Acne is most commonly seen during the teenage years, but can be seen in adults and young children as well. There are several types of acne, including comedonal, inflammatory, and nodulocystic. Comedonal acne consists of both closed comedones (whiteheads) and open comedones (blackheads). Inflammatory acne is erythematous and can be papular, pustular, or nodular. More inflammatory acne is known as nodulocystic acne, and consists of deeper nodules and cysts. Overlap is common.
Closed or open comedones, inflammatory papules, pustules, nodules, cystic lesions.
Most commonly found on the face, shoulders, and chest.
Most commonly in males and females 13-24 years of age.
ALL ACNE TREATMENTS TAKE WEEKS TO MONTHS TO WORK--- THEY ARE PREVENTING NEW LESIONS MORE THAN THEY ARE TREATING CURRENT ONES, SO RESULTS TAKE TIME.
- For comedonal acne, the most effective therapy is a topical retinoid (retinoic acid .025%) or retinoid derivative (retinoic acid, adapalene, and tazarotene). Used at bedtime.
- For inflammatory acne, topical antibiotic agents such as clindamycin, benzoyl peroxide/clindamycin or benzoyl peroxide/erythromycin combinations, sodium sulfacetamide, azelaic acid, salicylic acid BID should be added into the treatment regimen.
- For areas on the back and chest, use of a benzoyl peroxide wash can also be helpful.
- For nodulocystic acne, oral antibiotics should be initiated that cover P. Acnes. Common antibiotics that can be used include minocycline, doxycycline, tetracycline, and Keflex. If a three month course of one antibiotic does not result in any significant change, switching to another antibiotic can be helpful.
- For acne associated with menstrual cycles or in women with other signs of androgen excess, low-estrogen oral contraceptive pills can be a helpful adjunctive treatment. Ortho TriCylcen is one such agent.
- If different combinations of topical therapies for inflammatory acne do not result in any significant change, oral antibiotic therapy would be an appropriate next step (same agents as above). Remember that oral antibiotics do not show an improvement until 6 to 8 weeks of therapy.
Isotretinoin (original brand name Accutane) is reserved for acne resistant
to previous treatment, and requires careful monitoring of labs, pregnancy status,
appropriate contraceptive use, and evaluation for side effects including vision
changes, mood changes, suicide risk, and joint/muscle aches. Physicians must
follow the requirements set by the FDA, available on the web at: www.ipledgeprogram.com or