RISK FACTORS
β’ Adolescence; male sex
β’ Androgenic steroids, e.g., steroid abuse, some birth control pills
β’ Oily cosmetics, including cleansing creams, moisturizers, oil-based foundations
β’ Rubbing or occluding skin surface (eg, sports equipment - helmets and shoulder pads), holding the
telephone or hands against the skin
β’ Drugs - iodides or bromides, lithium, phenytoin, isoniazid, methotrexate, vitamin B-12, long acting progestins,
phenobarbital, ethionamide, azathioprine, disulfiram, cyclosporine
β’ Systemic corticosteroids
β’ Virilization disorders (PCOS)
β’ Hot, humid climate
GENERAL MEASURES
* Therapy goals - lessen physical discomfort, minimize scarring, improve appearance, avoid adverse psychological impact
* Cleansing: mild soap twice a day will control surface oiliness
* Avoid drying agents in combination with keratinolytics
* Skin type/recommended vehicle type: dry/sensitive - cream; oily - gel/solution; hairy - lotion
* Apply topicals to lesions and surrounding area
* Topical retinoid + antibiotic better than antibiotic alone
* Stop antibiotic therapy when lesions resolve
* Oil-free sun screens
* Stress management helpful if acne fl ares with stress
SURGICAL MEASURES
* Comedo extraction
* Injection of large cystic lesions with 0.05-0.3 mL of triamcinolone (Kenalog 2-5 mg/mL), use 30-gauge
needle, slightly distend cyst
* Acne scar treatment
1. TOPICAL AGENTS LIKE :
- RETINOIC ACID
-BENZOYL PEROXIDE
- SALICYLIC ACID
2. TOPICAL ANTIBIOTICS :
- CLINDAMYCIN
- ERYTHROMYCIN
- FUCIDIC ACID
- AZELAIC ACID
- BENZOYL PEROXIDE
3. SYSTEMIC ANTIBIOTICS :
- TETRACYCLINES
- MACROLIDES
4. HORMONAL THERAPY : WOMEN WHO DOES NOT RESPOND TO THESE THERAPIES MAY RESPOND TO ORAL CONTRACEPTIVES CONTAINING ETHINYL ESTRADIOL & NORGESTIMATE
5. ISOTRETINOIN : SHOULD BE USED WITH CAUTION BY EXPERTS ONLY AS IT IS TERATOGENIC.
POSSIBLE COMPLICATIONS
β’ Acne conglobata - a severe confl uent inflammatory acne with systemic symptoms
β’ Facial and psychological scarring
β’ Gram-negative folliculitis - superinfection due to long term oral antibiotic use, treatment with ampicillin,
trimethoprim-sulfa, isotretinoin