Factors affecting the course and severity of adult acne. Observational cohort study

Objective: To identify factors improving symptoms and shortening duration of AA. Material and methods: The observational cohort study was performed in 111 patients with AA (> 25 y. o.) in 2015-2016. Clinical manifestation, previous treatments, environmental risk factors and features of juvenile acne affecting AA were assessed. Results: The maximum severity of persistent acne was significantly lower after 25 years of age, as compared to adolescence (7.2 vs. 6.4; p =.0027). The number of acne therapies used in AA was twice as high as in juvenile acne (22 vs. 11). The severity of AA sufficient to leave scars was significantly lower than of juvenile acne (6.0 vs. 7.3; p =.0001) with 22% of patients developing scars only in adult life. Patients linked exacerbations to stress exposure (p =.09 and <. 0001 for those reporting at least one stressor and all patients, respectively), finding lifestyle changes the most stressful (p =.046). Those using full-coverage foundations received significantly more acne treatments over lifetime (5.4 vs. 3.6; p =.0359) and for AA (4.4 vs. 2.8; p =.0043). Discontinuation of oral contraceptives or sensitive, erythema-prone skin also worsened the symptoms. Conclusion: Lifestyle change-related stress, sensitive skin, discontinuation of oral contraceptives and using full-coverage foundations increase severity of AA.