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What it looks like. Lifestyle changes. Coping with acne. Accessed July 6, Graber E. Treatment of acne vulgaris. Thiboutot D, et al. Pathogenesis, clinical manifestations and diagnosis of acne vulgaris. Kermott CA, et al. Time; Maymone M, et al. Common skin disorders in pediatric skin of color.
Journal of Pediatric Health Care. Matthes BM, et al. Intralesional corticosteroid injection. Accessed July 8, Gibson LE expert opinion. Mayo Clinic. July 20, Related Acne mistakes Acne scars: What's the best treatment? Acne treatments: Medical procedures may help clear skin Adult acne: Can natural hormone treatments help?
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Mild inflammatory acne: Topical retinoid alone or with a topical antibiotic, benzoyl peroxide , or both. It is important to treat acne to reduce the extent of disease, scarring, and psychologic distress. See also guidelines of care for the management of acne vulgaris from the American Academy of Dermatology. Affected areas should be cleansed daily, but extra washing, use of antibacterial soaps, and scrubbing confer no added benefit.
A lower glycemic diet and moderation of skim milk intake might be considered for treatment-resistant adolescent acne. Peeling agents such as sulfur, salicylic acid , glycolic acid, and resorcinol can be useful therapeutic adjuncts but are no longer commonly used.
Oral contraceptives are effective in treating inflammatory and noninflammatory acne, and spironolactone beginning at 50 mg orally once a day, increased to to mg [maximum mg] orally once a day after a few months if needed is another anti-androgen that is occasionally useful in women. Various light therapies, with and without topical photosensitizers, have been used effectively, mostly for inflammatory acne. Treatment should involve educating the patient and tailoring the plan to one that is realistic for the patient.
Treatment failure can frequently be attributed to lack of adherence to the plan and also to lack of follow-up. Consultation with a specialist may be necessary. Treatment of mild acne should be continued for 6 weeks or until lesions respond. Maintenance treatment may be necessary to maintain control.
Single-agent therapy is generally sufficient for comedonal acne. A mainstay of treatment for comedones is daily topical tretinoin as tolerated.
Daily adapalene gel, tazarotene cream or gel, azelaic acid cream, and glycolic or salicylic acid are alternatives for patients who cannot tolerate topical tretinoin.
Adverse effects include erythema, burning, stinging, and peeling. Adapalene and tazarotene are retinoids; like tretinoin, they tend to be somewhat irritating and photosensitizing. Azelaic acid has comedolytic and antibacterial properties by an unrelated mechanism and may be synergistic with retinoids.
Dual therapy eg, a combination of tretinoin with benzoyl peroxide , a topical antibiotic, or both should be used to treat mild papulopustular inflammatory acne. The topical antibiotic is usually erythromycin or clindamycin. Combining benzoyl peroxide with these antibiotics may help limit development of resistance. Glycolic acid may be used instead of or in addition to tretinoin but is no longer used commonly. Treatments have no significant adverse effects other than drying and irritation and rare allergic reactions to benzoyl peroxide.
Physical extraction of comedones using a comedone extractor is an option for patients unresponsive to topical treatment. Comedone extraction may be done by a physician, nurse, or physician assistant. One end of the comedone extractor is like a blade or bayonet that punctures the closed comedone. The other end exerts pressure to extract the comedone.
Oral antibiotics eg, tetracycline , minocycline , doxycycline , erythromycin can be used when wide distribution of lesions makes topical therapy impractical. Oral systemic therapy with antibiotics is the best way to treat moderate acne. Antibiotics effective for acne include tetracycline , minocycline , erythromycin , doxycycline , and sarecycline. Doxycycline and minocycline are first-line drugs; both can be taken with food.
Tetracycline is also a good first choice, but it cannot be taken with food and may have lower efficacy than doxycycline and minocycline. Doxycycline and minocycline dosage is 50 to mg orally 2 times a day.
Doxycycline may cause photosensitivity, and minocycline may have more adverse effects with chronic use, including drug-induced lupus and hyperpigmentation. Tetracycline dosage is or mg orally 2 times a day between meals. To reduce the development of antibiotic resistance after control is achieved usually 2 to 3 months , the dose is tapered as much as possible to maintain control.
Sarecycline is a new tetracycline antibiotic. The dosages are weight-based: 33 to 54 kg, 60 mg orally once a day; 55 to 84 kg, mg orally once a day; and 85 to kg, mg orally once a day. Antibiotics may be discontinued if topical therapy maintains control. Erythromycin and azithromycin are other options, but they can cause gastrointestinal adverse effects and antibiotic resistance develops more often. Long-term use of antibiotics may cause a gram-negative pustular folliculitis around the nose and in the center of the face.
This uncommon superinfection may be difficult to clear and is best treated with oral isotretinoin after discontinuing the oral antibiotic. Post-inflammatory hyperpigmentation is often the major reason for seeking medical attention, causing significant psychological effects.
Pomade acne occurs more commonly in people with skin of colour due to cultural practices with hair styling products in African American and Hispanic populations.
The use of greasy hair products leads to follicular plugging and comedones along the hairline. Keloid scarring is more common in skin of colour following acne lesions, particularly along the jawline, chest, and upper back. Acne in skin of colour. Acne may be classified as mild, moderate or severe. Comedones and inflammatory lesions are usually considered separately. Classification of acne Mild acne. Some dermatologists assess the severity of a patient's acne more precisely by using a grading scale.
The inflammatory lesions are compared with a set of standard photographs to determine the grade, which may be 1 very mild to 12 exceptionally severe for example.
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