الفهرس 
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Abstract
Acne vulgaris is a common disease with prevalence up to 80% during adolescence. Acne vulgaris is the skin condition most commonly encountered by physicians, and it is estimated to affect between 40–50 million people in the United States. Though not life threatening, acne can have severe psychosocial consequences leading to poor self esteem, social isolation, and depression.
Acne frequently begins in the prepubertal period, when adrenal androgens released by the maturing adrenal gland lead to increased production of sebum, the lipid-rich secretion of the sebaceous glands. As the gonads mature, androgen production increases further, leading to additional sebum production than patients without acne, and the severity of acne is generally proportional to the amount of sebum production. However, the referral of patients over the age of 25 years with acne has significantly increased over the past years. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers.
Post-adolescent acne can be divided into ’persistent acne’, which represents a continuation of acne from adolescence into adult life, and ’late-onset’ acne, which describes significant acne occurring sometimes for the first time after the age of 25 years
There are four major factors implicated in the etiology of adolescent acne: increased sebum production, follicular hyperkeratinization, increased Propionibacterium acnes within the follicle and production of inflammation. Persistent acne as a continuation of adolescent acne appears to share these pathogenic features. There is a significantly higher sebum excretion rate among adults with persistent acne, compared with adult without acne, suggesting that there may be an underlying increase in sebum production in the former group. Other possible etiologic factors that have been considered include genetic predisposition, smoking, antibacterial-resistant propionibacteria, use of cosmetics, and/or stress.
Development of acne outside what was previously considered to be the usual age group warrant a thorough medical history, including family history, and exclusion of precipitating causes such as exposure to comedogenic substances or drugs. This should be followed by a physical examination. Although hormones influence acne, it is clear that the majority of acne patients do not have an endocrine disorder. Nevertheless, consideration should be given to endocrine causes. Hyperandrogenism, including polycystic ovary syndrome, should be considered in women whose acne is severe, is of sudden or late onset, is refractory to therapy, and/or is associated with other signs of hyperandrogenism such as hirsutism, irregular menses, or infertility. Additional clinical signs or symptoms of hyperandrogenism include cushinoid features, androgenic alopecia, increased libido, acanthosis nigricans, and deepening of the voice. Therefore important for the long-term health of these patients is to identify hyperandrogenism so that they can receive appropriate therapy to avoid these long-term complications. It is also important to consider investigating patients with true late-onset acne.
Clearly, adults with post adolescent acne are now recognized as an increasingly important population requiring treatment. In most cases, prescribed therapies are very similar to those used for adolescent acne. Thus, initially, topical treatments may be used for mild cases of acne, for example, benzoyl peroxide, salicylic acid, with antibiotics for inflammatory acne and retinoids for comedonal or more severe forms of the disease. Glycolic acid peels have been reported to be beneficial providing rapid improvement in comedonal acne.
The principles of treatment of acne in the elderly do not differ from those in other age groups, although the emphasis during counseling needs to focus on explanation and reassurance rather than prognosis. Low-dose systemic isotretinoin is reported to be helpful to patients in this age group. A combination of topical and systemic treatments should be considered in patients with persistent and late-onset acne. However, older skin does appear to be more sensitive to topical therapies.
The present work was done to find out possible reasons of post adolescent acne vulgaris through full history taking , general and local exanimation, pelvi abdominal ultasonography for diagnosis of poly cystic ovary in females and hormonal study of serum testosterone (free, total) and dehydroepiandrotestosterone sulphate (DHEAS).
Our Study included 100 patients (50 males and 50 females) of post adolescent acne vulgaris and 50 healthy acne free subjects (25 males and 25 females) all of them are above 25 years old.
Both patients and controls were subjected to full history taking with special consideration to age, sex, family history, age of menarche, onset, course, duration of the disease, history of menstrual irregularity (in the form of amenorrhea of greater than three months duration or irregularity of menstrual cycle of greater than 7 days from a standard 28-day cycle over three consecutive cycles), presence of hirsutism, androgenic alopecia and history of drug intake. Full general and dermatological examination was performed for all patients and controls with emphasis to distribution and type of acne, signs of hormonal irregularity (e.g. androgenic alopecia, hirsutism, menstrual irregularity) and hair distribution all over the body. Venous blood samples were collected for the assay of serum testosterone (free and total) and dehydroepiandrosterone-sulfate (DHEAS) by electrochemiluminescence immunoassay (ECLIA) using standard techniques. Pevli abdominal sonography was performed in all female subjects for diagnosis of poly cystic ovary.
In our study a positive family history was significantly higher in patients suggesting a familial tendency of the disease in some individuals.
Free testosterone level play an important role in female post adolescent acne vulgaris while total testosterone and DHEAS are important in male post adolescent acne vulgaris and its measurement in patients with post adolescent acne vulgaris can be helpful.
There is statically significant difference as regards total testosterone and high statically difference as regard DHEAS with higher mean values in male persistent acne compared to late onset acne while there was highly significant difference as regards free testosterone in comparison between female late onset and persistent acne vulgaris with higher mean value in late onset type.
Although PCO rate is not significant when comparing female controls and female patients with post adolescent acne vulgaris, but we found that the three cases with PCO have irregular hormonal manifestations and they were all complaining of late onset acne vulgaris so we should search for PCO in these patients.
All these investigations should be considered in evaluating post adolescent acne vulgaris especially when associated with other signs of hormonal irregularity and if elevated serum level of androgen is found, hormonal therapy could be of great benefit.
These patients with post adolescent acne vulgaris may represent a subgroup that have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require additional investigations and treatment.