Speaker: Adult women deserve new, innovative therapies for acne

Key takeaways:

• Adult women visit the dermatologist for acne 2.5 to three times more than adult men.
• Currently, available treatments can be limiting for women of child-bearing age.

MIAMI BEACH, Fla. — New, innovative therapies must be added to the existing arsenal of treatments for adult female acne, according to a presentation at South Beach Symposium.

“We have this perception in society that acne is a teenage disease, a teenage problem and that adults shouldn’t have it,” Christopher G. Bunick, MD, PhD, associate professor of dermatology at Yale School of Medicine and South Beach Symposium senior planning committee member, told Healio. “Yet, I keep seeing all these adult women in my clinic to the point I one day turned to my nurses and said, ‘What is this?’”

According to a 2023 study by Chang and colleagues referenced by Bunick during his presentation, adult women visit the dermatologist for acne 2.5-times more than adult men. Additionally, between 2002 and 2016, women aged 20 to 29 years received 10,899,975 acne diagnoses, whereas men only received 3,637,344 (P < .0001). Women aged 30 to 39 years also received 7,607,845 acne diagnoses vs. men who saw 1,977,692 diagnoses in the same time period (P < .0001).

“What that told me was that there’s this unique pathophysiology of acne in adult women and that maybe we haven’t uncovered all of the factors that drive acne,” Bunick told Healio.

Dermatologists know that one of the primary causes of acne in adult women is hormones, as women’s bodies must prepare to have children as they age. This makes the factors that drive acne in women very different from the factors that drive acne in men, according to Bunick.

“When you take that into consideration, you realize we need unique research that looks at these differences because there may be innovative therapies for adult women that can be developed beyond what we already have in our acne arsenal,” Bunick told Healio. “I think that adult women deserve that attention, and I think that they would welcome new innovative therapies.”

The therapies currently available and effective for adult female acne include spironolactone, oral contraceptives and isotretinoin.

According to Bunick, spironolactone is currently a superior option for acne in adult women as it targets androgens, such as testosterone, that can be a driving factor in adult female acne. A 2024 study published by Dréno and colleagues found that spironolactone was 1.37 times and 2.87 times more successful compared with doxycycline at month 4 and month 6 for female acne, respectively.

Oral contraceptives and isotretinoin are also excellent options, according to Bunick. He pointed out that dermatologists should keep in mind a recent study by Lai and Barbieri, which showed a higher cumulative dose of isotretinoin reduced relapse in acne. Moving forward, Bunick recommends that isotretinoin be prescribed with a higher cumulative dose.

However, all these options can be limiting for adult women depending on their stage of life, with those trying to get pregnant being unable to utilize these treatments. In some of these situations, oral antibiotics may be a suitable alternative, according to Bunick.

“It turns out in our study, the most common treatment for adult women with acne is still oral antibiotics,” Bunick told Healio. “I think we use these oral antibiotics largely for their anti-inflammatory properties and it would be really neat to figure out more what’s driving the inflammatory acne, papules and nodules in adult women to see if there’s any new therapies that could be innovated that specifically target that.”