The Aga Khan University Hospital, Karachi Dr. Marie Andrades Senior Instructor Family Medicine Acne Treatment and Therapeutic Strategies
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies One of the most common skin diseases presenting to family physicians Considerable psychological impact on the quality of life No cure, but the disease can be controlled through medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Four important factors plugging of the hair follicle hyperactivity of the sebaceous gland proliferation of Propionobacterium Acnes inflammation Pathophysiology
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Stages of Development
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Comedonal Lesions
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Inflammatory Lesions
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Nodulocystic Lesions
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Scarring
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Key Elements in History previous medications used current products being used for acne medical problems other medications use of cosmetics or hair pomades recreational activities and occupation Patient Evaluation
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies For Female Patients menstrual history hirsutism use of hormonal contraceptives Patient Evaluation
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Patient Education (Dispelling Myths) hygiene diet cosmetics hair styles Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Patient Education washing of lesions picking lesions premenstrual flare hair care products Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Patient Education improvement is not overnight treatment must be used regularly treatment is long term Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Therapy (Indications) comedonal acne mild to moderate inflammatory acne Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Therapy (Basic Rules) avoid applying medication right after washing face avoid over use of medication apply on all acne prone areas if face gets dry apply oil free moisturizer Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Therapy (Treatment Vehicle) cream sensitive or dry skin lotion any skin type gel oily skin solution oily skin Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Therapy (Anti Comedonal Agents) Topical Retinoids Azelaic acid Salicylic acid Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Retinoids 0.025% - 0.5% (application) apply at night always apply test dose start at low concentrations avoid in pregnancy Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Retinoids 0.025% - 0.1% (side effects) pustular flare photosensitivity skin irritation and erythema dryness and peeling Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Azelaic Acid 20% (application and side effects) applied twice daily erythema and irritation decrease in pigmentation Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Salicylic Acid % (application and side effects) applied twice daily skin dryness and irritation Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Therapy (Anti Inflammatory Agents) Benzoyl Peroxide Topical antibiotics Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Benzoyl Peroxide % (application and side effects) apply once to twice daily always apply test dose avoid use at night dryness of skin Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Topical Antibiotics, Clindamycin and Erythromycin (application and side effects) apply twice daily skin dryness Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Combination therapy 5% Benzoyl Peroxide and 3% Erythromycin 5% Benzoyl Peroxide and 1% Clindamycin Topical antibiotics and Azelaic acid or Tretinion Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Systemic therapy (Indications) moderate inflammatory acne non responsive to topical therapy nodulocystic acne Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Systemic therapy Oral Antibiotics Isotretinoin Hormonal Therapy Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Oral Antibiotics (used for 3-6 months) Tetracycline 500mg X BD Doxycycline 100mg X BD Minocycline 100mg X OD Eythromycin 500mg X BD combined with topical therapy Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Isotretinoin (Accutane) indicated in severe nodulocystic acne non responsive acne severe psychological distress Only to be used by physicians with experience in the therapy of severe dermatological disorders Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Isotretnoin (RoAccutane) side effects teratogenic mucosal dryness photosensitivity arthralgias alteration of liver enzymes hypertriglyceridemia and hypercholesterolemia Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Hormonal Therapy indicated in acne associated with hirsutism, menstrual irregularity and alopecia women desiring contraception Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Hormonal Therapy Oral contraceptives containing low androgenic progesterone Cyproterone Acetate Spironolactone Management
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Comedonal lesions LesionType(s)
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s)Lesion Comedonal lesions Topical retinoid Azelaic acid Salicylic acid
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s)Lesion Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s) Lesion Mixed comedonal lesions and papulopustules Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s) Lesion Types Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s) Lesion Types Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s) Papules and pustules Lesion Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s) Papules and pustules Benzoyl peroxide If results unsatisfactory switch to or add topical antibiotics Lesion Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Type(s) Papules and pustules Benzoyl peroxide If results unsatisfactory switch to or add topical antibiotics If results unsatisfactory add course of oral antibiotics Lesion Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Cystic lesions Type(s) Papules and pustules Benzoyl peroxide If results unsatisfactory switch to or add topical antibiotics If results unsatisfactory add course of oral antibiotics Lesion Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Cystic lesions Prescribe course of oral antibiotics + mixed comedonal- papulopustular topical therapy Type(s) Papules and pustules Benzoyl peroxide If results unsatisfactory switch to or add topical antibiotics If results unsatisfactory add course of oral antibiotics Lesion Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications
The Aga Khan University Hospital, Karachi Acne Treatment and Therapeutic Strategies Cystic lesions Prescribe course of oral antibiotics + mixed comedonal- papulopustular topical therapy If results unsatisfactory consider referral to dermatologist for oral isotretinoin therapy Papules and pustules Benzoyl peroxide If results unsatisfactory switch to or add topical antibiotics If results unsatisfactory add course of oral antibiotics Mixed comedonal lesions and papulopustules Retinoid+topical antibiotics Retinoid+benzoyl peroxide Retinoid+benzoyl peroxide+topical antibiotics Azelaic acid+benzoyl peroxide Azelaic acid+topical antibiotics If results unsatisfactory prescribe topical retinoid+course of oral antibiotics Comedonal lesions Topical retinoid Azelaic acid Salicylic acid If results unsatisfactory Increase strength or change medications