POST-ADOLESCENT ACNE - A REVIEW OF CLINICAL-FEATURES

Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significan tly increased over the past 10 years. The clinical features of 200 pat ients over the age of 25 years, referred to our department for treatme nt of acne, were evaluated with a view to establishing possible aetiol ogical factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years), The acne was m ild or moderate in severity, consisting principally of inflammatory le sions, with mean total acne grade (Leeds Grading Scale) of 1.125 for m en and 0.75 for women. Most patients had persistent acne; but true lat e-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had fe atures of hyperandrogenicity. One hundred and sixty-four patients (82% ) had failed to respond to multiple courses of antibiotics, and 64 (32 %) had relapsed after treatment with one or more courses of isotretino in, External factors, such as. cosmetics, drugs and occupation, were n ot found to be significant aetiological factors. A family history reve aled that 100 (50%) of patients had a first-degree relative with post- adolescent acne. Patients with post-adolescent acne appear to represen t an increasingly important population of acne sufferers. External fac tors do not seem to have a significant aetiological role. Two main cli nical groups were identified: those with persistent acne and those wit h late-onset acne. A minority of women also had features of hyperandro genicity. These patients, and those with late-onset acne, map represen t a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.