Acne

Data gathering

  • Red flags – scarring, mood
  • Others – weight gain, facial hair, irregular periods, impact
  • Examine – assess severity
    • Mild
      • Open + closed non inflammatory comedones, some papules and pustules
    • Moderate
      • Inflamed lesions + papules/pustules +- scarring
    •  Severe
      • Nodular abscesses/cysts + inflammatory papules/pustules leading to extensive scarring

 

Clinical management

  • Explanation
    • Acne is due to some skin pores becoming blocked by the natural skin oil sebum, bacteria can then multiply in these blocked pores, irritation of the surrounding skin can then happen
    • Not caused by diet, hygiene
    • Not contagious
  • Treatment
    • Lifestyle – avoid triggers, wash face BD, avoid picking spots (can cause scarring)
    • Topical preparations
      • may cause dryness and irritation, use 2 times/week initially then build up to once/night
    • Medications
      • see below
  • Follow-up / Safety net
    • Refer
      • inadequate response to two courses of oral antibiotics > 6 months

 

Medications

  • 1st line
    • Topical retinoid – Adapalene (AVOID in pregnancy) or topical benzoyl peroxide
  • 2nd line
    • Combination preparation AM (e.g. Zineryt/Duac/Aknemycin) + benzoyl peroxide PM
  • 3rd line
    • Oral antibiotic
      • Lymecycline 400mg OD
      • Doxycycline 100mg OD
      • Erythromycin 500mg BD
    • COCP
      • Dianette – max 2 years due to increased VTE risk + monitor LFTs
      • COCP – containing 30mg ethinylestradiol with norethisterone or levonorgestrel

nb: keep in mind teratogenicity of some oral antibiotics and topical retinoids