الفهرس 
Acne Vulgaris
Pathophysiology of AcneOnly 14 pages are availabe for public view
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Abstract
Acne frequently begins in the pre-pubertal period.
However, the referral of patients over the age of 25 years with
acne has significantly increased over the past years.
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.
The aim of this work was to study the clinical and
epidemiological data of adult onset acne in Egyptian female
patients to establish the possible contributing etiological factors
and observing whether clinical features differ from adolescent
acne.
This study included 150 females; 75 cases with late
onset acne and 75 controls (free of disease). Their age ranged
from 25-50 years with a mean age was 31.4 + 5.6 years. The
mean age of disease was 27.6 + 3.3 years.
Both patients and controls were subjected to interview
questionnaire with special consideration to age, family history,
menstrual history including (age of menarche, menstrual
regularity, premenstrual flare), contraceptive methods, onset,
course and duration of the disease, relation to (special diet, smoking, sun exposure, seasonal variation, stress, drug intake,
cosmetics and hormonal change as (pregnancy and
contraceptive pills). Full general and dermatological
examination was performed for all patients and controls
including assessment of acne severity by using global acne
score and estimating psychological impact of acne in female
patients by cardiff acne disability index.
Venous blood samples were collected from 20 cases
and controls for the assay of serum estradiol, testosterone (free
and total) and dehydroepiandrosterone-sulfate (DHEAS) by
electrochemiluminescence immunoassay (ECLIA) using
standard techniques.
There were no significant differences between cases and
controls as regards age, marital status, number of offspring,
menstrual history and contraceptive methods.
We also did not find significant differences between
cases and controls as regards the effect of smoking, diet, sun
exposure, seasonal variation, cosmetics and hormonal changes
as pregnancy on acne exacerbation.
There were significant differences between cases and
control as regards family history, premenstrual flare, stress and
using of steroids on acne exacerbation.
Concerning the distribution of acne in our cases; the
cheeks were the most common site for acne (74.7%), followed by the chin (36.7%), mandibular (33.3%), forehead (28.0%),
nose (12.0%) and back (11.3%).
We observed two clinical forms: the inflammatory form
made up of papules (74.7%), pustules (61.3%) and nodules
(29.3%) that lead to scarring (61.3%) versus the comedonal
form (25.3%).
There was a positive correlation between Cardiff and
global score in our cases. According to GAGS, (33.34%) of
cases had mild score, while (36.00%) had moderate score and
(30.66%) had severe global score. We noticed that (30.66%) of
cases had low Cardiff index (CADI) while (42.70%) had
medium (CADI) and (26.64%) had high (CADI), implicating
that, acne was associated with significant decrease in the quality
of life. The psychological impact of acne was influenced by its
severity.
There were no significant differences between cases and
controls as regards serum estradiol, total testosterone and
DHEAS while free testosterone showing a high significant
difference between cases and controls.