Acne Stages and Treatment

3 stages = CIN:
C omedonal -> black / white-head, open / closed
I nflammatory -> pimples/zits
N odulo-cystic

Treatment flow chart:

1. Topical
2. Systemic with ABx
3. Systemic with Retinoic acid

Treatment flow chart corresponds to the stages CIN - TAR (Topical, ABx, Retinoic acid)

Topical Treatment:

-Differin gel, better ~ Retin A
Use it as CCC-F-> Cheek, Chin, Cheek, Forehead

-Sulfacet-R-> zits

Systemic Treatment:

-Doxycycline 1 mo -> sun -> "bad sunburn"
-Erythromycin 250 po tid (please see below for the new guidelines)

Acne surgery (mechanical extraction) can be helpful in comedonal and inflammatory stages.

Nodulo-cystic acne:

Use Abx for 6 mo -> if no effect -> Retinoic acid po
Retinoic acid~chemo-tx

Effective but SE:

-Teratogenic – use 2 methods of contraception (pill + condoms), hCG test 1 mo before starting, then monthly and 1 mo after the end of treatment
-Dry eyes (contact lenses user have to switch to glasses), vaginal dryness – discomfort, dry lips (cheilitis)

Kenalog (steroid) SC injections of the inflammatory nodules are also helpful.

From Twitter:

• Acne Guidelines: topical retinoids should be first-line treatment and backbone of acne maintenance therapy http://is.gd/Fvog
  
  
• Long-term maintenance therapy with antibiotics is not recommended http://is.gd/Fvog
  
  
• Benzoyl peroxide (not ABx) may be added to a long-term retinoid regimen to provide antimicrobial action http://is.gd/Fvog

Resources

Diagnosis and Treatment of Acne - AFP 5/2004
Use of Systemic Agents in the Treatment of Acne Vulgaris - AFP 10/2000
Acne Management Guideline Updated. Michele G. Sullivan. Elsevier Global Medical News, 2009.