Monday, February 6th, 2012 Acne! José L. González, MD
Risk Factors first degree relative no data suggesting dietary influences endocrine steroids anabolic cortico- androgen excess PCOS
Classification inflammatory open comedo (whitehead) closed comedo (blackhead) non-inflammatory papule < 5mm tender, erythematous bump pustule < 5mm bump containing visible material nodule / cyst > 5mm
Types of Acne & Acne Impersonators acne conglobata / acne fulminans drug-induced acne rosacea – telengectasias, central face acne excoriée des jeunes filles bacterial folliculitis – s. aureus granulomatous & neoplastic d.o. sarcoidosis, tuberous sclerosis, multiple trichoepitheliomas
female pts & signs of androgen excess testosterone (free & total) dehydroepiandrosterene sulfate LH, FSH PCOS? fasting glucose & insulin levels
pathogenesis 1. hyperkeratinization 2. increased sebum production 3. propionobacterium acnes 4. inflammation
treatment non-inflammatory (comedolysis + keratolysis) – topical tx retinoids benzoyl peroxide salicylic acid azelaic acid inflammatory – combination tx topical + oral abx benzoyl peroxide + tetracycline
common oral abx & SEs Tetracyclines – phototoxicity, nausea doxycylcine – tooth staining & vertigo minocylcine – SLE-like reaction Macrolides erythro & azithromycin – GI upset / diarrhea Bactrim – Stevens Johnson
Other Oral Therapies Hormonal OCPs – 50 – 60% improvement norethindrone acetate-ethinyl estradiol norgestimate-ethinyl estradiol SEs: migraines, nausea, VTE Steroids high dose → taper; short term low dose; long term
Isotretinoin aka Retinoic Acid long term remission use in severe nodular acne, resistant to abx SEs birth defects, iPLEDGE skin: dry eyes, mm, epistaxis, hair shedding MSK: hyperostosis, premature epiphyseal closure neuropsych: it'll make you crazy! (but beautiful) liver: check triglycerides & LFTs
Other Options Newer treatments blue light, phototherapy, laser therapy, radiofrequency non-ablative high cost relapse in 3-6 months Referral to Dermatologist very severe acne use of isotretinoin