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

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. ( J Am Acad Dermatol 2016;75:1134-41.)