Original Research

The Role of Adolescent Acne Treatment in Formation of Scars Among Patients With Persistent Adult Acne: Evidence From an Observational Study

Author and Disclosure Information

Persistent adult acne is one of the most difficult types of acne to treat. It is a long-lasting disease with uncontrolled exacerbations that often result in scarring. The aim of this study was to analyze the influence of acne therapy used in adolescence on patients who later developed persistent adult acne. The use of oral antibiotics, isotretinoin, and topical retinoids in adolescence and their role in diminishing scar formation during adult acne was analyzed. This population-based study included 111 patients, 91 of whom had persistent adult acne. Results indicated that the use of isotretinoin or topical retinoids for adolescent acne decreased the risk for scar occurrence in adulthood.

Practice Points

  • Postacne scarring is the most severe complication of acne.
  • Isotretinoin or topical retinoid treatment in adolescence decreases the risk for scars during adult acne, justifying the role of maintenance therapy with topical retinoids.



In the last 20 years, the incidence of acne lesions in adults has markedly increased. 1 Acne affects adults (individuals older than 25 years) and is no longer a condition limited to adolescents and young adults (individuals younger than 25 years). According to Dreno et al, 2 the accepted age threshold for the onset of adult acne is 25 years. 1-3 In 2013, the term adult acne was defined. 2 Among patients with adult acne, there are 2 subtypes: (1) persistent adult acne, which is a continuation or recurrence of adolescent acne, affecting approximately 80% of patients, and (2) late-onset acne, affecting approximately 20% of patients. 4

Clinical symptoms of adult acne and available treatment modalities have been explored in the literature. Daily clinical experience shows that additional difficulties involved in the management of adult acne patients are related mainly to a high therapeutic failure rate in acne patients older than 25 years. 5 Persistent adult acne seems to be noteworthy because it causes long-term symptoms, and patients experience uncontrollable recurrences.

It is believed that adult acne often is resistant to treatment. 2 Adult skin is more sensitive to topical agents, leading to more irritation by medications intended for external use and cosmetics. 6 Scars in these patients are a frequent and undesirable consequence. 3

Effective treatment of acne encompasses oral antibiotics, topical and systemic retinoids, and oral contraceptive pills (OCPs). For years, oral subantimicrobial doses of cyclines have been recommended for acne treatment. Topical and oral retinoids have been successfully used for more than 30 years as important therapeutic options. 7 More recent evidence-based guidelines for acne issued by the American Academy of Dermatology 8 and the European Dermatology Forum 9 also show that retinoids play an important role in acne therapy. Their anti-inflammatory activity acts against comedones and their precursors (microcomedones). Successful antiacne therapy not only achieves a smooth face without comedones but also minimizes scar formation, postinflammatory discoloration, and long-lasting postinflammatory erythema. 10 Oral contraceptives have a mainly antiseborrheic effect. 11

Our study sought to analyze the potential influence of therapy during adolescent acne on patients who later developed adult acne. Particular attention was given to the use of oral antibiotics, isotretinoin, and topical retinoids for adolescent acne and their potential role in diminishing scar formation in adult acne.

Materials and Methods

Patient Demographics and Selection
A population-based study of Polish patients with adult acne was conducted. Patients were included in the study group on a consecutive basis from among those who visited our outpatient dermatology center from May 2015 to January 2016. A total of 111 patients (101 women [90.99%] and 10 men [9.01%]) were examined. The study group comprised patients aged 25 years and older who were treated for adult acne (20 patients [18.02%] were aged 25–29 years, 61 [54.95%] were aged 30–39 years, and 30 [27.02%] were 40 years or older).

The following inclusion criteria were used: observation period of at least 6 months in our dermatologic center for patients diagnosed with adult acne, at least 2 dermatologic visits for adult acne prior to the study, written informed consent for study participation and data processing (the aim of the study was explained to each participant by a dermatologist), and age 25 years or older. Exclusion criteria included those who were younger than 25 years, those who had only 1 dermatologic visit at our dermatology center, and those who were unwilling to participate or did not provide written informed consent. Our study was conducted according to Good Clinical Practice.

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