PEER-REVIEW | DERMATOLOGY | Key points


Acne in adult women is becoming more common and has a major negative impact on quality of life


The causes are


different from acne in adolescence and the mechanisms involved are stress, endocrine changes, tobacco, cosmetics, and P. acnes resistance to common antibiotics


Acne management should be holistic and individualised. It should involve a diet plan, the use of correct methods of photoprotection, dermatocosmetics products specially designed for acne skin, local and systemic treatment, and laser surgery (for active acne or post acne sequelae)


decrease serum IGF-1114 testosterone114, 115 secretion116


Metformin treatment in patients with PCOS will , fasting insulin, DHEAS, and


. Insulin is a stimulator of hepatic IGF-1 and by reducing the insulin level, metformin


will reduce elevated serum IGF-1 levels, therefore, decreasing the level of acne. Metformin117


not only improves insulin


metabolism but results in a depression of adrenocorticotropic hormone- stimulated androgen production in women with PCOS. Both of these physiological changes would be therapeutic for acne patients, supporting the positive effects of metformin in acne. The basic principles of diet in


a patient with acne refers to the prohibition of consumption of milk or milk-derived and high glycemic index foods. The regime is designed


Conclusions Acne is a polymorphic disease with non-inflammatory and inflammatory aspects and nowadays is considered to be a chronic disease118


. Before any


the lesions and developing scars, changing the diet, and using topical products in the ways which were prescribed (quantity and frequency). Adult female acne is different from adolescent acne and two factors are involved, hormones and innate immunity. The public health issue in acne is frequency, cost, impact on QOL, antibiotic resistance of P. acnes, and associated morbidity. Practitioners have the opportunity to reduce antibiotic resistance for both P. acnes and other bacteria. Also, by reducing mTORC1 activation through diet manipulation, practitioners have the


to minimise the effects of


food on various pathways involved in the development of acne lesions.


opportunity to prevent serious diseases like diabetes type 2, obesity, neurodegenerative diseases, and


cancer. Practitioners should


Acne treatment is not only an acute intervention, but also maintenance therapy119


treatment, practitioners must inform and educate their patients and the myths surrounding acne should be discussed. It is a lot of little actions which will have a big impact on


emphasise the importance of not picking and popping the pimples because there is a very high risk of multiplying the lesions and developing scars.


acne evolution and it is essential to discuss the time required to see a positive effect (acne wil not be cured overnight). Practitioners should also emphasise the importance of: not over-washing the face (too frequently and too aggressively), not picking and popping the pimples because there is a very high risk of multiplying


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and periods is more likely to lead to scarring120


and psychological. Declaration of interest None


practitioners have to address individual needs of a specific patient and the treatment should consider a lot of factors. One of the more important is the duration of disease, because acne that persists for longer , both physical


July/August 2014 | prime-journal.com


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