• Essentials of Diagnosis
• Often occurs at puberty, though onset may be delayed until the third or fourth decade
• Open and closed comedones the hallmarks
• Severity varies from comedonal to papular or pustular inflammatory acne to cysts or nodules
• Face, neck, upper chest, and back may be affected
• Pigmentary changes and severe scarring can occur
• Differential Diagnosis
• Acne rosacea, perioral dermatitis, folliculitis, and tinea.
• Trunk lesions may be confused with folliculitis or miliaria.
• May be induced by topical, inhaled, or systemic steroids, oily topical products, and anabolic steroids.
• Foods neither cause nor exacerbate acne.
• In women with resistant acne, hyperandrogenism should be considered; may be accompanied by hirsutism and irregular menses.
• Treatment
• Improvement usually requires 4--6 weeks
• Topical retinoids very effective for comedonal acne but usefulness limited by irritation
• Topical benzoyl peroxide agents
• Topical antibiotics (erythromycin combined with benzoyl peroxide, clindamycin) effective against comedones and mild inflammatory acne
• Oral antibiotics (tetracycline, doxycycline, minocycline) for moderate inflammatory acne; erythromycin is an alternative when tetracyclines contraindicated
• Low-dose oral contraceptives containing a nonandrogenic progestin can be effective in women
• Diluted intralesional corticosteroids effective in reducing highly inflammatory papules and cysts
• Oral isotretinoin useful in some who fail antibiotic therapy; pregnancy prevention and monitoring essential
• Surgical and laser techniques available to treat scarring
• Advice:
Don't waste time continuing failing therapies in scarring acne; treat
aggressively if needed to prevent further scars.
Friday, January 4, 2008
Acne tips
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11:35 AM
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