Acne, one of the most common skin problems in dermatological practice, is a condition that affects not only adolescents but also adults. While approximately 80% of cases occurring in adulthood are persistent from teenage years, around 20% are described as ‘late-onset' disease, appearing for the first time in adulthood. The disease can be triggered by hormonal changes (including a change from one contraceptive to another), or it can be induced by certain nonhormonal medications, emotional stress, and various underlying diseases such as polycystic ovary syndrome. In many cases acne becomes a chronic skin condition with undulating activity, including improvement and relapse phases, and is often experienced as a major psychological burden. It is, therefore, even more important to provide an effective as well as a safe and tolerable treatment. The spectrum of topical acne treatments has expanded substantially in recent years and various topical medications are available, ranging from azelaic acid, antibiotics, retinoids and benzoyl peroxide to several fixed combinations of these active compounds. The following case collection illustrates how 15% azelaic acid gel, as a well-established monotherapy, can be successfully employed to treat mild-to-moderate forms of adult female acne.

Cunliffe WJ, Gould DJ: Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J 1979;1:1109-1110.
Plunkett A, Merlin K, Gill D, Zuo Y, Jolley D, Marks R: The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia. Int J Dermatol 1999;38:901-908.
Goulden V, Stables GI, Cunliffe WJ: Prevalence of facial acne in adults. J Am Acad Dermatol 1999;41:577-580.
Choi C, Lee DH, Kim HS, Kim BY, Park KC, Youn SW: The clinical features of late onset acne compared with early onset acne in women. J Eur Acad Dermatol Venereol 2011;25:454-461.
Gamble R, Dunn J, Dawson A, Petersen B, McLaughlin L, Small A, Kindle S, Dellavalle RP: Topical antimicrobial treatment of acne vulgaris: an evidence-based review. Am J Clin Dermatol 2012;13:141-152.
Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, Thiboutot DM, Van Voorhees AS, Beutner KA, Sieck CK, Bhushan R: Guidelines of care for acne vulgaris management. J Am Acad Dermatol 2007;56:651-663.
Nazzaro-Porro M, Passi S: Identification of tyrosinase inhibitors in cultures of pityrosporum. J Invest Dermatol 1978;71:205-208.
Breathnach AS, Martin B, Nazzaro Porro M, Passi S, Mann P, Cooper J, Morpurgo G: Effect of dicarboxylic acids on normal human melanocytes in dispersed tissue culture. Br J Dermatol 1979;101:641-649.
Nazzaro-Porro M, Passi S, Picardo M, Breathnach A, Clayton R, Zina G: Beneficial effect of 15% azelaic acid cream on acne vulgaris. Br J Dermatol 1983;109:45-48.
Mastrofrancesco A, Ottaviani M, Aspite N, Cardinali G, Izzo E, Graupe K, Zouboulis CC, Camera E, Picardo M: Azelaic acid modulates the inflammatory response in normal human keratinocytes through PPARγ activation. Exp Dermatol 2010;19:813-820.
Hjorth N, Graupe K: Azelaic acid for the treatment of acne. A clinical comparison with oral tetracycline. Acta Derm Venereol Suppl (Stockh) 1989;143:45-48.
Katsambas A, Graupe K, Stratigos J: Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin. Acta Derm Venereol Suppl (Stockh) 1989;143:35-39.
Cavicchini S, Caputo R: Long-term treatment of acne with 20% azelaic acid cream. Acta Derm Venereol Suppl (Stockh) 1989;143:40-44.
Graupe K, Cunliffe WJ, Gollnick HP, Zaumseil RP: Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Cutis 1996;57:20-35.
Thiboutot D: Versatility of azelaic acid 15% gel in treatment of inflammatory acne vulgaris. J Drugs Dermatol 2008;7:13-16.
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO: The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-2749.
Azziz R, Marin C, Hoq L, Badamgarav E, Song P: Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 2005;90:4650-4658.
Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R: Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 2005;83:1717-1723.
Goodman G: Cleansing and moisturizing in acne patients. Am J Clin Dermatol 2009;10(suppl 1):1-6.
Kircik LH: Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study. J Drugs Dermatol 2011;10:586-590.
Thiboutot DM, Fleischer AB, Del Rosso JQ, Rich P: A multicenter study of topical azelaic acid 15% gel in combination with oral doxycycline as initial therapy and azelaic acid 15% gel as maintenance monotherapy. J Drugs Dermatol 2009;8:639-648.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.