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Acne: Who, What, and When?


As an introduction to a panel discussion on incorporating new medications into acne treatment, dermatology experts provide an overview of the who, what, and when of acne.

Hilary E. Baldwin, MD: Welcome to this Dermatology Times®Viewpoints® program entitled “Incorporating New Medications into Acne Treatment.” I’m Dr Hilary Baldwin, and I’m the medical director of the Acne Treatment & Research Center in Brooklyn, New York. Our discussion today is going to focus on diagnosis and new options for treating acne. Joining me today are 3 well-known colleagues and good friends: Dr Fran Cook-Bolden, who is a clinical assistant professor of dermatology and director of FCB Dermatology and Wellness in New York; Dr James Del Rosso, a dermatologist who practices is Las Vegas, Nevada; and Dr Julie Harper, a dermatologist practicing in Birmingham, Alabama. Let’s go ahead and begin.

Let’s start with you, Julie. What is acne vulgaris, when does it start, and who gets it?

Julie C. Harper, MD: That’s a big question, Hilary. We have plenty of time to talk about this, but I would think of acne vulgaris as being an inflammatory skin condition. It can involve the face, the chest, and the back and shoulders. We see it at almost any age. It’s certainly most prevalent during adolescent years, and adolescence has moved down recently. Earlier, we might have said ages 12 and up, or 12 to 19, but we now have products that are FDA approved down to age 9, and we can see acne down to age 7. If you see acne before age 7, you’ve got to be a bit worried about whether there could be a potential hormonal problem in the background that needs to be worked up. We can see it in young kids, but keep this in mind: if you get it between the ages of 1 and 7, that period is when you would be suspicious of an underlying cause. People 7 years of age and older can get acne, but we see it in the adult years as well. In that adolescent age group, I would say that most people have some amount of acne in their lifetime, it’s that prevalent.

Regarding what it looks like clinically, we all know this, but acne presents with red, inflamed bumps, papules, and pustules. There is also comedonal acne, which are the little blackheads and whiteheads that we see with acne. It’s an inflammatory condition. We can see it in almost any age group. The last thing I would say about it is that it stinks; nobody wants to have it.

Hilary E. Baldwin, MD: Fran, why don’t you continue here with this discussion of the prevalence of acne? What do you see in your practice in terms of the distribution between the teenager and older patients?

Fran E. Cook-Bolden, MD: Hilary, as Julie mentioned, acne is common in adolescents. It’s considered a disease of adolescents, although we know we can see it in all age groups. It’s the most common skin disease in the United States, affecting 50 million Americans, and it affects 80% of Americans at some time in their life. Because it’s considered a disease in adolescents, there have been a lot of studies that have examined the prevalence in adolescents and reported it at almost 95%. I challenge that a bit because if you have a patient who has an occasional comedone or papule, then that can go to 100% prevalence of acne at some point in the patients’ lives.

As Julie said, you can get acne at any other age. I would like to supplement by saying this: it’s common in patients from infancy to 2 years of age, which is largely because of effects from the mother. As Julie said, it’s rare in young children, so it’s rare in toddlers from 3 to 5, or up to 7 years of age. It’s common in preadolescents, which is the age group of about 6 to 13. When we talk about age ranges and prevalence, they’re all over the place in studies. They sometimes include adolescents in those numbers, and we know it’s extremely common in adolescents, which includes patients from 14 to 18 years of years of age. It’s common in young adults, and I’m going to put that in an age range of about 19 to 40. It’s somewhat common in adults between the ages of 41 to 60. In my practice, most of my patients are young adults, adults, and a lot of adolescents as well. It’s rare in seniors.

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