الفهرس | Only 14 pages are availabe for public view |
Abstract Acne frequently begins in the pre-pubertal period. However, the referral of patients over the age of 25 years with acne has significantly increased over the past years. Post-adolescent acne can be divided into ’persistent acne’, which represents a continuation of acne from adolescence into adult life and ’late-onset’ acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The aim of this work was to study the clinical and epidemiological data of adult onset acne in Egyptian female patients to establish the possible contributing etiological factors and observing whether clinical features differ from adolescent acne. This study included 150 females; 75 cases with late onset acne and 75 controls (free of disease). Their age ranged from 25-50 years with a mean age was 31.4 + 5.6 years. The mean age of disease was 27.6 + 3.3 years. Both patients and controls were subjected to interview questionnaire with special consideration to age, family history, menstrual history including (age of menarche, menstrual regularity, premenstrual flare), contraceptive methods, onset, course and duration of the disease, relation to (special diet, smoking, sun exposure, seasonal variation, stress, drug intake, cosmetics and hormonal change as (pregnancy and contraceptive pills). Full general and dermatological examination was performed for all patients and controls including assessment of acne severity by using global acne score and estimating psychological impact of acne in female patients by cardiff acne disability index. Venous blood samples were collected from 20 cases and controls for the assay of serum estradiol, testosterone (free and total) and dehydroepiandrosterone-sulfate (DHEAS) by electrochemiluminescence immunoassay (ECLIA) using standard techniques. There were no significant differences between cases and controls as regards age, marital status, number of offspring, menstrual history and contraceptive methods. We also did not find significant differences between cases and controls as regards the effect of smoking, diet, sun exposure, seasonal variation, cosmetics and hormonal changes as pregnancy on acne exacerbation. There were significant differences between cases and control as regards family history, premenstrual flare, stress and using of steroids on acne exacerbation. Concerning the distribution of acne in our cases; the cheeks were the most common site for acne (74.7%), followed by the chin (36.7%), mandibular (33.3%), forehead (28.0%), nose (12.0%) and back (11.3%). We observed two clinical forms: the inflammatory form made up of papules (74.7%), pustules (61.3%) and nodules (29.3%) that lead to scarring (61.3%) versus the comedonal form (25.3%). There was a positive correlation between Cardiff and global score in our cases. According to GAGS, (33.34%) of cases had mild score, while (36.00%) had moderate score and (30.66%) had severe global score. We noticed that (30.66%) of cases had low Cardiff index (CADI) while (42.70%) had medium (CADI) and (26.64%) had high (CADI), implicating that, acne was associated with significant decrease in the quality of life. The psychological impact of acne was influenced by its severity. There were no significant differences between cases and controls as regards serum estradiol, total testosterone and DHEAS while free testosterone showing a high significant difference between cases and controls. |