madman
Super Moderator
What is new in adult acne for the last 2 years: focus on acne pathophysiology and treatments (2022)
Marie-Ange Dagnelie, PhD, Alexandra Poinas, PhD and Brigitte Dreno, MD, PhD
Abstract
Acne affects more than 640 million people worldwide, including about 85% of adolescents. This inflammatory dermatosis affects the entire population, from teenagers to adults, which reinforces the need to investigate it. Furthermore, in adults, acne has serious consequences, including a psychological impact, low self-esteem, social isolation, and depression. Over the last years, the understanding of acne pathophysiology has improved, mainly thanks to the identification of the pivotal role of the microbiota. The aim of this review was to screen the most recent scientific literature on adult acne and the newly tested treatments. Clinically, therapeutic innovations for the treatment of acne have been recently developed, including pre/probiotics, new molecules, and innovative formulations associated, however, with fewer side effects. Moreover, clinical trials are underway to use off-label molecules that seem to be proving their value in the fight against adult acne.
Introduction
Acne vulgaris is the most common skin disorder worldwide as estimated by global skin disease prevalence studies,1 and it may persist into or appear during adulthood. This chronic inflammatory skin disease may affect the entire population, regardless of gender, including teenagers and adults.
Serious consequences of acne have been reported in adults, including a psychological impact associated with low self-esteem, social isolation, and depression
Acne results from the interplay between androgen-induced hyperseborrhea, follicular hyperkeratinization, a loss of skin microbial diversity, and an inappropriate inflammatory response.2 A loss of diversity of Cutibacterium acnes subgroups has recently been identified as crucial in the initiation of skin inflammatory responses in acne,3 and the microbiome appears to play a significant role in the development of inflammatory lesions.4,5
Therapeutic innovations for the treatment of acne have been recently developed, including pre/probiotics, new molecules, and innovative formulations associated with fewer side effects.6,7 Indeed, current first-line treatments target one or two steps in acne pathogenesis, including benzoyl peroxide, topical retinoids, and topical or oral antibiotics.8 Nevertheless, antibiotic resistance is a concern in acne because it is increasing worldwide, not to forget the problem of resistance in all diseases, which the WHO alerted us to on April 30, 2014.9 Also, oral isotretinoin is recommended in more severe cases, but it is associated with side effects and should be used with caution in women of childbearing age because of its teratogenic risk. Note, in March 2021, the Agence nationale de securite du medicament et des produits de sante (ANSM - French regulatory authorities) organized a public hearing to help strengthen the information of patients and health professionals on the teratogenic and psychiatric risks associated with isotretinoin. The ANSM recommends stopping treatment and consulting “as soon as possible” with her physician in the event of a pregnancy occurring during treatment.10
*Prevalence and risk factors of adult acne
*Microbiome and adult acne
*Adult female acne
*Update of adult acne recommendations and treatments
What is the medical impact of these recent data?
-Microbiota modulation
-Spironolactone
-Topical agents
Conclusion
Acne is a common inflammatory dermatosis. New treatments are continuously being developed, and the role of various agents is evolving, with newly identified actors that play crucial roles in the development of acne. Skin microbiome modulation appears to be a promising target for future therapies but still needs to be further investigated. In parallel, antibiotic resistance is increasing worldwide, and there is, therefore, an urgent need to reduce their use, especially in acne management as they have been extensively used in the last 20 years. Through their effect on microcomedones and their preventive action on initial lesions, retinoids may be one of the cornerstones of acne therapy. The variety of acne treatments and diversity of molecules (antiandrogenic hormones, retinoids, antibiotics, etc.) offer great flexibility to dermatologists to personalize patients’ therapeutic regimens while achieving good results.
Marie-Ange Dagnelie, PhD, Alexandra Poinas, PhD and Brigitte Dreno, MD, PhD
Abstract
Acne affects more than 640 million people worldwide, including about 85% of adolescents. This inflammatory dermatosis affects the entire population, from teenagers to adults, which reinforces the need to investigate it. Furthermore, in adults, acne has serious consequences, including a psychological impact, low self-esteem, social isolation, and depression. Over the last years, the understanding of acne pathophysiology has improved, mainly thanks to the identification of the pivotal role of the microbiota. The aim of this review was to screen the most recent scientific literature on adult acne and the newly tested treatments. Clinically, therapeutic innovations for the treatment of acne have been recently developed, including pre/probiotics, new molecules, and innovative formulations associated, however, with fewer side effects. Moreover, clinical trials are underway to use off-label molecules that seem to be proving their value in the fight against adult acne.
Introduction
Acne vulgaris is the most common skin disorder worldwide as estimated by global skin disease prevalence studies,1 and it may persist into or appear during adulthood. This chronic inflammatory skin disease may affect the entire population, regardless of gender, including teenagers and adults.
Serious consequences of acne have been reported in adults, including a psychological impact associated with low self-esteem, social isolation, and depression
Acne results from the interplay between androgen-induced hyperseborrhea, follicular hyperkeratinization, a loss of skin microbial diversity, and an inappropriate inflammatory response.2 A loss of diversity of Cutibacterium acnes subgroups has recently been identified as crucial in the initiation of skin inflammatory responses in acne,3 and the microbiome appears to play a significant role in the development of inflammatory lesions.4,5
Therapeutic innovations for the treatment of acne have been recently developed, including pre/probiotics, new molecules, and innovative formulations associated with fewer side effects.6,7 Indeed, current first-line treatments target one or two steps in acne pathogenesis, including benzoyl peroxide, topical retinoids, and topical or oral antibiotics.8 Nevertheless, antibiotic resistance is a concern in acne because it is increasing worldwide, not to forget the problem of resistance in all diseases, which the WHO alerted us to on April 30, 2014.9 Also, oral isotretinoin is recommended in more severe cases, but it is associated with side effects and should be used with caution in women of childbearing age because of its teratogenic risk. Note, in March 2021, the Agence nationale de securite du medicament et des produits de sante (ANSM - French regulatory authorities) organized a public hearing to help strengthen the information of patients and health professionals on the teratogenic and psychiatric risks associated with isotretinoin. The ANSM recommends stopping treatment and consulting “as soon as possible” with her physician in the event of a pregnancy occurring during treatment.10
*Prevalence and risk factors of adult acne
*Microbiome and adult acne
*Adult female acne
*Update of adult acne recommendations and treatments
What is the medical impact of these recent data?
-Microbiota modulation
-Spironolactone
-Topical agents
Conclusion
Acne is a common inflammatory dermatosis. New treatments are continuously being developed, and the role of various agents is evolving, with newly identified actors that play crucial roles in the development of acne. Skin microbiome modulation appears to be a promising target for future therapies but still needs to be further investigated. In parallel, antibiotic resistance is increasing worldwide, and there is, therefore, an urgent need to reduce their use, especially in acne management as they have been extensively used in the last 20 years. Through their effect on microcomedones and their preventive action on initial lesions, retinoids may be one of the cornerstones of acne therapy. The variety of acne treatments and diversity of molecules (antiandrogenic hormones, retinoids, antibiotics, etc.) offer great flexibility to dermatologists to personalize patients’ therapeutic regimens while achieving good results.
