Major Finding: Out of the study patients, 85% had CPPA.
Data Source: Postadolescent women (226) with acne, aged 25–50 years, seen at a clinic by three dermatologists.
Disclosures: The authors reported having no conflicts of interest.
Among adult females with acne, 85% have large and small comedones, with few inflammatory lesions, a study has shown.
The finding goes against the commonly held belief that postadolescent acne is more often associated with inflammatory papules and pustular lesions, suggesting that “the commonly accepted model for postadolescent female acne should be critically revised for important academic, pathogenetic, and therapeutic reasons,” according to study investigators.
Cigarette smoking was also found to be strongly correlated with the comedonal form of acne, and not the inflammatory, papulopustular type.
According to the investigators, led by Dr. Bruno Capitanio of the pediatric dermatology department at the San Gallicano Institute in Rome, postadolescent acne had previously been considered a “predominantly inflammatory, mild to moderate form, characterized by papules and pustules, mainly located on the lower third of the face, jawline, and neck, with rare and not prominent comedonal lesions.”
The authors classified this type as “papulopustular postadolescent acne,” or PPAA.
“However, we have previously reported a frequent clinical form characterized by a predominance of retention lesions (microcomedones and macrocomedones) with few inflammatory lesions,” which the investigators call “comedonal postadolescent acne,” or CPAA.
For the current study, Dr. Capitanio and his colleagues sought to characterize the prevalence and severity of PPAA and CPAA among a group of 226 postadolescent women with acne, aged 25–50 years, seen at his clinic by three dermatologists (J. Am. Acad. Dermatol. 2010 July 7 [doi:10.1016/j.jaad.2009.11.021]).
All patients were classified as either nonsmokers (patients who had quit smoking more than 5 years before the study) or current smokers (patients who had quit smoking within 6 months prior to the study).
In total, 85% (192) of the study patients had CPAA.
The authors also found that smoking was strongly correlated with the more predominant, CPAA form. Of the 150 patients in the study who smoked, 93% (140) were CPAA patients, accounting for nearly 73% of the total CPAA cohort.
In contrast, the 10 remaining smokers, who had PPAA, represented just under 30% of that group.
Additionally, “a positive correlation was found between number of daily cigarettes and CPAA severity,” wrote Dr. Capitanio and his associates. For example, among the 19 total patients in the study who reported smoking more than 20 cigarettes per day, 11 had what the authors characterized as “severe” CPAA, with cysts greater than 3 mm in diameter spread over the entire face, and the presence of “ice-pick” scarring lending a “crater effect.”
Seven of the heavy smokers (more than 20 cigarettes per day) had mild to moderate CPAA; the remaining one patient had PPAA.
The authors postulated that one reason for the discrepancy between their data and previous findings about postadolescent acne may be because prior studies have “been mainly conducted on Nordic (in particular Anglo-Saxon) populations, presumably (even if not specified) characterized by a predominance of fair skin type and by a low-grade ultraviolet exposure.” This study was of women of Mediterranean descent.
The authors conceded that the study did not take into account patients' stress levels, sleep, milk intake, or consumption of foods with high glycemic indices, “but they will be included in future studies.”