touchDERMATOLOGY coverage from EADV 2025:

Adult acne in women is common but often overlooked, with many patients experiencing persistent breakouts and significant emotional impact, including anxiety and low self-esteem. Despite its prevalence, gaps remain in understanding and treatment, underscoring the need for tailored approaches and increased research focus on this underserved population.

In this interview, expert faculty member Prof. Dedee Murrell (St George Hospital Campus, Kogarah, Sydney, Australia) highlights the key factors driving adult acne in women, how this can impact the quality of life of patients, and the unmet needs and advancements in treatment.

“Understanding adult acne in women: challenges and updates” was presented at EADV 2025, 17-20 September, Paris, France.

What are the key factors driving adult acne in women and how do they differ from adolescent acne?

There hasn’t been a lot of research into adult acne, most research has been carried out in teenage acne – the typical acne. However, research has shown that approximately 30% of acne can persist into adulthood and that this happens more often in women than men. A lot of teenage acne is believed to be driven by testosterone, but, as we know, women have much lower testosterone levels than men. So why do more women have acne than men?

In the case of adult women, some of the research has shown that women are more likely to have insulin resistance. This is inherited through the family and can cause patients who consume dairy products containing whey protein, such as milk, or who follow a diet high in carbohydrates, beyond what the body can handle, to trigger the mammalian target of rapamycin complex 1 (mTORC1) pathway.

mTORC1 is a signalling pathway in the body that creates proteins and builds muscles, when there is enough energy. If the diet is triggering too much insulin in the body it produces seborrhea in the skin. Insulin resistance can cause: the body to conserve fat; mood swings; changes in the reproductive cycle causing irregular periods; and the development of polycystic ovaries. This seems to be a big part of female acne.

Could you describe the emotional toll of adult acne and how this can affect patient quality-of-life?

There are a lot of studies on teenagers which show the significant effect of teenage acne. This is the age when patients might start getting bullied at school or on social media, and there’s been a suicide increase in that age group.

Surprisingly, studies in adult women have shown an even greater quality-of-life impairment, as many people expect acne to have resolved by adulthood and it’s also a time when they’ll face judgement by employers and want to make a lifelong partnership. If people have visible acne on their face, which is difficult to disguise, it really affects them emotionally – the stigmatisation doesn’t go away just because they have left school.

What unmet needs persist in this indication, and why is acne so challenging to treat?

There are a lot of unmet needs in adult acne. Firstly, we don’t fully understand adult acne, therefore we don’t have any specific treatments – we only have traditional therapies.

Like in many research situations, what’s new in acne is accidental: you discover something useful by something bad happening. In this case, a previous Ukrainian President was poisoned with dioxin causing his face to be completely pockmarked with acne. Following this, researchers started looking into what they could do to prevent this acne from causing so much scarring. What they found in this research was that dioxin was stimulating the aryl hydrocarbon receptor, and this was acting on one of the liver enzymes that’s also expressed in the skin.

A study from Italy examined biopsies from patients with persistent acne who were suspected of having been exposed to an environmental toxin. Sixteen of these patients had just as high expression and activation of this receptor pathway as people who had been poisoned with dioxin.

There have also been further studies which have shown that UV light can trigger this pathway, which is surprising as a lot of doctors recommend UV as a way to improve acne. Furthermore, certain foods and vegetables that are in the diet can stimulate it.

Makeup or skincare could also be causing acne. There is not a lot of policing of the different ingredients and how they work together, individually there is, but what happens when the ingredients are mixed together? A recent paper about benzoyl peroxide showed that while it’s good at killing off some acne bacteria, if it’s left out in the heat, it produces toxic chemicals. Showing that although benzoyl peroxide works when it is tested, when it goes into the environment and is heated, the chemical properties might change.

What recent advances are shaping treatment strategies for adult acne in women?

There is an extract from milk thistle, which is called silybum marianum, which researchers found is inhibiting the activation of the aryl hydrocarbon receptor. Often plants naturally produce these detoxifying agents, if they’re out in the environment and they are exposed to chemicals. This detox compound is in a line of products called Cleanance Comedomed, and there have been randomised controlled studies of products with or without this ingredient to show that it can reduce the size of comedones.

They have also demonstrated that the activation of this pathway reduces keratins 75 and 79, which are normally expressed in sebaceous glands, causing an abnormal production of large blackheads; the comedo-switch. This product helps to reverse that and to prevent the acne from coming back, for example, when patients have finished a course of treatment and the skin appears to be clear. There was a study which showed that 85% of patients using the product maintained clear skin, with about 4% of patients having to go back on antibiotics.

We’ve been using taparinof, an aryl hydrocarbon agonist, to treat eczema, but that wasn’t applied to people who had acne because they were excluded from the trials, so it would be interesting to see if any acne is being induced by the activator. Recently, clinical trials have been carried out on a testosterone blocker, clascoterone, which was shown to be effective for acne patients.

A clinical trial I would like to see would be a trial of GLP-1 inhibitors against placebo to see if they would work as a treatment for acne in adult women. We’ve seen case reports of women who have insulin resistance, obesity or polycystic ovaries, taking GLP-1 inhibitors. I’ve had to give GLP-1 inhibitors to some of my patients with severe acne, who could not tolerate metformin, where a persistent insulin resistance was causing acne. Some of these patients have gone on to these treatments and got better, just like hidradenitis patients.

How might personalized medicine and emerging research influence the future management of adult acne?

I think what’s exciting is that the cost of whole exome sequencing has come way down, at least performed in some countries like China. With such information, if that was done in a group of people with acne, it might give us better insights into how to personalize treatment.

For example, this could indicate who has insulin resistance genes, who has a polymorphism in the aryl hydrocarbon receptor meaning that they’re more susceptible to toxins in the environment than others, and then there’s the genetics of how patients respond to normal hormone levels and how many testosterone receptors they’ve got in their skin. That would enable us to personalize therapy towards the underlying cause of the acne.