Acne vulgaris is a common skin condition with substantial cutaneous and psychologic disease burden. Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases, like diabetes and epilepsy. In conjunction with the considerable personal burden experienced by patients with acne, acne vulgaris also accounts for substantial societal and health care burden. The pathogenesis and existing treatment strategies for acne are complex. This article discusses the epidemiology, pathogenesis, and treatment of acne vulgaris. The burden of disease in the United States and future directions in the management of acne are also addressed.
Acne vulgaris is a common skin condition with substantial cutaneous and psychologic disease burden. Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases, like diabetes and epilepsy. In conjunction with the considerable personal burden experienced by patients with acne, acne vulgaris also accounts for substantial societal and health care burden. Americans use more than 5 million physician visits for acne each year, leading to annual direct costs in excess of $2 billion. Acne is the most common diagnosis made by dermatologists and is also commonly made by nondermatologist physicians. The pathogenesis and existing treatment strategies for acne are complex. This article discusses the epidemiology, pathogenesis, and treatment of acne vulgaris. The burden of disease in the United States and future directions in the management of acne is also addressed.
Epidemiology
Acne is a highly common skin condition. Still, estimates of acne prevalence vary substantially given the absence of a universally accepted diagnostic or grading schema. Additionally, estimates continue to change as the prevalence of acne decreases secondary to improved treatment modalities. Acne is most common in adolescents, affecting approximately 85% of teenagers. Acne prevalence after adolescence decreases with increasing age, but disease burden in younger adults is still quite high. A common misconception by the medical and lay community is that acne is a self-limited teenage disease and, thus, does not warrant attention as a chronic disease. Nevertheless, the chronicity of many cases of acne as well as the well-documented psychologic effects of chronic acne contributes to the burden of the disease.
The average age of onset of acne is 11 years in girls and 12 years in boys. Acne is increasing in children of younger ages, with the appearance of acne in patients as young as 8 or 9 years of age. This trend toward earlier development of acne is thought to be related to the decreasing age-of-onset of puberty that has been observed in the United States. Acne is more common in males in adolescence and early adulthood, which is a trend that reverses with increasing age. It is well known that adult acne is more common in women. Adult acne typically represents chronic acne persisting from adolescence, not new-onset disease.
Other factors impacting acne prevalence and severity include ethnicity and genetic propensity. Acne age of onset and disease character vary among patients of different ethnicities. Scarring and pigmentary changes are common in skin of color. Propensity to scar and to develop hyperpigmentation is highest among Hispanic and African American patients, respectively. These long-term disease consequences are challenging to treat and contribute to the disease burden. In addition, genetic factors impact the propensity to develop acne. Adolescent and adult acne is more common in children of parents with a history of acne.
Several modifiable factors alter acne risk. Cigarette smoking, for example, raises acne risk with disease severity worsening in a dose-dependent fashion with increasing number of cigarettes smoked daily. Although evidence regarding the impact of dietary factors on acne is equivocal, studies suggest that dairy intake increases acne risk. Finally, traditional opinion in dermatology holds that acne tends to improve during summer months when sun exposure is greater. This finding is supported by an observed seasonal decrease in physician visits for acne during summer months. Nevertheless, no studies exist to support this association and use of UV light to treat acne has been rejected. Undoubtedly, acne is a complex disease process influenced by both genetic and environmental factors.
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