Page 53 - LECTURE NOTES

Treatment TIALS

Treatment should be directed toward the known pathogenic factors involved in acne.

These include follicular hyperproliferation, excess sebum, P acnes, and inflammation.
The grade and the severity of the acne help in determining, which of the following

treatments, alone or in combination, is most appropriate.

Topical treatments

Each works a little differently. Benzoyl peroxide (2.5-10%) at night is best at killing P.
acnes and may reduce oil production. Resorcinol, salicylic acid, and sulfur help break

down blackheads and whiteheads. Salicylic acid also helps cut down the shedding of

cells lining the follicles of the oil glands. Topical medications are available in many
forms, such as gel, lotion, cream, soap, or pad.

o Topical antibiotic; -Topical antibiotics are mainly used for their role against P

acnes. They may also have anti-inflammatory properties. The development of

resistance is lessened if topical antibiotics are used in combination with benzoyl
peroxide. Erythromycin and clindamycin alone or in combination with benzoyl

peroxide.
o Topical retinoids are comedolytic and anti-inflammatory. They cause epidermal

differentiation and, thus, normalize follicular hyperproliferation and

hyperkeratinization. Adapalene, tazarotene, and tretinoin are in common use. they
are applied once daily to clean, dry skin.

Systemic treatment

Tetracycline, (minocycline, docycyline and tetracycline, erythromycin 1g daily for one
month then 250 bid for 4-6 moths). Trimethoprim, alone or in combination with

sulfamethoxazole, are systemic antibiotics and anti-inflammatory.

Isotretinoin is a systemic retinoid that is highly effective in the treatment of severe,

recalcitrant acne vulgaris

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