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Marco Alexandre Dias da Rocha,1 Markéta Saint Aroman,2 Valérie Mengeaud,3 Fabienne Carballido,4 Gautier Doat,5 Ana Coutinho,6 Edileia Bagatin1 1Department of Dermatology, Universidade Federal de São Paulo, São Paulo, Brazil; 2Corporate Medical Direction Dermocosmetics Care & Personal Care, Pierre Fabre, Toulouse, France; 3Laboratoires Dermatologiques Ducray, Pierre Fabre Dermo-Cosmétique, Lavaur, France; 4Laboratoires Dermatologiques A-Derma, Pierre Fabre Dermo-Cosmétique, Lavaur, France; 5Laboratoires Dermatologiques Avène, Pierre Fabre Dermo-Cosmétique, Lavaur, France; 6Laboratorios Pierre Fabre do Brasil LTDA, Rio de Janeiro, BrazilCorrespondence: Marco Alexandre Dias da Rocha, Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), R. Botucatu, 821 - Vila Clementino, São Paulo, SP, 04039-001, Brazil, Tel +55-(11)-3129-5007, Email marcoderm@hotmail.comAbstract: 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.Keywords: adult female acne, epidemiology, treatment, dermocosmetics, menopause, hormonal dynamics

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. [ABSTRACT FROM AUTHOR]