PHARMACOTHERAPY OF ACNE

  • Acne is a chronic inflammatory disorder affecting the pilosebaceous unit leading to non-inflammatory and inflammatory lesions.
  • Affects nearly 10% of the global population
  •  85% boys % & 83% girls affected in adolescent & young adult life
  •  Occurs around puberty
  •  Severity peak age 16 to 17 years in females & 17 to 19 years in males
  •  Commonly involved sites à face, chest, upper back, upper arms.
Preadolescent 7 year to 12 years or before menarche in girls
Adolescent 12 year to 19 years or after menarche in girls
Persistent Onset in adolescence and continuing after 25 years
Late-onset Onset after 25 years

Types –

  • Non-InflammatoryComedones
    • Open Closed
  • Inflammatory
    •  Papule, pustule, nodule, and cyst

Treatment

Topical Antibiotics

  • Slower acting, less effective than oral antibiotics.
  • Clindamycin and erythromycin of 1% to 4% with or without the addition of zinc.
  •  Dapsone 5% gel (1995)
  •  No monotherapy
  •  Discontinuation once improvement
  •  No improvement within 6 to 8 weeks, discontinuation and alternate therapy
  •  Erythema, itching, dryness, and burning.

BENZOYL PEROXIDE

  •  Highly reactive oxygen species
  •  Cytotoxicity of PMNLs.
  •  Effective comedolytic and keratolytic agent
  •  Highly lipophilic
  •  2.5%, 5% and 10% concentrations as gels, aquagels, creams and lotions.
  •  Prevents the development of resistance
  •  Oily skin advised to use gels, washes or solutions having a drying effect
  •  Dry or sensitive skin àprefer a cream formulation.

Systemic Antibiotics

  • Tetracycline or oxytetracycline 250–500 mg BD for 4–6 months
  • Doxycycline is at 50–100 mg BD or a single daily dose of 100 mg for 4–6 months
  • Minocycline 50–100 mg BD
  • Erythromycin 500 mg BD for 4–6 months.

Oral Isotretinoin

  • Start at a dosage of 0.5 mg⁄ kg daily.
  • severe papulopustular acne ⁄ moderate nodular acne
  • Not recommended for patients under 12 years of age.
  • Monitor liver enzymes and lipids, before treatment, 1 month after starting, every 3 months thereafter.
  • Duration of therapy should be at least 6 months
  • Avoid laser treatment, peeling and wax epilation for at least 6 months after stopping therapy.

For Acne in PCOS

FDA approved

  • Norgestimate 180/215/250 mcg + 35mcg Ethinyl estradiol
  • Norethindrone acetate 1 mg + EE 20/30/ 35mcg 7 day

Peeling agents

  • Rationale: Controlled chemical-induced injury to the skin promoting regeneration and remodeling
  • Comedonal, papulopustular:
    • 20-30% Salicylic acid,
    • 70% Glycolic acid
    • 40-60% Pyruvic acid
    • 20-25% Mandelic acid
    • Jessner’s solution
    • 10% Trichloroacetic acid

PHOTODYNAMIC THERAPY

  • Photosensitizer, 5-aminolevulinic acid or methyl aminolevulinate
  •  Accumulate selectively à sebaceous glands
  •  Decreases size and function of sebaceous glands
  •  Anti-inflammatory effects, and down-regulates immune response
  •  Pain with illumination, erythema, and edema.

Guidelines

Strategies for limiting antibiotic resistance

  • Combine a topical retinoid plus an antimicrobial
  •  Use of antibiotics to short periods
  •  Co-prescribe a BPO-containing product or use as the washout
  •  Oral and topical antibiotics should not be used as monotherapy
  •  Concurrent use of oral and topical antibiotics should be avoided
  •  Use topical retinoids for maintenance therapy
  •  Avoid the use of antibiotics for maintenance therapy

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