ADULT ACNE: HORMONAL FACTORS, PSYCHOSOCIAL IMPACT, AND CURRENT THERAPEUTIC APPROACH

Abstract

Acne that persists, relapses, or begins in adulthood is a clinically relevant problem because pilosebaceous unit activity, androgen signaling, scarring risk, and psychosocial burden interact over a prolonged disease course. This critical narrative review integrated evidence on hormonal factors, psychosocial impact, and contemporary treatment, with searches performed in 2026 in PubMed/MEDLINE, SciELO, and the Cochrane Library, complemented by guidelines and official documents. In 2021, an estimated 49.4 million prevalent cases occurred among people aged 25 years or older, with consistently higher burden among women. Androgen signaling may be relevant despite normal serum levels, whereas isolated acne remains a weak marker of biochemical hyperandrogenism. A meta-analysis found associations with depression (r = 0.22) and anxiety (r = 0.25). Current treatment combines maintenance topical therapy, judicious antibiotic use, selected hormonal options, and isotretinoin when indicated. Brazilian randomized evidence also supports clinical benefit from azelaic acid and spironolactone in adult women. Limitations include frequent mixing of adolescents and adults in trials and the inability of a narrative design to provide exhaustive effect estimates. Individualized care should integrate phenotype, scarring risk, psychosocial distress, reproductive context, access, and relapse risk.