ACNE VULGARIS
DR RAMINDER SAWHNEY
GPR
17/2/05
1
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)
2
ACNE – What is it?
Disease of pilosebaceous follicle
Non-inflammatory
Comedones - open blackhead
- closed whitehead
Inflammatory
- papules,
- pustules,
- nodules
- scarring 3
Acne vulgaris
comedones dominant
4
Acne vulgaris- pus
dominant 5
Acne Treatment
Benzoyl peroxide-(cheap+cheerful)
Start at low strength 2.5% at night
Mild erythema-transient
Warn it bleaches clothes
Build up to 10% gradually
Stop if irritation occurs
6
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
7
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)
8
Acne treatment
Azelaic acid cream-keratolytic
Alters composition of fat/decrease
bacteria
Short term use only
May cause irritation/ photosensitivity
9
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
10
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
11
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)
12
Acne- referrals
Refer if very severe or psychological
distress
Specialists can prescribe
ISOTREIN(Roaccutane)-specialist only
prescription.terratogenic+lots of side
effects
UV light
Intralesional steroid injections
High dose antibiotics
13