of acne using a 3-milligram drospirenone/20-microgram ethinyl estradiol oral contraceptive administered in a 24/4 regimen: a randomized controlled trial. Obstet Gynecol. 2008;112(4):773–781.
    1. Zouboulis CC. Sebaceous gland receptors. Dermatoendocrinol. 2009;1(2):77–80.
    1. Speroff L, DeCherney A. Evaluation of a new generation of oral contraceptives. The advisory board for new progestins. Obstet Gynecol. 1993;81(6):1034–1047.
    1. Thorneycroft IH. Evolution of progestins. Focus on the novel progestin drospirenone. J Reprod Med. 2002;47(11):975–980.
    1. Greenwood R, Brummitt L, Burke B, Cunliffe WJ. Acne: double blind clinical and laboratory trial on tetracycline, oestrogen-cyproterone acetate, and combined treatment. Br Med J. 1985;291(6504):1231–1235.
    1. Lemay A, Dewailly SD, Grenier R, Huard J. Attenuation of mild hyperandrogenic activity in postpubertal acne by a triphasic oral contraceptive containing low doses of ethynyl estradiol and d,l-norgestrel. J Clin Endocrinol Metab. 1990;71(1):8–14.
    1. Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012;7:CD004425.
    1. Klipping C, Marr J. Effects of two combined oral contraceptives containing ethinyl estradiol 20 microg combined with either drospirenone or desogestrel on lipids, hemostatic parameters and carbohydrate metabolism. Contraception. 2005;71(6):409–416.
    1. Tyler KH, Zirwas MJ. Contraception and the dermatologist. J Am Acad Dermatol. 2013;68(6):1022–1029.
    1. Raymond EG, Burke AE, Espey E. Combined hormonal contraceptives and venous thromboembolism: putting the risks into perspective. Obstet Gynecol. 2012;119(5):1039–1044.
    1. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ., 3rd Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143(10):697–706.
    1. Rathnayake D, Sinclair R. Use of spironolactone in dermatology. Skinmed. 2010;8(6):328–332.
    1. Goodfellow A, Alaghband-Zadeh J, Carter G, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111(2):209–214.
    1. Kim GK, Del Rosso JQ. Oral spironolactone in post-teenage female patients with acne vulgaris: practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012;5(3):37–50.
    1. Sato K, Matsumoto D, Iizuka F, et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesthetic Plast Surg. 2006;30(6):689–694.
    1. Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000;43(3):498–502.
    1. Plovanich M, Weng QY, Mostaghimi A. Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne. JAMA Dermatol. 2015;151(9):941–944.
    1. Shaw JC, White LE. Long-term safety of spironolactone in acne: results of an 8-year follow-up study. J Cutan Med Surg. 2002;6(6):541–545.
    1. Friedman AJ. Spironolactone for adult female acne. Cutis. 2015;96(4):216–217.
    1. Krunic A, Ciurea A, Scheman A. Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone. J Am Acad Dermatol. 2008;58(1):60–62.
    1. Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral spironolactone for acne vulgaris in adult females: a hybrid systematic review. Am J Clin Dermatol. 2017;18(2):169–191.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit