The Academy offers a wealth of treatment help for the public in the Acne Resource Center. Understanding of acne pathogenesis is evolving, but may involve a combination of the following factors:. The acne treatments including:. An acne grading system may be helpful in patient care, but at present there is no universal system for grading and assessing severity of acne. To facilitate therapeutic decisions and assess treatment response, clinicians can use a consistent method of grading and classifying acne using the following characteristics:.
Routine testing is NOT recommended, though patients exhibiting acne-like lesions suggestive of gram negative folliculitis may benefit from microbiologic testing. Routine testing is NOT recommended, though laboratory evaluation of acne patients with additional signs of androgen excess is recommended. Benzoyl peroxide in combination with topical retinoids or systemic antibiotic therapy for moderate to severe acne. Combination therapy should be used in the majority of acne patients to target different aspects of acne pathogenesis.
Patients should be counseled on pregnancy risks when starting a retinoid or if a female patient desires pregnancy. The topical therapy of acne in children under the age of 12 years with FDA-approved products has expanded. Topical therapies can accomplish continued efficacy months after discontinuation of systemic antibiotics. Systemic antibiotics are recommended for use in moderate to severe inflammatory acne that are resistant to topical therapies.
They should be used in combination with a topical retinoid and benzoyl peroxide. Limiting antibiotic use to minimize antibiotic resistance is suggested. Trimethoprim-sulfamethoxazole and trimethoprim use should be restricted to patients unable to tolerate tetracyclines or in treatment-resistant patients.
Limit antibiotic use to the shortest possible duration, typically three months, to minimize the development of bacterial resistance. Limiting systemic antibiotic use is urged due to reported associations of inflammatory bowel disease, pharyngitis, Clostridium difficile infection, and induction of Candida vulvovaginitis.
Acne clinical guideline
Oral contraceptives may improve acne for many women. They could be used alone or in combination with other acne treatments. Spironolactone can be useful in the treatment of acne in select females, though evidence of its efficacy is limited. Oral corticosteroid therapy can be of temporary benefit in patients who have severe inflammatory acne while starting standard acne treatment.
Low-dose isotretinoin can be used to effectively treat acne and reduce the frequency and severity of medication-related side effects.
Routine monitoring of liver function tests, serum cholesterol and triglycerides at baseline and again until response to treatment is established is recommended. If you're still experiencing breakouts after eight weeks, visit a dermatologist, especially if you have big, angry pimples. Your exact treatment will depend on what the doctor learns after examining you and talking to you about your acne. But there are a few main paths that doctors take. And it's not particularly drying or irritating.
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She says, "When you're using an antibiotic for acne, benzoyl peroxide helps increase the effectiveness. Dermatologists also offer some high-tech remedies. If your acne is the hormonal type, "no topical product alone will make a huge difference," says Jennifer MacGregor, a dermatologist in New York City. In fact, the treatment a doctor gives you may not even seem like it's about skin at all. For many women, taking birth-control pills can help clear up skin. Because most contain estrogen and progestin, they help suppress testosterone and prevent breakouts.
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A doctor may prescribe spironolactone , a drug for hypertension that controls androgens. Don't take it if you're thinking of getting pregnant, though, since it can cause birth defects. Many doctors prescribe spironolactone to women of child-bearing age only if they're also on the pill. If you try a doctor-prescribed acne regimen for at least a month and you're still experiencing severe breakouts, there's one treatment that's very effective — but it has significant side effects. Isotretinoin commonly referred to as Accutane , a brand that was taken off the market in can help with almost all types of acne, though it may be slightly less likely to clear up hormonal acne, says Zeichner.
A type of oral retinoid, isotretinoin works by "significantly reducing oil production from your sebaceous glands, which subsequently reduces the amount of P.
It also has an anti-inflammatory effect. If you're interested in finding out more, ask your doctor about the isotretinoin brands that are available now, such as Claravis, Amnesteem, Myorisan, Zenatane, and Absorica. Zeichner says that all patients who finish a course of isotretinoin typically lasting five months, but many physicians recommend a longer treatment plan will be "significantly better than when they started.
This program was established to prevent pregnancy in patients taking the medication. Isotretinoin is a potent teratogen and is associated with abnormalities of the face, eyes, ears, skull, central nervous system, cardiovascular system, thymus, and parathyroid glands. Negative pregnancy tests are mandated before starting therapy, then monthly before receiving a prescription refill, immediately after taking the last dose, and one month after taking the last dose.
The use of isotretinoin has been suggested to worsen depression and increase the risk of suicide, but no causal relationship has been established. Common adverse effects include headaches, dry skin and mucous membranes, and gastrointestinal upset. Several estrogen-containing oral contraceptives are FDA-approved for the treatment of acne. There is also no evidence to support their use over other studied therapies. Spironolactone Aldactone is an androgen receptor antagonist with unclear effectiveness in the treatment of acne.
It is usually reserved as a second- or third-line agent, or as an alternative to isotretinoin for women who cannot use this medication. A systematic review found insufficient evidence to recommend the use of spironolactone for the treatment of acne. It is a potassium-sparing diuretic and may cause severe hyperkalemia. Additionally, it is a potential teratogen. Light and laser therapies can be used for the treatment of acne. Examples include visible light, pulsed-dye laser, and photodynamic therapies. There is insufficient evidence to recommend the routine use of these therapies for the treatment of acne.
There are no established guidelines on the optimal dosing, device, timing, and frequency to be used. Table 6 summarizes other therapies that are used in the treatment of acne, with varying levels of evidence to support their use. May help with treatment-resistant comedones and provide short-term reductions in the number of noninflammatory lesions. Effective for total lesion reduction of papules, pustules, and comedones in mild to moderate acne.
Information from references 5 , and 23 through Treatment goals in patients with acne include the prevention of scars, the reduction of psychological morbidity, and the resolution of noninflammatory and inflammatory lesions. Therapy should be continued for a minimum of eight weeks before a treatment response can be accurately assessed.
Referral to a dermatologist should be considered when treatment goals are not met or when there is significant scarring. Search date: March Already a member or subscriber? Log in.
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Reprints are not available from the authors. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official, or as reflecting the views of the U. Army Medical Corps or the U. Army at large.
Figures 1 through 4 provided by Melissa Scorza, MD. White GM.