Ann Hui Ching, Contributing Photographer
A recent study led by researchers at the School of Medicine found that women seek dermatology care for acne at over double the rate that men do.
The report is among the first to analyze trends in acne clinic visits and treatments around the country broken down by age and sex. The researchers also found that medications known as tetracycline-class antibiotics are the most prescribed therapy in female acne patients.
“Our overall goal with this research was to demonstrate that acne is not only a juvenile problem but something that has and is affecting adult females well into their 40s,” Jungsoo Chang MED ’23, the study’s lead author, wrote to the News. “With this in mind, we also wanted to show different treatments providers have used in the past years.”
The researchers analyzed data from the National Ambulatory Medical Care Survey — a federally administered survey that looks at the use of healthcare services nationwide — to study patterns in acne clinic visits and treatments for females. They also analyzed the acne medications that healthcare providers prescribed, including antibiotics, oral contraceptive pills and gel medications like tretinoin.
The report found that adult women are 2.5 times more likely than men to seek acne care. For Emmy Graber, the president of the Dermatology Institute of Boston who was not involved in the study, the finding mirrors what sees in her own clinic.
The disparity could be for two reasons, Graber said.
The first possibility is that adult women experience acne at higher rates than men. According to Christopher Bunick, an associate professor of dermatology at the School of Medicine and the study’s senior author, it is likely that there are biological differences in how acne develops in men and women.
However, Graber also theorized that adult females with acne may be more likely to seek dermatologic care than adult males.
While previous studies have looked at trends in acne care in women, all of them used self-reported data — interviews and questionnaires, the report said, that can be inaccurate. People who are embarrassed about receiving care for acne, for instance, might not accurately disclose details about their treatment.
Both Chang and Bunick noted that there is a stigma surrounding adult acne in older females. Popular media, they added, can promote the idea that it is “abnormal” for adult women to experience acne.
“Over my career I have seen many 20-50 year-old women come into the Yale Dermatology-Middlebury clinic concerned about their acne and perplexed as to why they have acne at their age,” Bunick wrote to the News. “They commonly say, ‘but I am not a teenager.’ However, my personal experience in the clinic strongly suggested otherwise.”
As a result, Bunick approached Jeffrey Cohen, a dermatology professor at the School of Medicine and a study author, to explore the reality of how often adult women sought care for acne.
“The hope was our work would help adult women suffering from acne feel less isolated, alone, or embarrassed, and provide real impetus for a change in society’s discourse around adult female acne,” Bunick wrote.
The researchers also found that medications called broad-spectrum tetracycline-class antibiotics were the most commonly prescribed treatment for females. However, they also found that providers are increasingly prescribing the drug spironolactone to treat acne in adult women.
As an anti-androgen medication, spironolactone is popular because of its ability to reduce “hormonal acne,” Bunick said. Patients also have a lower risk of developing antibiotic resistance while on the drug.
However, Bunick added, after the study period ended, the Food and Drug Administration approved a new medication for acne called sarecycline, which is even less susceptible to antibiotic resistance and has fewer side effects. Based on his own research, Bunick believes that sarecycline should be the go-to medication for acne treatment.
“We hope that [the study] leads to more research on pathogenic differences in adolescent and adult acne and it helps to improve and expand treatment options including spironolactone and sarecycline,” Chang wrote.
Graber, though, doesn’t see antibiotics as a long-term solution for acne.
She said that antibiotics should not be used over long periods of time.
”If an adult has had acne for many years, it is unlikely to stop in the coming weeks to months and therefore a more appropriate long term chronic therapy should be considered,” Graber said.
Experts are still unsure why acne affects women differently than men. Chang believes that a combination of genetics, stress and cosmetics play a role.
Women may also be impacted by fluctuations in hormone levels, like androgen, estrogen and progesterone throughout adulthood, she added.
“I think this study opens the door for more rigorous investigation into the unique mechanisms driving adult female acne, and creates potential for innovation of targeted therapeutics for this particular group of patients,” Bunick wrote.
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