ACNE VULGARIS

1
ACNE VULGARIS

• DR RAMINDER SAWHNEY
• GPR
• 17/2/05

2
ACNE - Goals

• Decrease scarring
• Decrease unsightly appearance
• Decrease psychological stress
• Explain long length of treatment may be several
  months and initial response may be poor but must
  persevere (poor compliance has been demonstrated
  in studies at 3/12)

3
ACNE What is it?

• Disease of pilosebaceous follicle
• Non-inflammatory
• Comedones - open blackhead
• - closed whitehead
• Inflammatory
• - papules,
• - pustules, - nodules
• - scarring

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Acne vulgaris comedones dominant
5
Acne vulgaris- pus dominant
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Acne Treatment

• Benzoyl peroxide-(cheapcheerful)
• Start at low strength 2.5 at night
• Mild erythema-transient
• Warn it bleaches clothes
• Build up to 10 gradually
• Stop if irritation occurs

7
Acne treatment

• Topical retinoids
• Start low strength (0.025)every other night-may
  cause redness/irritation
• Increase strength until response
• Avoid sunlight/uv light,not during pregnancy

8
Acne Treatment

• Topical Antibiotics-no better than benzoyl
  peroxide
• Reduces propionobacterium acnes
• Less irritation
• Topical tetracycline the cheapest
• Glows in UV light (warn patient not to go
  CLUBBING)

9
Acne treatment

• Azelaic acid cream-keratolytic
• Alters composition of fat/decrease bacteria
• Short term use only
• May cause irritation/ photosensitivity

10
Acne Treatment

• Oral Antibiotics
• Oxytetracycline 500mg bd
• Warn patient can take 6/52 for response-must be
  compliant.treat for 6 months
• Avoid milk,and have 30mins before meals
• If effective reduce dose to 500mg od and then
  250mg od at 3/12 intervals
• DO NOT GIVE WITH TOPICAL ABX-RESISTANCE.CAN
  COMBINE WITH OTHER TOPICALS

11
Acne treatment

• Oral abx cont
• If initially responds but then gets worse could
  be due to resistance
• Try erythromycin 500mgbd , trimethoprim 100-200mg
  bd ,doxycycline 100mg od
• Minocycline last resort(fears of hepatitis /
  pneumonitis/ pigmentation) cost

12
Acne treatment

• Hormonal
• In women on OCP consider less androgenic
  progestogen eg marvelon/cilest, but increased
  risk of DVT
• Consider cyproterone acetate with
  oestrogen(dianette) .NB endorse perscription with
  OC if patient using as a contraceptive(not
  licensed as a contraceptive)

13
Acne- referrals

• Refer if very severe or psychological distress
• Specialists can prescribe
• ISOTREIN(Roaccutane)-specialist only
  prescription.terratogeniclots of side effects
• UV light
• Intralesional steroid injections
• High dose antibiotics