Resumen

Objectives: How female acne needs an holistic and specific management Introduction: Adult female acne (AFA) has become one of the most frequent dermatological consultations worldwide, driven by lifestyle, hormonal fluctuations, stress, cosmetics, sleep disruption, and microbiome alterations. In 2026, its management relies on a more personalized, phenotype-driven, and biomarker-informed approach, integrating traditional therapeutics with new evidence on hormones, inflammation, skin barrier biology, and the follicular microbiome. Materials / method: AFA presents predominantly with inflammatory papules on the lower face, jawline, and neck, often associated with sensitive skin, post-inflammatory hyperpigmentation, and significant psychosocial burden. Unlike adolescent acne, it is frequently chronic, relapsing, and triggered by stress-induced neuroinflammation, dietary glycaemic load, endocrine disruptors, and cosmetic products. Updated 2025 global guidelines emphasize a combined endocrine–inflammatory–microbiome perspective. Results: First-line management in 2026 still includes topical retinoids and benzoyl peroxide (fixed combination) Topical anti-androgens such as clascoterone 1% have become standard for hormonally driven AFA. Azelaic acid remains central, especially for post-inflammatory pigmentation. Advances in microbiome skincare, including postbiotics and non-disruptive cleansers, Systemic therapy with low-androgenic progestins, spironolactone, metformin for polycystic ovary syndrome features represent alternative to isotretinoin in moderate to severe female acne. In 2026, the role of diet is establish Conclusion: Procedural dermatology has expanded its place in AFA care. LED therapy, fractional lasers, microneedling, and energy-based devices are widely combined to accelerate clearance, treat scarring, and improve pigmentation. Overall, managing adult female acne in 2026 requires a holistic approach addressing hormones, lifestyle, stress axes, microbiome balance, and barrier health, alongside evidence-based topical and systemic treatments.