Download Acne Vulgaris Guidelines

Acne Vulgaris
DIAGNOSIS:
Acne is most commonly seen during the teenage years, but can be seen in adults and young children
as well. There are several variants: comedonal, inflammatory, and nodulocystic. Comedonal acne
consists of both closed comedones (whiteheads) and open comedones (blackheads). Inflammatory
acne is characterized by papular, pustular, or nodular lesions. Nodulocystic acne consists of deep
nodules and cysts and tends to scar.
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Most common on the face, shoulders, and chest
Most commonly in males and females 13-24 years old
Adult female acne seen in 20-50 year olds and has a predilection for the chin and jaw area
Nodulocystic acne can persist well past teenage years
REFERRING PROVIDER:
ALL ACNE TREATMENTS TAKE WEEKS TO MONTHS TO WORK. RESULTS
TAKE TIME.
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Cleansers (see list)
Topical retinoid (retinoic acid .025%) or retinoid derivative (retinoic acid, adapalene, and
tazarotene). Used at bedtime. Can be irritating. Start every other night and titrate up.
Topical antibiotic agents such as clindamycin, benzoyl peroxide/clindamycin, sodium
sulfacetamide, azelaic acid, salicylic acid BID are useful for inflammatory lesions
To prevent bacterial resistance use benzoyl peroxide wash or gel
Oral antibiotics should be initiated for nodulocystic acne such as minocycline, doxycycline,
tetracycline, and cephalosporins. Oral antibiotics take 6-8 weeks to see improvement.
For acne associated with menstrual cycles or in women with other signs of androgen excess,
low-estrogen oral contraceptive pills can be a helpful adjunctive treatment. Spironolactone
(25-100mg) is also a useful adjunct therapy and does not require lab monitoring.
WHEN TO REFER:
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Cysts or nodules present and/or scarring is occurring despite treatment
Acne is associated with signs of androgen excess or part of systemic disease
Nodulocystic acne unresponsive
We address acne scarring in the Cosmetic Dermatology and Laser Center
PRODUCT RECOMMENDATIONS FOR ACNE-PRONE SKIN:
Body Wash (for chest and back acne)
Neutrogena Body Clear Body Wash (salicylic acid)
PanOxyl Acne Cleansing Bar (5% or 10% benzoyl peroxide)
PanOxyl Foaming Wash (10% benzoyl peroxide)
Cleansers
Purpose Gentle Cleansing Wash (pump)
Neutrogena Fresh Foaming Cleanser (pump)
Olay Gentle Foaming Face Wash (pump)
Cetaphil Antibacterial Soap (bar)
Facial Moisturizers
Cetaphil UVA/UVB Defense Facial Moisturizer (SPF 50)
Neutrogena Oil-Free Moisture (SPF 15)
Olay Complete (SPF 20)
Over-the-counter Acne Treatment
Clearasil Daily Acne Control Cream (10% benzoyl peroxide)
Clean and Clear Persa Gel-10, Maximum Strength (10% benxoyl peroxide)
Clean and Clear Invisible Blemish Treatment, Maximum Strength (2% salicylic acid)
Neutrogena Rapid Clear 2