In 1999, Professor William Cunliffe  and colleagues at the University of Leeds in the United Kingdom published the first study in almost 20 years to investigate the prevalence of acne vulgaris in adults. The authors introduced their study by noting that over the past 10 years they had seen the mean age of patients seeking treatment for acne in their clinic climb from 20.5 to 26.5 years, although they were not certain as to whether this was due to a greater prevalence of adult acne or a greater awareness of the disease and willingness to seek treatment.

In this community-based study, 749 people older than 25 years of age were evaluated for facial acne. The overall prevalence of acne in this population was 54%, although most acne was physiologic (0.25 to 0.75 on a 10-point scale). Clinical acne was observed in 3% of men and 12% of women; 82% of subjects reported that their acne had persisted since adolescence. Acne prevalence did not substantially decrease until after the age of 44 years.

A more recent study was conducted in France.^[5] In this study, a representative sample of French women aged 25-40 years was sent a validated self-administered questionnaire developed to determine the number and type of acne lesions. The questionnaire also assessed other factors, such as skin type, current skin care, factors influencing acne, and the effect of acne on quality of life. Total acne prevalence was 41%: 17% of women surveyed had clinical acne and 24% had physiologic acne. Thirty-four percent of the women with clinical acne reported that they had not been affected by acne during their teenage years. Menstrual periods and stress were the most frequently reported perceived triggers for an acne outbreak. The authors noted that the presentation of acne in this group was somewhat different from that of typical adolescent acne. Women reported that the lower part of the face -- especially the chin -- was most affected; minimal skin oiliness but high levels of "sensitive skin" were also reported.

These 2 studies highlight many of the compelling questions in the area of adult acne: What is the relationship between persistent acne and recurrent acne? How does the presentation of adult acne differ from adolescent acne? Is adult acne experienced predominantly by women? While the answers to these and other important questions are not completely clear, their consideration will help inform the treatment of the increasing number of adult patients seeking help for acne.