Chemical pharmacotherapy options for managing adult acne

ABSTRACT

Introduction: The incidence of adult acne is increasing worldwide. Despite clinical overlap with conventional acne, it has distinct features.

Areas covered: A literature search of English-language review articles, randomized control studies and retrospective studies conducted over the past 30 years was performed using PubMed and Google Scholar. Search terms included acne, adult, topical medication, oral medication and skin of color. We highlight important clinical features and treatment modalities pertinent to the evaluation and management of adult acne. Given the relative dearth of literature detailing treatment options specific to adult acne, we offer expert opinion regarding management of the condition especially in special populations such as skin of color and pregnancy.

Expert Opinion: It is unclear whether adult acne represents a distinct entity or a continuum of adolescent disease. Providers may opt to use topical medication as first-line, but should have a low threshold for switching to systemic therapy given the magnitude of psychosocial and emotional burden associated with the condition.

KEYWORDS:

• Acne vulgaris
• adult-onset
• late-onset
• treatment
• pharmacotherapy
• general dermatology

Article highlights

• Adult acne is a condition that carries significant psychological burden and negatively impacts quality of life.

• Treatment of this chronic, potentially disfiguring condition may improve quality of life and reduce the psychosocial burden of disease.

• Acne persisting from adolescence to adulthood is commonly characterized by inflammatory lesions and few comedones localized to the lower-third of the face, jawline and neck. Late onset acne is often characterized by inflammatory lesions and few comedones localized to the chin and perioral region. Though some patients may exemplify these precise clinical descriptions, many may have a mixed presentation.

• Patients should be routinely assessed for improvement, worsening or stagnancy. If no improvement is noted, treatment escalation should be considered to avoid sequelae of post-inflammatory hyperpigmentation or scarring.

• Providers may opt to use topical medication as first-line, but should have a low threshold for switching to systemic therapy given the magnitude of psychosocial and emotional burden potentially associated with adult acne.

This box summarizes key points contained in the article.

Declaration of interest

SR Feldman is a speaker for Janssen and Taro. He is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Leo Pharma Inc. SR Feldman has received grants from Galderma, Janssen, Abbott Labs, Amgen, Stiefel/GlaxoSmithKline, Celgene and Anacor. He is a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Kikaku, Lilly, Merck & Co Inc, Merz Pharmaceuticals, Mylan, Novartis Pharmaceuticals, Pfizer Inc, Qurient, Suncare Research and Xenoport. He is on an advisory board for Pfizer Inc. SR Feldman is the founder and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives Royalties from UpToDate and Xlibris. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper is not funded.