Acne Vulgaris

  • Gila Isman Nelkenbaum


Acne is a skin disorder of the pilosebaceous unit influenced by androgenic hormones and therefore there are many variances in its appearance between genders. Different forms of acne during infancy, adolescence, adult life, pregnancy and due to hormonal disturbances will be discussed with emphasis on diversity between genders and the derived possible treatments.


Acne vulgaris Adult onset acne PCOS Acne fulminans Acne conglobata Acne inversa 


  1. 1.
    Bolognia JL, Jorizzo JJ, Schaffer JV, Callen JP, Cerroni L, Heymann WR, et al. Dermatology. 3rd ed. London: Elsevier; 2012.Google Scholar
  2. 2.
    McCarty M. Evaluation and management of refractory acne vulgaris in adolescent and adult men. Dermatol Clin. 2016;34(2):203–6.CrossRefGoogle Scholar
  3. 3.
    Lucky AW, et al. Acne vulgaris in premenarchal girls: an early sign of puberty associated with rising levels of dehydroepiandrosterone. Arch Dermatol. 1994;130(3):308–14.CrossRefGoogle Scholar
  4. 4.
    Strauss JS, Pochi PE. Effect of cyclic progestin-estrogen therapy on sebum and acne in women. JAMA. 1964;190(9):815–9.CrossRefGoogle Scholar
  5. 5.
    Fabbrocini G, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080.CrossRefGoogle Scholar
  6. 6.
    Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol. 1994;19(4):303–8.CrossRefGoogle Scholar
  7. 7.
    Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. 1999;140:273–82.CrossRefGoogle Scholar
  8. 8.
    Del Rosso JQ, Levin J. The clinical relevance of maintaining the functional integrity of the stratum corneum in both healthy and disease-affected skin. J Clin Aesthet Dermatol. 2011;4(9):22.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287(2):214–8.CrossRefGoogle Scholar
  10. 10.
    Luebberding S, Krueger N, Kerscher M. Skin physiology in men and women: in vivo evaluation of 300 people including TEWL, SC hydration, sebum content and skin surface pH. Int J Cosmet Sci. 2013;35(5):477–83.CrossRefGoogle Scholar
  11. 11.
    Youn SH, et al. The skin surface pH and its different influence on the development of acne lesion according to gender and age. Skin Res Technol. 2013;19(2):131–6.CrossRefGoogle Scholar
  12. 12.
    Silverberg NB. Whey protein precipitating moderate to severe acne flares in 5 teenaged athletes. Cutis. 2012;90(2):70–2.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Kraus SL, et al. The dark side of beauty: acne fulminans induced by anabolic steroids in a male bodybuilder. Arch Dermatol. 2012;148(10):1210–2.CrossRefGoogle Scholar
  14. 14.
    Karvonen S-L. Acne fulminans: report of clinical findings and treatment of twenty-four patients. J Am Acad Dermatol. 1993;28(4):572–9.CrossRefGoogle Scholar
  15. 15.
    Fyrand O, Fiskaadal HJ, Trygstad O. Acne in pubertal boys undergoing treatment with androgens. Acta Derm Venereol. 1991;72(2):148–9.Google Scholar
  16. 16.
    Traupe H, et al. Acne of the fulminans type following testosterone therapy in three excessively tall boys. Arch Dermatol. 1988;124(3):414–7.CrossRefGoogle Scholar
  17. 17.
    Heydenreich G. Testosterone and anabolic steroids and acne fulminans. Arch Dermatol. 1989;125(4):571–2.CrossRefGoogle Scholar
  18. 18.
    Hartmann RR, Plewing G. Acne fulminans: tratamento de 11 pacientes com o acido 13-cis-retinoico. An Bras Dermatol. 1983;58(1):3–10.Google Scholar
  19. 19.
    Chew EW, Bingham A, Burrows D. Incidence of acne vulgaris in patients with infantile acne. Clin Exp Dermatol. 1990;15(5):376–7.CrossRefGoogle Scholar
  20. 20.
    Bolognia L. Dermatology. 3rd ed. London: Elsevier; 2012. p. 545–55.Google Scholar
  21. 21.
    Elling SV, Powell FC. Physiological changes in the skin during pregnancy. Clin Dermatol. 1997;15(1):35–43.CrossRefGoogle Scholar
  22. 22.
    Tagawa N, et al. Serum concentrations of dehydroepiandrosterone and dehydroepiandrosterone sulfate and their relation to cytokine production during and after normal pregnancy. Clin Chim Acta. 2004;340(1):187–93.CrossRefGoogle Scholar
  23. 23.
    Mesiano S. Roles of estrogen and progesterone in human parturition. Front Horm Res. 2001;27:86–104.CrossRefGoogle Scholar
  24. 24.
    Yang C-C, et al. Inflammatory facial acne during uncomplicated pregnancy and post-partum in adult women: a preliminary hospital-based prospective observational study of 35 cases from Taiwan. J Eur Acad Dermatol Venereol. 2016;30(10):1787–9.CrossRefGoogle Scholar
  25. 25.
    Wong RC, Ellis CN. Physiologic skin changes in pregnancy. J Am Acad Dermatol. 1984;10(6):929–40.CrossRefGoogle Scholar
  26. 26.
    Meredith FM, Ormerod AD. The management of acne vulgaris in pregnancy. Am J Clin Dermatol. 2013;14(5):351–8.CrossRefGoogle Scholar
  27. 27.
    Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779–87.CrossRefGoogle Scholar
  28. 28.
    Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: part II. Lactation. J Am Acad Dermatol. 2014;70(3):417–e1.CrossRefGoogle Scholar
  29. 29.
    Hale TW, Hartmann PE. Hale & Hartmann’s textbook of human lactation. 1st ed. Amarillo: Hale; 2007.Google Scholar
  30. 30.
    Tankeyoon M, et al. Effects of hormonal contraceptives on milk volume and infant growth: WHO special programme of research and development and research training in human reproduction. Contraception. 1984;30(6):505–22.CrossRefGoogle Scholar
  31. 31.
    Williams C, Layton AM. Persistent acne in women. Am J Clin Dermatol. 2006;7(5):281–90.CrossRefGoogle Scholar
  32. 32.
    Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999;41(4):577–80.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Preneau S, Dreno B. Female acne–a different subtype of teenager acne? J Eur Acad Dermatol Venereol. 2012;26(3):277–82.CrossRefGoogle Scholar
  34. 34.
    Kaur S, et al. Etiopathogenesis and therapeutic approach to adult onset acne. Indian J Dermatol. 2016;61(4):403–7.CrossRefGoogle Scholar
  35. 35.
    Seirafi H, et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007;46(11):1188–91.CrossRefGoogle Scholar
  36. 36.
    Goodman NF, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1. Endocr Pract. 2015;21(11):1291–300.CrossRefGoogle Scholar
  37. 37.
    Legro RS, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metabol. 2013;98(12):4565–92.CrossRefGoogle Scholar
  38. 38.
    Lane DE. Polycystic ovary syndrome and its differential diagnosis. Obstet Gynecol Surv. 2006;61(2):125–35.CrossRefGoogle Scholar
  39. 39.
    Kokandi A. Evaluation of acne quality of life and clinical severity in acne female adults. Dermatol Res Pract. 2010;2010:410809.CrossRefGoogle Scholar
  40. 40.
    Tan JKL, Vasey K, Fung KY. Beliefs and perceptions of patients with acne. J Am Acad Dermatol. 2001;44(3):439–45.CrossRefGoogle Scholar
  41. 41.
    Lakshmi C. Hormone therapy in acne. Indian J Dermatol Venereol Leprol. 2013;79(3):322.CrossRefGoogle Scholar
  42. 42.
    Zaenglein AL, et al. Guidelines of care for the manageent of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–73.CrossRefGoogle Scholar
  43. 43.
    Lucky AW, et al. A combined oral contraceptive containing 3-mg drospirenone/20-microg ethinyl estradiol in the treatment of acne vulgaris: a randomized, double-blind, placebo-controlled study evaluating lesion counts and participant self-assessment. Cutis. 2008;82(2):143–50.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Maloney JM, 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):773–81.CrossRefGoogle Scholar
  45. 45.
    Maloney JM, et al. A randomized controlled trial of a low-dose combined oral contraceptive containing 3 mg drospirenone plus 20 microg ethinylestradiol in the treatment of acne vulgaris: lesion counts, investigator ratings and subject self-assessment. J Drugs Dermatol. 2009;8(9):837–44.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Gierisch JM, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Prev Biomarkers. 2013;22(11):1931–43.CrossRefGoogle Scholar
  47. 47.
    International Collaboration of Epidemiological Studies of Cervical Cancer. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16 573 women with cervical cancer and 35 509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007;370(9599):1609–21.CrossRefGoogle Scholar
  48. 48.
    Gieler U, et al. Self-inflicted lesions in dermatology: terminology and classification–a position paper from the European Society for Dermatology and Psychiatry (ESDaP). Acta Derm Venereol. 2013;93(1):4–12.CrossRefGoogle Scholar
  49. 49.
    Leyden JJ, et al. A randomized, phase 2, dose-ranging study in the treatment of moderate to severe inflammatory facial acne vulgaris with doxycycline calcium. J Drugs Dermatol. 2013;12(6):658–63.Google Scholar
  50. 50.
    Strauss JS, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56(4):651–63.CrossRefGoogle Scholar
  51. 51.
    Grover C, Reddu BS. The therapeutic value of glycolic acid peels in dermatology. Indian J Dermatol Venereol Leprol. 2003;69(2):148.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Dreno B, et al. Expert opinion: efficacy of superficial chemical peels in active acne management–what can we learn from the literature today? Evidence-based recommendations. J Eur Acad Dermatol Venereol. 2011;25(6):695–704.CrossRefGoogle Scholar
  53. 53.
    Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60(4):539–61.CrossRefGoogle Scholar
  54. 54.
    Riis PT, et al. The role of androgens and estrogens in hidradenitis suppurativa–a systematic review. Acta Dermatovenerol Croat. 2016;24(4):239.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Vazquez BG, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Investig Dermatol. 2013;133(1):97–103.CrossRefGoogle Scholar
  56. 56.
    Revuz JE, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008;59(4):596–601.CrossRefGoogle Scholar
  57. 57.
    Canoui-Poitrine F, et al. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol. 2009;61(1):51–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gila Isman Nelkenbaum
    • 1
  1. 1.Department of DermatologyTel Aviv Sourasky Medical CenterTel AvivIsrael

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