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Adult acne is a chronic inflammatory disease of the pilosebaceous unit characterized by the excessive production of abnormal sebum favoring an imbalance of the skin microbiota and the hyperproliferation of Cutibacterium acnes and other virulent microbial strains, leading to an inflammatory environment, innate immunity overactivation, and keratinocyte hyperproliferation in hair follicles pores. Degraded keratinocytes plug the pores, consequently forming microcomedons, which can later evolve to papules, nodules, pustules and scars. Distinct from juvenile acne, in adult female acne (AFA) the symptomatology occurs or persists in postadolescence (after age 25). Although hyperandrogenism or the excessive sensitivity of androgen receptors are the main causes, AFA can be triggered by multiple factors, either including or not including androgen disturbances. The prevalence in adult women is 15–20%. Hyperandrogenism is present in 50% of cases; 70% of hyperandrogenism cases feature polycystic ovary syndrome (PCOS), a complex endocrine and metabolic condition. Genetic susceptibility occurs in 80% of acne cases, often with familial inheritance. Beyond classical stepwise therapeutic protocols (topical agents, isotretinoin, antibiotics, hormonal therapy with estrogens, progestins, spironolactone), novel approaches include the highly effective topical antiandrogen clascoterone, the management of insulin resistance by diet, exercise, stress avoidance, and adjuvant therapies such as berberine. Vaccines against the pathogenic proinflammatory C. acnes hyaluronidase A are in development. [ABSTRACT FROM AUTHOR]

We present the case of a 39-year old male patient with various comorbidities including spastic paraparesis due to peripartum hypoxia subsequent to a gemellary pregnancy, coexisting with seizures (under treatment with sodium valproate), intravenous drug abuse since childhood, chronic hepatitis C virus (HCV) infection and human immunodeficiency virus (HIV) infection. Numerous hospitalizations and continuously monitored combined antiretroviral therapy were required for HIV infection. His immunocompromised status led to an infection started in 2013 with multi-drug resistant Mycobacterium tuberculosis, debuted in a lymph node and further extended to the lungs, brain and spleen, remitted after 2015. Since 2018, a different clinical entity appeared and the patient presented multiple condylomas in the genital and inguinal regions. The lesions progressed rapidly despite the self-administered treatment with 5mg/ml podophyllotoxinum cutaneous solution. During the most recent admissions the clinical picture consisted of extensive exophytic cauliflowerlike protrusions as well as plane brown-violaceous tumour masses located in the genital area, completely covering the inguinal folds, penian basis and scrotum bilaterally, without tendency to spontaneous remission. During hospitalization, multiple cryotherapy sessions combined with podophyllin cream 25% were performed. Due to a deficiency and asymmetry in walking, with the left lower limb more adducted than the right one, leading to relative closure of the right inguinal fold, lack of ventilation and a tendency to moisture formation and tissue maceration, the healing was slower on this side. The patient was discharged with an indication for home treatment with an ointment containing Camellia sinensis dry leaf extract, remaining under observation with monthly controls for some persisting lesions. [ABSTRACT FROM AUTHOR]