Unveiling the Nuances of Adult Female Acne: A Comprehensive Exploration of Epidemiology, Treatment Modalities, Dermocosmetics, and the Menopausal Influence

Figures & data

Figure 1 Clinical case of acne in an adult woman - 37-year-old normoandrogenic patient with moderate acne on the face and neck associated with dyschromia.

Figure 2 Clinical case of acne menopausal adult woman - 54-year-old normoandrogenic patient with moderate to severe acne on the face and neck associated with dyschromia.

Table 1 Characteristics of Adult Female Acne (≥25 Years Old)

	Before Menopause	After Menopause
Prevalence	20–40%	15.3% (in their 50’s or older)
Hormonal changes	Most patients do not exhibit detectable hormonal changes in laboratory assessments	Menopause is associated with a decline in estrogen levels and an imbalance with androgens
Collagen loss	Around 20% (on average up to 45 years old)	More than 50% (over 50 years) (Menopause is associated with a decline in collagen production, contributing to skin thinning and making it more prone to scarring from acne lesions)
Hirsutism	Rare	Not rare (related to postmenopausal hyperandrogenism – decreased SHBG)
Typical location	Cheeks, around the mouth, lower chin (U-zone)	Cheeks, around the mouth, lower chin (U-zone)
Morphological characteristics	Two clinical profiles: Hyperseborrhea, non-inflammatory lesions Superficial inflammatory lesions, deep seated nodules and cysts	Deep-seated inflammatory papules or nodules with a predominant perioral distribution Multiple closed comedones visible on stretching the skin, with enlarged pores in nasal and malar areas
Severity	Mild-to-moderate	Mild-to-moderate
Duration	Chronic duration	Chronic duration
Skin type	Normal to oily skin	Normal to dry skin
Skin sensitivity	Affected by skin aging process	Affected by skin aging process
Impact on quality of life	Greater impact than on younger people; affects self-esteem and body satisfaction	Greater impact than on younger people; affects self-esteem and body satisfaction
Skin care	Must always be associated	Must always be associated
Topical therapy	Intended for the treatment of acne and its consequences	Intended for the treatment of acne and its consequences but also to improve concomitant signs of photoaging that are common in this group
Oral therapy	Combined oral contraceptives are an option	Combined oral contraceptives are not an option

Note: Adapted according to Khunger and Mehrotra²⁶ and Layton AM, Dias da Rocha MA.⁹⁸

Khunger N, Mehrotra K. Menopausal acne - challenges and solutions. Int J Women’s Health. 2019;11:555–567. doi:10.2147/IJWH.S174292

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Layton AM, Dias da Rocha MA. Real-world case studies showing the effective use of azelaic acid in the treatment, and during the maintenance phase, of adult female acne patients. Clin Cosmet Invest Dermatol. 2023;16:515–527. doi:10.2147/CCID.S396023

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