17 Etiology The main underlying cause of acne is a genetic predisposition In

17 etiology the main underlying cause of acne is a

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[ 17 ] Etiology The main underlying cause of acne is a genetic predisposition. In addition, other aggravating factors are recognized. Cosmetic agents and hair pomades may worsen acne. [ 18 ] Medications that can promote acne development include steroids, lithium, some antiepileptics, and iodides. [ 19 ] Congenital adrenal hyperplasia , polycystic ovary syndrome , and other endocrine disorders associated with excess androgens may trigger the development of acne vulgaris. Even pregnancy may cause a flare- up. [ 20 ] Mechanical occlusion with headbands, shoulder pads, back packs, or under-wire bras can be aggravating factors. [ 21 ] Excessive sunlight may either improve or flare acne. In any case, the ultraviolet exposure ages the skin. Epidemiology United States Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. [ 22 ] Acne vulgaris affects 80% of Americans at some time during their lives. [ 7 ] Twenty percent have severe acne, which can result in permanent physical and mental scarring. International Persons of some races are affected more than others. Cystic acne is prevalent in the Mediterranean region from Spain to Iran. [ 23 ] Race Acne is common in North American whites. African Americans have a higher prevalence of pomade acne, likely stemming from the use of hair pomades. Ethnicities with darker skin are also more prone to postinflammatory hyperpigmentation. [ 18 ] Sex During adolescence, acne vulgaris is more common in males than in females. In adulthood, acne vulgaris is more common in women than in men. [ 22 , 24 ] Age Acne or acneform lesions, such as in neonatal cephalic pustulosis, may be present in the first few weeks and months of life, when a newborn is still under the influence of maternal hormones and when the androgen-producing portion of the adrenal gland is disproportionately large. [ 25 ] This neonatal acne tends to resolve spontaneously. However, some neonates may require therapy (eg, topical retinoids). [ 25 ] Adolescent acne usually begins with the onset of puberty, when the gonads begin to produce and release more androgen hormone. It affects many adolescents and young adults. Approximately 85% of people between the ages of 12 and 24 years experience at least minor acne. [ 22 ] Acne is not limited to adolescence. It can occur at any stage of life and may continue into one’s 30s and 40s. Acne occurring in adults is increasing, affecting up to 12-15% of women. [ 22 ] By age 45 years, 5% of both men and women still have acne. [ 26 ] Prognosis Acne may cause long-lasting and detrimental psychosocial and physical effects. It is associated with depression and anxiety, regardless of disease severity, although the psychological effects usually improve with treatment. Furthermore, acne may cause permanent scarring that is difficult to correct. [ 27 ] A 2017 Swedish study has added further statistically significant evidence that teenage acne may be a risk factor for the later development of early prostate cancer. [ 28 , 29 , 30 ] Researchers suggest that C acnes (formerly P acnes ) may be an associated link.
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