Unveiling the Nuances of Adult Female Acne: A Comprehensive Exploration of Epidemiology, Treatment Modalities, Dermocosmetics, and the Menopausal Influence.

Previously considered a skin disease exclusively affecting adolescents, characterized by inflammatory and non-inflammatory skin lesions, acne vulgaris is now increasingly observed in adult life, including post-menopause. Today, adult female acne (AFA) is a common chronic inflammatory disease of the pilosebaceous unit, with polymorphic lesions presenting as open or closed comedones, papules, pustules, and even nodules or cysts, often with the presence of sequelae. AFA may persist from adolescence or manifest de novo in adulthood. Its etiology is multifactorial, involving genetic, hormonal, dietary, and environmental factors, yet still incompletely understood. Increased sebum production, keratinocyte hyper-proliferation, inflammation, and reduced diversity of Cutibacterium acnes strains are the underlying disease mechanisms. During menopausal transition, a relative increase in androgen levels occurs, just as estrogens begin to decline, which can manifest itself as acne. Whereas most AFA exhibit few acne lesions with normo-androgenic serum levels, baseline investigations including androgen testing panel enable associated comorbidities to be eliminated, such as polycystic ovarian syndrome, congenital adrenal hyperplasia, or tumors. Another interesting feature is AFA's impact on quality of life, which is greater than in adolescents, being similar to other chronic diseases like asthma. The therapeutic approach to AFA depends on its severity and associated features. This review investigates the intricate facets of AFA, with a specific focus on incidence rates, treatment modalities, and the curious impact of menopause. Utilizing insights from contemporary literature and scientific discussions, this article seeks to advance our understanding of AFA, offering new perspectives to shape clinical practices and improve patient outcomes.

Effect of Makeup Use on Depressive Symptoms: An Open, Randomized and Controlled Trial.

INTRODUCTION: Depression is one of the most disabling diseases globally, with a high disease burden that generates high direct and indirect costs. The incidence of depression is twofold higher in adult women than in men. Biological and psychosocial factors constitute the pathophysiological bases of the condition and due to the complexity of the condition, current understanding is that the "treatment strategy must be multimodal". The objective of this study was to measure the effect of introducing the frequent use of makeup on improving depressive symptoms in adult women of medium-low purchasing power METHODS: Participants with the targeted profile who did not frequently use makeup were selected and randomised to receive (test group) or not (control group) stimuli and makeup products intended for encouraging the frequent use of makeup. The Zung Depression Self-Assessment Scale was used to assess depressive symptoms, with additional assessments on self-image perception using the mirror test and salivary cortisol level. RESULTS: The results demonstrated a sustained reduction in depressive symptoms (8.3 percentage points reduction in the Average Zung Index; P < 0.05), with a significant improvement in self-image perception (25% increase in the average score obtained in the mirror test; P < 0.05) and a specific influence on salivary cortisol levels (55% reduction in salivary cortisol concentration; P < 0.05) after the first makeup application. CONCLUSION: The results show that encouraging the frequent use of makeup, a practice that can be achieved by most people and which is simple and inexpensive to implement, can contribute to effective and sustainable improvement in the well-being and mental health of a significant portion of the population.

Sequential therapy with topical clobetasol for 14 days followed by hydroquinone versus hydroquinone alone in facial melasma treatment: a randomized, double-blind, controlled clinical trial.

BACKGROUND: Clobetasol has demonstrated remarkable results in treating melasma within a short time frame; however, its use is limited because of the risk of local side effects. To date, there is no controlled trial on sequential clobetasol/hydroquinone for melasma. This study aimed to investigate the tolerability and efficacy of 0.05% clobetasol followed by 4% hydroquinone (CLOB-HQ) in comparison to the isolated use of 4% hydroquinone (HQ). METHODS: A double-blinded, randomized clinical trial involving 50 women with facial melasma was performed. They were directed to apply 0.05% clobetasol every night for 14 days, followed by 4% hydroquinone for 46 days (CLOB-HQ group), or the use of hydroquinone for 60 days (HQ group). Evaluations were carried out at inclusion, and after 14 and 60 days of treatment, measuring modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life scale (MELASQoL), and colorimetry. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator. RESULTS: There was no difference in the main outcomes at D14 and D60 (P > 0.1). For CLOB-HQ, the mean (CI 95%) reduction in mMASI was 13.2% (5.1-21.3%) and 43.1% (32.2-54.0%) at D14 and D60, and for HQ, they were 10.6% (5.9-27.5%) and 44.8% (33.2-52.3%). The MELASQoL, colorimetric luminosity, and GAIS showed a progressive improvement for both groups despite no difference between them. No severe side effects were identified. No cases of telangiectasias, atrophy, or perioral dermatitis were associated with the use of CLOB. CONCLUSION: The sequential CLOB-HQ regimen was safe and well tolerated, even though its efficacy was not different from HQ after 14 or 60 days of treatment. Based on these findings, the use of clobetasol 14 days before hydroquinone is not advisable for the treatment of melasma.

Dermatological ultrasound in assessing skin aging.

Ultrasonography (US) has emerged as a pivotal tool in Dermatology since its inaugural use in 1979. Its evolution encompasses technological advancements, higher frequencies, and diverse applications in clinical, surgical, and research aspects. The discussion centers on its crucial role in assessing skin aging through various parameters such as skin thickness, subepidermal low echogenicity band (SLEB) characterization, and echogenicity assessment. This analysis can help guide interventions in a more personalized manner for each patient and assess the effectiveness of cosmetics and procedures. Despite its widespread utility, challenges persist, including discrepancies in research outcomes, operator dependence, inability to detect minute lesions, and measurement variations throughout the day. Combining US with complementary methodologies is advocated for a better understanding of skin aging in vivo. The cost-effectiveness and non-invasiveness of the US emphasize its promising future in dermatology, but ongoing research remains imperative to enhance its accuracy and expand its applications.

Efficacy and safety of botulinum toxin for rosacea with positive impact on quality of life and self-esteem.

BACKGROUND: Rosacea is a prevalent chronic inflammatory skin disease with a multifactorial pathophysiology. It compromises several skin structures, including the proliferation and dilation of dermal blood vessels, primarily in the central areas of the face, accompanied by significant psychosocial impairment, leading to reduced quality of life (QoL) and self-esteem. There are consensus guidelines for its treatment, but few options for the erythema. This study hypothesizes that treating rosacea skin lesions with botulinum toxin (BTX) could improve signs and symptoms, resulting in enhanced QoL and self-esteem. METHODS: This interventional, open, uncontrolled, and prospective study, conducted at a single center, included 33 individuals diagnosed with rosacea, treated with standard therapeutic options according to the rosacea subtype plus superficial injections of BTX, and followed up for 90 days. Botulinum toxin injections were applied on Days 1 and 14. Clinical features and side effects were assessed at each visit; QoL, self-esteem, and medication adherence questionnaires were administered on Days 1 and 90. RESULTS: Treatment with BTX yielded improvement in the clinical signs of rosacea, registered by the investigators, and reported by 94% of the participants. Improved QoL scores (P < 0.05) and a notable increase in self-esteem scores (P < 0.001) were demonstrated. Rare adverse events were observed. CONCLUSIONS: The utilization of BTX superficial injections in patients with rosacea was safe and effective, improving the clinical appearance of the lesions. Despite some limitations, to our knowledge, this is the first study that showed the positive impact of this treatment modality on both QoL and self-esteem.

Association Between Frequent Use of Makeup and Presence of Depressive Symptoms-Population-Based Observational Study, Including 2400 Participants.

INTRODUCTION: The increased prevalence of depression is a global phenomenon, with an estimated 320 million cases worldwide. In Brazil, the World Health Organization (WHO) estimated that there are about 12 million cases or more, mainly among adult women with lower socioeconomic status, leading to a high consumption of health resources. Studies suggest a positive association of measures related to appearance care on depressive symptoms, but usually with no objective methodology. This study aimed to estimate the prevalence of depressive symptoms in adult Brazilian women with lower purchasing power and to verify the association between the intensity of symptoms and the use of makeup. METHODS: A national sample of 2400 cases from all regions of the country, drawn randomly from an online panel representative of the Brazilian population, was studied using an online questionnaire accessible via computer or smartphone, from which the frequency of use of makeup was surveyed, and the Zung Depressive Self-Rating Scale was applied for the inventory of symptoms. RESULTS: A prevalence of 61.4% (0.59-0.63) of depressive symptoms was identified. The association between frequent use of makeup and a lower prevalence of cases with a Zung index suggestive of mild depression was confirmed. Association between frequent use of makeup and lower intensity of depressive symptoms was also identified among cases with a Zung index suggestive of absence of depression. Additionally, an association was identified between the habit of frequent use of makeup and higher economic class as well as the younger age group. CONCLUSION: The results suggest the hypothesis that use of makeup may contribute both to a lower prevalence of mild depression and less expressive symptoms when index of absence of depression is observed.

The usefulness of a dermocosmetic containing Myrtus communis extract and azelaic acid for maintenance phase of adult female acne: Results from a randomized exploratory investigator-blinded comparative study.

BACKGROUND: Acne is a very common condition. Currently, there are relatively few studies available to help guidance-based decisions for its long-term management, especially studies with cosmetic care products. We have developed a skin care product dedicated to adult female acne. OBJECTIVES: Evaluate the efficacy and tolerance of the test product containing Myrtus communis extract and azelaic acid compared with a light moisturizing cream (LCM) in adult females in the acne maintenance phase. METHODS: A clinical study was conducted as a Brazilian, multicentre, randomized, investigator-blinded trial in adult females with clear or almost clear facial acne after anti-acne treatment. The test group (26 subjects) applied the test product and the comparative product group (27 subjects) applied LCM. Both groups applied the products twice daily on the whole face. Subjects were evaluated every 4 weeks over 16 weeks. Efficacy was evaluated according to acne relapse; Investigator's Global Assessment (IGA); acne lesions counting; AcneQoL questionnaire; Subject Global change Assessment (SGA) of acne severity; and the number of Post-Inflammatory Hyperpigmentation (PIH) and Post-Inflammatory Erythema (PIE) lesions. Tolerance was assessed according to a 5-point scale. RESULTS: Over 16 weeks, the number of acne relapse was more than double in the comparator compared to the test product group (eight subjects vs. three subjects respectively). There was no statistical difference in the evolution of the mean IGA from baseline between the two groups; however, 85% of subjects were assessed as clear or almost clear in the test product group and 67% in the comparative group. CONCLUSIONS: This study demonstrated the effectiveness topical application of the test product compared to LCM on acne severity in the maintenance phase of adult female acne. Efficacy results after 16 weeks suggested a trend to limit acne relapses and a benefit of the test product in maintaining long-term remission.

Perspectives of topical formulations for melasma.

Melasma is acquired hyperpigmentation that mainly affects the face, can cause negative changes in self-esteem, and mostly affects women. Treatment is difficult, and different drugs can be used in mono or combination therapy. In this article, we present a brief overview of melasma, how to evaluate it, and a synthesis of the most commonly used topical therapies and their indications, including sunscreens, pharmacological agents, and plant extracts. Hydroquinone (4%) in monotherapy or combined with corticosteroids (dexamethasone and fluocinolone acetonide) and retinoids (tretinoin); arbutin (1%); methimazole (5%); kojic (2%), azelaic (20%), and tranexamic (5%) acids are the pharmacological agents that stand out. Correct application of these substances determines a variable improvement in melasma but often causes adverse reactions such as erythema, itching, and burning at the application site. Vitamin C can contribute to the reduction of melasma and have little or no adverse effects while sunscreens are normally used as coadjuvant therapies. In conclusion, we have compiled specific topical therapies for treating melasma and discussed those that are the most used currently. We consider it important that prescribers and researchers evaluate the best cost-benefit ratio of topical therapeutic options and develop new formulations, enabling efficacy in the treatment with safety and comfort during application, through the reduction of adverse effects.

Efficacy and Safety of Topical or Oral Hydrolyzed Collagen in Women with Dermatoporosis: A Randomized, Double-Blind, Factorial Design Study.

BACKGROUND: Dermatoporosis defines the progressive chronic cutaneous insufficiency syndrome. Stage I is characterized by cutaneous atrophy, senile purpura, and stellate pseudoscars. OBJECTIVE: To assess clinical, histologic, quality of life, and biophysical effects of oral and/or topical hydrolyzed collagen (HC) on forearm skin of postmenopausal women with Dermatoporosis stage I. METHODS: Double-blind randomized placebo-controlled factorial design study. Two groups of menopausal women with stage I dermatoporosis on forearms were randomized to oral HC 5 g/day or matching placebo, and also to topical serum 2.5% HC or matching placebo once a day, for 6 months. RESULTS: A total of 56 women, age range 60-93 years (mean 69.5 ± 7.3 years) were included. Comparing data from baseline and after 6 months, no significant difference was observed for each intervention nor their comparison, for all efficacy parameters: clinical and quality of life scores, dermal elasticity, thickness and echogenicity, and histologic and immunohistochemical markers (p > 0.1). LIMITATIONS: Larger studies to confirm our findings are warranted. CONCLUSIONS: In menopausal women with stage I dermatoporosis, oral or topical collagen peptides used alone or in combination do not have benefits on forearm skin after 6 months of intervention, and therefore should not be used routinely in this population. CONSORT flow chart.

Update on Melasma-Part I: Pathogenesis.

Melasma is a multifactorial dyschromia that results from exposure to external factors (such as solar radiation) and hormonal factors (such as sex hormones and pregnancy), as well as skin inflammation (such as contact dermatitis and esthetic procedures), in genetically predisposed individuals. Beyond hyperfunctional melanocytes, skin with melasma exhibits a series of structural and functional alterations in the epidermis, basement membrane, and upper dermis that interact to elicit and sustain a focal hypermelanogenic phenotype. Evolution in the knowledge of the genetic basis of melasma and the cutaneous response to solar radiation, as well as the roles of endocrine factors, antioxidant system, endothelium proliferation, fibroblast senescence, mast cell degranulation, autophagy deficits of the melanocyte, and the paracrine regulation of melanogenesis, will lead to the development of new treatments and preventive strategies. This review presents current knowledge on these aspects of the pathogenesis of melasma and discusses the effects of specific treatments and future research on these issues.

Update on Melasma-Part II: Treatment.

Melasma is a prevalent chronic relapsing pigmentary disorder that affects photoexposed areas, especially in women of childbearing age. Although there is currently no curative treatment available for melasma, this manuscript critically reviews the knowledge regarding photoprotection, topical and oral therapies, and procedures such as peelings, laser, and microneedling that represent the main strategies for control and prevention of this disease. As the pathogenesis of melasma is not entirely understood, there are prospects for the development of new therapeutic strategies that might act on the pathways that promote sustained pigmentation rather than merely decreasing melanin synthesis and removing melanin from the epidermis.

Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling: A randomised clinical trial.

Background Melasma is an acquired dyschromia with several histologic alterations in the epidermis, basement membrane and upper dermis. The treatment of melasma is challenging due to the irregular response and chronicity of the disease. To date, there are no curative strategies, largely due to the limited understanding of the intrinsic effects of each treatment. Objectives The objective of the study was to evaluate the histological changes promoted by triple combination cream, with or without complementary treatment with microneedling and oral tranexamic acid, in the treatment of melasma. Methods A factorial, randomised, controlled and evaluator-blinded clinical trial was performed involving 64 women with facial melasma, divided in four groups, who underwent 60 days of treatment with triple combination cream alone (control group) or combined with two monthly microneedling sessions (microneedling group), TA 250 mg twice daily (tranexamic acid group), or both tranexamic acid group and microneedling group. The participants underwent biopsy of the area with melasma at inclusion (D1) and D60. The primary outcomes were the variation (D1 × D60) between the variables: Thickness of the epidermis and stratum corneum, stratum corneum compaction and solar elastosis; melanin density in the epidermis and upper dermis; proportion between the extension of the nonintact and intact basement membrane zone; mast cell count in the upper dermis; melanocyte count in the basal layer, pendulum melanocyte count and melanocyte area; immunostaining density of vascular endothelial growth factor; stem cell factor and keratinocyte growth factor. Results One participant in the TG discontinued tranexamic acid due persistent headache; and herpes simplex occurred in three patients after microneedling. The groups showed a 24% (CI95%: 17-35%; P < 0.01) reduction in epidermal melanin density. There was no change in dermal melanin density or the area of melanocytes after treatment. There was an overall 25% (CI95%: 7-42%; P < 0.01) reduction in the number of pendulum melanocytes, especially in the microneedling and tranexamic acid group, that presented a 41% (CI95%: 7-73%; P < 0.01) reduction. The extension of the nonintact basal membrane relative to the intact basal membrane decreased after treatment, especially in microneedling group and microneedling and tranexamic acid group. There was an increase of 13% (CI95%: 5-21%; P = 0.02) in epidermal thickness and 6% (CI95%: 0-22%; P = 0.04) thinning of the stratum corneum in the groups. All groups showed stratum corneum compaction. Solar elastosis improved only in the microneedling group and microneedling and tranexamic acid group. Vascular endothelial growth factor immunostaining increased 14% (CI95%: 4-24%; P = 0.03) in the groups; and stem cell factor increased only in microneedling group. There was no change in the number of mast cells, CD34 and keratinocyte growth factor immunostaining. Limitations The site of biopsy may not represent all of the facial melasma and the immunohistochemical sensitivity of the cytokines does not have a stoichiometric relationship with proteins. Conclusion A greater thickness of the epidermis is associated with melasma bleaching. Dermal melanin seems to have no impact on melasma prognosis. Damage to the skin barrier and stimulus of angiogenesis should be avoided in the treatment of melasma. Microneedling complements the topical treatment of melasma by improving patterns of skin photoaging. Oral tranexamic acid complements the topical treatment of melasma by inhibiting the stem cell factor.

Prevalence and factors associated with gynoid lipodystrophy in Brazilian adolescent girls: a cross-sectional study.

BACKGROUND: Gynoid lipodystrophy (GLD), or female cellulitis, is a chronic multifactorial disorder characterized by the irregular appearance of the skin surface on the thighs and gluteal regions, which affects 80-90% of women after puberty. No curative treatments are available, and there is a paucity of epidemiological studies related to its prevalence, quality of life impact, and risk factors. We aimed to identify the prevalence and factors associated with the development of GLD in Brazilian adolescent girls. METHODS: A cross-sectional study examined adolescent girls from São Paulo, Brazil. The explored factors were grouped: familial history, gynecological and hormonal characteristics, exercise practice, nutrition and diet, anthropometric measures, body mass index, and body composition, according to GLD severity assessed through multivariate hierarchic statistics. RESULTS: In total, 184 girls, aged from 12 to 18 years, were included in the study. The overall prevalence of GLD was 77.7% (CI 95% 71.7-82.1%); moderate and severe categories of GLD occurred in 56.5% (CI 95% 48.9-62.5%) of the sample. An impact on the quality of life was identified in 39.7% of the girls. GLD was independently associated with higher body mass index, early menarche, higher carbohydrate intake, lower water consumption, menstrual irregularity, familial report of GLD, and less exercise practice. CONCLUSION: Gynoid lipodystrophy is a multifactorial disorder; its onset in adolescent girls is associated with familial occurrence, body composition, diet habits, exercise, and hormonal factors. These results support further interventions for GLD prevention and treatment.

Cienciometria: uma ferramenta para inserção da Dermatologia brasileira na produção científica mundial / Scientometrics: a tool for the insertion of Brazilian Dermatology in the world scientific production

Introdução: foi verificada a produção científica brasileira em Dermatologia no cenário internacional pela Cienciometria (segmento da Sociologia sobre aspectos quantitativos da ciência). Objetivo: é plausível afirmar que a inserção do Brasil na produção científica internacional pode e deve ser realizada a partir de uma perspectiva mais estratégica, sendo necessário observar a produção de documentos indexados em Scopus na área de Dermatologia e temas relacionados de forma mais minuciosa. Métodos: por meio de pesquisa exploratória, quanti-quali indutiva na plataforma Scopus - plataforma digital que reúne mais de 25 mil artigos científicos e disponibiliza ferramentas analíticas para extrair resultados e tendências no campo da pesquisa -, foi possível obter dados quantitativos sobre a produção científica brasileira em Dermatologia geral e em seis dermatoses proeminentes. Resultados: foi possível extrair análise a fim de apontar as dermatoses mais importantes atualmente na literatura e os autores relacionados, comparar os dados brasileiros com os de outros países que se destacam na literatura científica em Dermatologia e elaborar e justificar as estratégias efetivas de inserção internacional da produção científica da Dermatologia brasileira

Introduction: The Brazilian scientific production in Dermatology in the international scenario was verified by scientometrics (Sociology segment on quantitative aspects of science). Objective: The insertion of Brazil in the international scientific production scenario can and should be conducted from a more strategic perspective, and it is necessary to observe the production of documents indexed in Scopus in the Dermatology area and related topics in a more detailed way. Methods: Through exploratory, inductive, quantitative, and qualitative research on the Scopus platform ­ a digital platform comprising more than 25 thousand scientific articles and analytical tools to extract results and trends in the field of research, it was possible to obtain quantitative data on Brazilian scientific production in General Dermatology and six prominent dermatoses. Results: It was possible to analyze and point out the most prominent dermatoses currently in the literature and the related authors, compare Brazilian data with those from other countries that stand out in the scientific literature in Dermatology, and elaborate and justify effective strategies for the international insertion of Brazilian Dermatology scientific production.

Transcriptomic and histological analysis of exposed facial skin areas wrinkled or not and unexposed skin.

BACKGROUND: Skin aging involves genetic, environmental and hormonal factors. Facial wrinkles also depend on muscular activity. Gene expression investigation may be useful for new anti-aging products. METHODS AND RESULTS: To evaluate structure and gene expression differences among exposed and unexposed skin in menopausal women. Cross-sectional study, including 15 menopausal women, 55-65 years, phototype III; photo-exposed, periorbital wrinkles (A1), preauricular, not wrinkled (A2), and unexposed gluteal (A3) areas were described and compared by non-invasive measures, histology, immunohistochemistry and gene expression (RNASeq); participants mean age was 61yo, presenting moderate periorbital wrinkles and light facial photodamage. Higher roughness, wrinkles number and echogenicity were observed in A1 and A2 versus A3. Decreased epidermal thickness and dermal collagen IV were demonstrated in A1 versus A2 and A3. Exposed areas impacted different pathways compared to unexposed. Exposed wrinkled skin (A1) showed impact on cell movement with decreased inflammatory activation state. Pathways related to lipid and aminoacids metabolism were modulated in non-wrinkled exposed (A2) compared to unexposed (A3) skin. CONCLUSIONS: Expected histological findings and gene expression differences among areas were observed. Photoaging in menopausal women may modulate lipid and aminoacids metabolism and decrease inflammatory and keratinization pathways, cellular homeostasis, immune response, fibrogenesis and filament formation. These findings may help development of new therapies for skin health and aging control.

Effectiveness of sunscreens and factors influencing sun protection: a review

Abstract The effectiveness of sun protection depends directly on the photo-protective product employed, the way it is used and the amount applied. Many studies report that sunscreens are often applied incorrectly, at amounts much lower than those recommended for the sun protection factor (SPF) specified on the label. When not used properly, the effectiveness of the product against sun exposure damage is reduced. Currently, sunscreens are available in a variety of different formulations and types, such as stick (bar), aerosol, cream, lotion, oil, tanning formulations and makeup. However, developing an effective stable photo-protective formula that can be correctly applied regardless of type poses a challenge, as effectiveness is dependent on several factors. Factors influencing effectiveness include sun exposure conditions (direct or indirect), level of protection (SPF), amount of product applied, maximum exposure period before reapplication, product type (spray, lotion, etc.), layer thickness required, coverage, and ability to spread and permeate into the skin. Studies comparing the effectiveness of different forms of sunscreens, the amount of product applied by consumers and SPF and UVA protection determined by validated methodologies, are lacking. Therefore, the objective of this study was to review the available literature on the topic and discuss the effectiveness of sunscreen formulations and factors influencing sun protection. This review was carried out on the scientific databases MEDLINE, PubMed and Scielo. Of the many publications retrieved, thirty-nine articles most relevant for this review were selected.

Treatment challenges in adult female acne and future directions.

Introduction: Acne is a chronic, inflammatory, and immune-mediated disease of the pilosebaceous unit, highly prevalent in adolescents. However, an increasing number of adults over 25 years old with facial acne, particularly women, have been observed. It is considered a different disease when compared to acne vulgaris. Face is the mainly involved area with inflammatory lesions and more sensitive skin, pointing out the need of a holistic approach.Areas covered: We performed a comprehensive literature search on PubMed database, up to January 2021, regarding adult female acne. We synthesized data about pathogenesis; differences compared to acne vulgaris; and treatment, with focus in the management challenges and perspectives.Expert opinion: It is essential to value the negative impact on quality of life of adult female acne, independently of severity. The disease has prolonged evolution, and patient might be resilient once the improvement, regardless of the treatment option, will just be noticeable after 3 months. Aggravating factors should be clearly discussed, such as the need of changing many habits, especially lesions manipulation. The therapeutic regimen includes make-up and tailored skin care (considering proneness to sensitivity), while anti-acne drugs should be chosen in accordance with desire to be pregnant, presence of pregnancy or breastfeeding.