Adult female acne and associated risk factors: Results of a multicenter case-control study in Italy

J Am Acad Dermatol. 2016 Dec;75(6):1134-1141.e1. doi: 10.1016/j.jaad.2016.06.060. Epub 2016 Aug 16.


Background: The reasons for the appearance of acne in adulthood are largely unknown.

Objective: We explored the role of personal and environmental factors in adult female acne.

Methods: We conducted a multicenter case-control study in the outpatient departments of 12 Italian cities. Cases (n = 248) were consecutive women ≥25 years of age with newly diagnosed acne of any grade. Controls (n = 270) were females diagnosed with conditions other than acne.

Results: In multivariate analysis, a history of acne in parents (odds ratio [OR] = 3.02) or siblings (OR = 2.40), history of acne during adolescence (OR = 5.44), having no previous pregnancies (OR = 1.71), having hirsutism (OR = 3.50), being an office worker versus being unemployed or being a housewife (OR = 2.24), and having a high level of reported psychological stress (OR = 2.95) were all associated with acne. A low weekly intake of fruits or vegetables (OR = 2.33) and low consumption of fresh fish (OR = 2.76) were also associated with acne.

Limitations: We did not establish an onset date for acne. Some of our associations may reflect consequences of established acne.

Conclusion: Lifestyle factors may play an important role for acne development in adulthood, but their role should be further assessed in prospective studies.

Keywords: adult female acne; case-control study; diet; family history; risk factors; stress.

Publication types

  • Multicenter Study

MeSH terms

  • Acne Vulgaris / epidemiology*
  • Acne Vulgaris / genetics
  • Adolescent
  • Adult
  • Case-Control Studies
  • Diet*
  • Female
  • Fruit
  • Gravidity
  • Hirsutism / epidemiology*
  • Humans
  • Italy / epidemiology
  • Occupations
  • Recurrence
  • Risk Factors
  • Seafood
  • Stress, Psychological / epidemiology*
  • Unemployment
  • Vegetables