11

ACNE VULGARISACNE VULGARIS

DR RAMINDER SAWHNEYDR RAMINDER SAWHNEY

GPRGPR

17/2/0517/2/05

22

ACNE - GoalsACNE - Goals

Decrease scarringDecrease scarring Decrease unsightly appearanceDecrease unsightly appearance Decrease psychological stressDecrease psychological stress Explain long length of treatment may Explain long length of treatment may

be several months and initial be several months and initial response may be poor but must response may be poor but must persevere (poor compliance has been persevere (poor compliance has been demonstrated in studies atdemonstrated in studies at 3/12)3/12)

33

ACNE – What is it?ACNE – What is it?

Disease of pilosebaceous follicleDisease of pilosebaceous follicle

Non-inflammatoryNon-inflammatoryComedonesComedones - open blackhead- open blackhead

- closed whitehead- closed whitehead

InflammatoryInflammatory- papules, - papules, - pustules,- pustules,

- nodules- nodules- scarring- scarring

44

Acne vulgaris Acne vulgaris comedones dominantcomedones dominant

55

Acne vulgaris- pus Acne vulgaris- pus dominantdominant

66

Acne TreatmentAcne Treatment

Benzoyl peroxideBenzoyl peroxide-(cheap+cheerful)-(cheap+cheerful) Start at low strength 2.5% at nightStart at low strength 2.5% at night Mild erythema-transientMild erythema-transient Warn it bleaches clothesWarn it bleaches clothes Build up to 10% graduallyBuild up to 10% gradually Stop if irritation occursStop if irritation occurs

77

Acne treatmentAcne treatment

Topical retinoidsTopical retinoids Start low strength (0.025%)every Start low strength (0.025%)every

other night-may cause other night-may cause redness/irritationredness/irritation

Increase strength until responseIncrease strength until response Avoid sunlight/uv light,not during Avoid sunlight/uv light,not during

pregnancypregnancy

88

Acne TreatmentAcne Treatment

Topical AntibioticsTopical Antibiotics-no better than -no better than benzoyl peroxidebenzoyl peroxide

Reduces propionobacterium acnesReduces propionobacterium acnes Less irritationLess irritation Topical tetracycline the cheapestTopical tetracycline the cheapest Glows in UV light (warn patient not to Glows in UV light (warn patient not to

go CLUBBING)go CLUBBING)

99

Acne treatmentAcne treatment

Azelaic acidAzelaic acid cream-keratolytic cream-keratolytic Alters composition of fat/decrease Alters composition of fat/decrease

bacteriabacteria Short term use onlyShort term use only May cause irritation/ photosensitivityMay cause irritation/ photosensitivity

1010

Acne TreatmentAcne Treatment Oral AntibioticsOral Antibiotics Oxytetracycline 500mg bdOxytetracycline 500mg bd Warn patient can take 6/52 for response-Warn patient can take 6/52 for response-

must be compliant.treat for 6 monthsmust be compliant.treat for 6 months Avoid milk,and have 30mins before mealsAvoid milk,and have 30mins before meals If effective reduce dose to 500mg od and If effective reduce dose to 500mg od and

then 250mg od at 3/12 intervalsthen 250mg od at 3/12 intervals DO NOT GIVE WITH TOPICAL ABX-DO NOT GIVE WITH TOPICAL ABX-

RESISTANCE.CAN COMBINE WITH OTHER RESISTANCE.CAN COMBINE WITH OTHER TOPICALSTOPICALS

1111

Acne treatmentAcne treatment

Oral abx cont…Oral abx cont… If initially responds but then If initially responds but then

gets worse could be due to gets worse could be due to resistanceresistance

Try erythromycin 500mgbd , Try erythromycin 500mgbd , trimethoprim 100-200mg trimethoprim 100-200mg bd ,doxycycline 100mg odbd ,doxycycline 100mg od

Minocycline last resort(fears Minocycline last resort(fears of hepatitis / pneumonitis/ of hepatitis / pneumonitis/ pigmentation) +costpigmentation) +cost

1212

Acne treatmentAcne treatment

HormonalHormonal In women on OCP consider less androgenic In women on OCP consider less androgenic

progestogen eg marvelon/cilest, but progestogen eg marvelon/cilest, but increased risk of DVTincreased risk of DVT

Consider cyproterone acetate with Consider cyproterone acetate with oestrogen(dianette) .NB endorse oestrogen(dianette) .NB endorse perscription with “OC” if patient using as a perscription with “OC” if patient using as a contraceptive(not licensed as a contraceptive(not licensed as a contraceptive)contraceptive)

1313

Acne- referralsAcne- referrals

Refer if very severe or psychological Refer if very severe or psychological distressdistress

Specialists can prescribeSpecialists can prescribe ISOTREIN(Roaccutane)-specialist only ISOTREIN(Roaccutane)-specialist only

prescription.terratogenic+lots of side prescription.terratogenic+lots of side effectseffects

UV lightUV light Intralesional steroid injectionsIntralesional steroid injections High dose antibioticsHigh dose antibiotics