Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acne 11

management

What to Do First

■Assess type and distribution of acne lesions – comedonal v. inflam-

matory v. cystic

General Measures

■Keratolytic or antibacterial cleansers: salicylic acid, benzoyl perox-

ide, sulfur

■Topical vitamin A acid (and similar agents): tretinoin, Adapalene,

tazarotene

■Topical antibiotics: erythromycin, Clindamycin, sulfacetamide

preparations (both erythromycin and clindamycin may be com-

bined with benzoyl peroxide)

■Oral antibiotics: Tetracycline, Doxycycline, or Minocycline

■Less commonly: sulfones, sulfamethoxazole-trimethoprim, Erythro-

mycin, ampicillin or cephalosporins

■Oral retinoids: Isotretinoin 1 mg/kg/d for 16–20 weeks for severe

cases

■Other Therapies

■Azaleic acid (topical), spironolactone, intralesional triamcinolone

acetonide for individual inflamed lesions, very rarely oral corticos-

teroids

■No role for dietary manipulation has been proven

specific therapy

■Keratolytic agents: Indicated for early acne forms, side effects may

include irritation

■Topical vitamin A acid: indicated for early and more advanced acne

stages. For pregnant patients discuss use with obstetrician.

■Topical antibiotics: Best for early papulopustular acne. Cream, lotion

and gel bases

■should be matched with patient’s tolerance and preference, irritation

possibly

■Oral antibiotics: Indicated for moderate to severe papulopustular

acne and early stages

■of cystic acne.

➣Minocycline use rarely complicated by pigment deposition, a

lupus-like syndrome and reports of depression.

■Oral Retinoids

➣Indication: Severe, recalcitrant nodulocystic acne+/−scarring