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Adult Female Acne

Clinical Pearls for NPs: Adult Female Acne, Patient Education


Acne vulgaris is one of the most commonly treated dermatologic diseases in adult females, but treatment selection and patient education should be tailored specifically to this population.

These recommendations for patient education are part of a Continuing Education activity that can be found here.


Adult female acne can be caused or exacerbated by heavy use of cosmetics. Although C. acnes is the most common pathogen in acne, individual cosmetic practices by females may also impact the skin health. In a study investigating the extent of microbial contamination of cosmetic products, researchers identified the specific type and load of bacteria in lipstick, lip gloss, eyeliners, mascaras, and beauty blenders. The role and potential risk of all of the pathogens for acne have not been determined but are concerning. Approximately 79% to 90% of the products were contaminated with bacteria including Staphylococcus aureus, Escherichia coli, and Citrobacter freundii. In addition, beauty blenders had a high prevalence of Enterobacteriaceae and fungi (56%–96%). Patient education on the use and cleaning of cosmetics and applicators should be foremost in avoiding use of contaminated products. About 93% of the beauty blenders had not been cleaned, while 64% were reported dropped on the floor and continued use.

Skin care

All acne care should begin with washing twice daily using a gentle cleanser along with other measures to prevent/control flares. Patients benefit from education that guides them through avoiding the gauntlet of skin care products with unfounded advertisements promising a cure for acne.

Lifestyle modifications

It is postulated that foods with high glycemic index, dairy products, high stress levels, and lack of sleep may all play a role in the severity of acne in some females. Further studies are required to fully understand the impact of these factors but talking to patients about how some of these can contribute may prompt lifestyle changes that may make a positive difference in both their acne and overall health.

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