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ExcelFemale
HRT in Women
Treatment challenges in adult female acne and future directions
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<blockquote data-quote="madman" data-source="post: 200933" data-attributes="member: 13851"><p><strong>Article highlights</strong></p><p></p><p><em><strong>• Adult female acne (AFA) has been demonstrating an increasing prevalence all over the world. It is an impacting disease for adult women, in their social, and professional life. Quality of life and patients’ suffering should be valued.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>• In accordance with the available data from a more recent international observational study, lesions may have a different distribution from adolescent acne in about 10 % of the cases, when there is a predominance of mild to moderate inflammatory papules along with mandibular and perioral areas of the face, in a “surgical mask-like” pattern. The presence of comedones and inflammatory papules, with a full-face involvement, is the most common clinical picture in AFA; and more than 50% of the affected women have truncal lesions.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>• The pathogenesis is similar to acne vulgaris, but additional factors trigger and aggravate the disease's chronic evolution, including a high level of stress, sleep deprivation, picking habits, sensitive skin, pollution, and diet. It seems that peripheral production of androgens, at the sebaceous gland level, is responsible for its prolonged duration.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>• It is important to treat AFA as early and as effectively as possible to avoid scars and psychological sequelae, taking into account the desire to be pregnant. The majority of patients have normal androgen levels in the serum. However, other signals of hyperandrogenism, mainly hirsutism, and menstrual irregularities, should be addressed and hormonal investigation, as well as transvaginal ultrasound, requested.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>• There are many topical but only three different systemic drugs (antibiotics, antiandrogens, and isotretinoin) available for treatment, usually in combination for inflammatory acne.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>• For mild acne, topical treatment, always combined with adjuvant measures (gentle cleanser, moisturizer, sunscreen, and dermo-cosmetics), may be sufficient for disease control, in a prolonged period of time. For this reason, topical antibiotics should be avoided.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>• Oral hormones represent the most important drugs for AFA, especially spironolactone and contraceptives, containing Ethinyl estradiol and cyproterone acetate, drospirenone or chlormadinone as progestins </strong></em></p><p><em><strong></strong></em></p><p><em><strong>• Oral isotretinoin might be considered in severe and refractory disease as it is highly effective and safe for acne vulgaris. Off-label low daily doses and variable duration of the treatment is the best approach, always associated with contraception methods, starting one month before the treatment up to one month after drug interruption, This regimen promotes fewer mucocutaneous side effects, same efficacy, and better adherence. Lab tests (lipid profile, transaminases, Gama-GT, total blood count) should be requested at baseline and repeated after two months, as well as beta-HCG monthly. Serious adverse events, including depression and inflammatory bowel disease, are rare and individual and do not justify excessive warning and concern. </strong></em></p><p><em><strong></strong></em></p><p><em><strong>• Topical clascoterone (androgen blocker) and new anti-inflammatory substances, as well as a new use of oral non-steroidal anti-androgen, such as bicalutamide, are interesting perspectives for AFA control.</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 200933, member: 13851"] [B]Article highlights[/B] [I][B]• Adult female acne (AFA) has been demonstrating an increasing prevalence all over the world. It is an impacting disease for adult women, in their social, and professional life. Quality of life and patients’ suffering should be valued. • In accordance with the available data from a more recent international observational study, lesions may have a different distribution from adolescent acne in about 10 % of the cases, when there is a predominance of mild to moderate inflammatory papules along with mandibular and perioral areas of the face, in a “surgical mask-like” pattern. The presence of comedones and inflammatory papules, with a full-face involvement, is the most common clinical picture in AFA; and more than 50% of the affected women have truncal lesions. • The pathogenesis is similar to acne vulgaris, but additional factors trigger and aggravate the disease's chronic evolution, including a high level of stress, sleep deprivation, picking habits, sensitive skin, pollution, and diet. It seems that peripheral production of androgens, at the sebaceous gland level, is responsible for its prolonged duration. • It is important to treat AFA as early and as effectively as possible to avoid scars and psychological sequelae, taking into account the desire to be pregnant. The majority of patients have normal androgen levels in the serum. However, other signals of hyperandrogenism, mainly hirsutism, and menstrual irregularities, should be addressed and hormonal investigation, as well as transvaginal ultrasound, requested. • There are many topical but only three different systemic drugs (antibiotics, antiandrogens, and isotretinoin) available for treatment, usually in combination for inflammatory acne. • For mild acne, topical treatment, always combined with adjuvant measures (gentle cleanser, moisturizer, sunscreen, and dermo-cosmetics), may be sufficient for disease control, in a prolonged period of time. For this reason, topical antibiotics should be avoided. • Oral hormones represent the most important drugs for AFA, especially spironolactone and contraceptives, containing Ethinyl estradiol and cyproterone acetate, drospirenone or chlormadinone as progestins • Oral isotretinoin might be considered in severe and refractory disease as it is highly effective and safe for acne vulgaris. Off-label low daily doses and variable duration of the treatment is the best approach, always associated with contraception methods, starting one month before the treatment up to one month after drug interruption, This regimen promotes fewer mucocutaneous side effects, same efficacy, and better adherence. Lab tests (lipid profile, transaminases, Gama-GT, total blood count) should be requested at baseline and repeated after two months, as well as beta-HCG monthly. Serious adverse events, including depression and inflammatory bowel disease, are rare and individual and do not justify excessive warning and concern. • Topical clascoterone (androgen blocker) and new anti-inflammatory substances, as well as a new use of oral non-steroidal anti-androgen, such as bicalutamide, are interesting perspectives for AFA control.[/B][/I] [/QUOTE]
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ExcelFemale
HRT in Women
Treatment challenges in adult female acne and future directions
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