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Acne is a common chronic skin condition which has a significantly negative psychological impact that can be directly improved with treatment It is a disease common but not limited to adolescence. It can often persist into adulthood It is estimated that acne accounts for 3.5 million GP visits a year Severe acne has been associated with suicidal ideation

Infection/ blockage of pilosebaceous units Multifactorial pathogenesis including genetics Four main processes include altered keratinization, androgen induced sebum production, follicular colonisation by P acnes and inflammation Diagnostic features - comedones, greasy skin, P acnes and inflammatory papular pustular lesions, nodules and cysts.

Mild acne: Presence of comedones and a few papulopustules  <20 comedones  <15 inflammatory lesions  Or total lesion count <30

Moderate acne: Presence of comedones, inflammatory papules, and pustules A greater number of lesions are present than in milder inflammatory acne

Nodulocystic acne: Presence of comedones, inflammatory lesions, and large nodules Scars: Raised (hypertrophic or keloid) or atrophic Acne conglobata: Severe and uncommon form of acne - interconnecting nodules, abscesses, sinuses and scars as well as haemorrhagic and purulent discharge

Can be targeted to severity Mild acne - topical treatments including topical retinoids (1 st line), benzoyl peroxide, topical antibiotics. Topical azelaic acid can cause hypopigmentation. Moderate acne - oral antibiotics at least 2 different antibiotics for prolonged time >6months for their anti-inflammatory properties, COCP, AND topical treatment Severe acne - Isotretinoin- warn about side effects - dryness, pregnancy tests, mood

New treatments such as radiofrequency, light, and laser devices are all active areas of research and development. Blue-light photodynamic therapy is the only US FDA-approved treatment. Systemic reviews show they may improve inflammatory acne in the short term but are ineffective when for severe acne Other treatment options particularly for scarring include resurfacing techniques, laser therapy and dermal fillers Warn patients looking for treatments such as dermabrasion / lasers to wait at least 1 year after completing a course of isotretinoin

 Radiofrequency Devices – Use radio waves to heat the dermis and SC tissue. High temperatures kill bacteria and shrink sebaceous glands. Promising results in studies but small sample sizes.  Light treatment- Cause membrane damage to P acnes. Some penetrate deeper than others. Confliciting efficacy in studies.  Blue light treatment is FDA approved in US. Initial studies have shown after 8 weeks of treatment the number of inflammatory lesions are reduced( 30-70%). But not comedonal lesions.  Laser- Photothermolysis of dilated blood vessels in acne lesions. (TGF- β ) a wound healing cytokine.

 Eating chocolate and sugary foods have previously been linked with acne but studies show there is little evidence for these beliefs.  Recent data – mainly from 2013 onwards show preliminary evidence of a low glycaemic load diet and improvement in acne.  Recent data suggests that dairy products may increase the risk of acne, particulalry from pregnant cows. Skimmed is worse due to higher concentration of hormones  Need to be cautious- Some studies show milk has a positive effect on reducing obesity

The Global Alliance to improve outcome in acne recommends: 1. Benzoyl peroxide may reduce the development of resistant P. acnes strains and further emergence. 2. Bacterial resistance may be reduced by using topical benzoyl peroxide with topical antibiotics, topical retinoids or oral antibiotics. 3. The combination of benzoyl peroxide and a topical antibiotic (eg. clindamycin, erythromycin) is more effective than either agent alone 4. Topical antibiotic monotherapy is not recommended 5. Use benzoyl peroxide in between abx therapies to prevent future resistance

 Common  Treatment has a big impact on QOL  Beware of new evidence on diet  Beware of new treatments- not all on NHS  Prescribe benzoyl peroxide with oral antibiotics  Prescribe benzoyl peroxide between antibiotics

 British association of Dermatologists  Shinjita Das; Rachel V. Reynolds. Recent Advances in Acne Pathogenesis Implications for Therapy. American Journal of Clinical Dermatology. 2014;15(6):  Dermnet New Zealand Facts on Acne:  National Institute for Health and Care Excellence Clinical Knowledge Summaries on Acne:  Medscape  The Global Alliance to improve outcome in acne

 Thank You  Any Questions?