Cosmetic Dermatology and Hair Care

Acne is one of most common skin diseases in the general population especially among adolescents. However, the number of patients aged over 25 years referred to dermatology department complaining of acne are increasing. The complaint is more common in females. Based on the time of onset; two subtypes of acne have been recognized in females; “persistent acne” as a continuation of adolescent acne and the late onset acne is first present in adulthood. Different names have been given to the adulthood acne; late onset acne, hormonal acne and acne tarda. The causes of adulthood acne remain to be fully elucidated, and hormones, colonization by resistant bacteria, the use of cosmetics, drugs and chronic stress have been put forward as possible etiological factors. Since adult acne is more common in women, there has always been an emphasis on underlying hormonal imbalance. End-organ hypersensitivity and not androgen levels may be the central factor in development of adult acne in women. Increased sensitivity of the sebaceous gland to androgens or increased local metabolism of androgen hormones in the skin to potent androgen metabolites may offer alternative mechanisms for the pathogenesis of this disorder. Hormonal agents are one of the standard systemic medications in addition to antibiotics and isotretinoin. Appropriate patient selection is the key to start hormonal agents as treatment for acne.