Management of Acne

Dr. (Sqn. Ldr.) V. K. Upadhyaya

Head Dept. of Dermatology
Pushpanjali Crosslay Hospital
ACNE IS NO LONGER A BANE OF
ADOLESCENCE
Consider Acne as a Cosmetic Emergency ?

Do not brush it aside as a purely cosmetic

problem because for the GeneXt it affects
the QOL tremendously.
 DIAGNOSIS
Age
Site
Background oiliness
Comedones, open and
closed
Polymorphic eruption

Courtesy Prof. Neena Khanna (AIIMS)

COMEDONES

OC

CC
CYSTIC ACNE
POLYMORHIC ERUPTION

Papules
Pustules
Nodules
Cysts
Scars
COMEDONES
 OFTEN ASKED QUESTIONS

LOCAL HYGIENE
Can I use soap?
Which soap do I use ?
How frequently?
DIET
Can I eat chocolates?
Can I eat nuts?
Can I eat fried foods?
Can I drink aerated drinks?
 COSMETICS

Can I use cosmetics?

Which cosmetics should I use?
Can I bleach my face?
Can I get a facial massage done?

Courtesy Prof. Neena Khanna (AIIMS)

 WHEN DO I SUSPECT A
CHEMICAL/DRUG INDUCED
ACNE?

When the age is all wrong.

When the site is all wrong.
When lesions are monomorphic.
Comedones are absent.
 DRUGS /CHEMICALS & ACNE

ATT
Anticonvulsants
Steroids
Androgens
Some occupational chemicals
 PATHOGENESIS
Antibiotics Retinoids

BP AA

Microbes Sebum

Occlusion
BP
Retinoids
 HOW DO I MANAGE ACNE

General measures
Topical therapy
Systemic therapy
Intense Pulse Light
 GENERAL MEASURES
Wash face frequently & thoroughly ? Washing
of face is aimed towards cleansing &
degreasing
• Non Soap Cleansers
• Benzoyl Peroxide/Salicylic Acid washes ?
If oily, try degreasing- use acetone (Poor Mans
Degreasing Agent)
No dietary restrictions
 TOPICAL AGENTS

Retinoic acid 0.025%, 0.05%, 0.1%

Adaplene 1%
Benzoyl peroxide 2.5% - 10%
Eythromycin 2-4%
Clindamycin 1%
Azelaic acid 10-20%
 SYSTEMIC AGENTS

• Tetracyclines / Doxycycline / Minocycline

• Erythromycin/Azithromycin
• Isotretinoin
• Antiandrogens
LET US SEE HOW TO MAKE THE
BEST OF THIS AMMUNITION
 MILD ACNE

Predominantly comedones
with a few inflammatory
lesions
 MILD ACNE IS BEST MANAGED
WITH TOPICAL AGENTS
• Comedones:
Retinoic acid at night
or
Adaplene at night
or
Benzoyl peroxide at night
• Comedones Retinoic acid
+ +
few inflamm lesions Topical antibiotics

Benzoyl peroxide

• Electric Fulguration
 SOME PRECAUTIONS WHILE
USING
TOPICAL AGENTS
Retinoic acid
Use only at night
Start with lower percentage and graduate
Avoid close to eyes, nasolabial folds
If the scaling/erythema is uncomfortable, use
on A/D
Precautions …….

Benzoyl peroxide
• Start with lower concentration, shorter period.
• Avoid combining with RA at same time.
• Can bleach hair, so avoid scalp margin.
MODERATE ACNE
 MODERATE ACNE

Use combination of topical and systemic

therapy
Topical RA, Ada, BP, Azelaic acid, AHA
Systemic Antibiotics
Doxy 100 mg
Mino 50 – 100 mg
Azithro 250 mg 1/7
Oral retinoids!!!
SCHEDULE FOR ORAL ANTIBIOTICS
2 schedules available:
Short duration (2-3 wks), full dose.
Repeated sos

Tetra 1g/d
Doxy 100mg/d
Cyno 100mg/d
Erythro 1g/d
SCHEDULE FOR ORAL ANTIBIOTICS

Long term (6-9 m), low dose schedule.

Tetra, 250mg/d
Doxy, 100/twice a wk
Cyno, 100mg/twice a wk
Azithro, 250mg/wk
PROBLEMS WITH LONG TERM
ANTIBIOTIC THERAPY

Cost
Gastritis (Doxy)
Pigmentation (Mino)
Candidal superinfection
Drug resistance
SEVERE ACNE/ACNE CONGLOBATA
 OPTIONS

Isotretinoin
0.5 mg/kg/day
12-16 weeks
Antibiotics +short course of steroids ! + topical
agents
Intense Pulse Light
Antiandrogens / OC
 ISOTRETINOIN

Advantages Disadvantages

• Fool proof • Cost (cliché!!!)

• Long lasting effect • Close monitoring
• Glow • Dryness of skin / eyes
•Delay in pregnancy
 ISOTRETINOIN

PRE-TREATMENT ASSESSMENT

Consent
LFT / Se lipid - 4 weekly
Pregnancy test- Base line/4 weekly
Contraception mandatory 3 / 12 months
 SIDE EFFECTS
Retinoid dermatitis:
Chapping of lips, dryness of skin, burning.
 Can be reduced by administrating vit E;
 Counter by using oil free moisturisers, lip balm
Eyes:
Dryness, redness.
 Do not wear CLs, use artificial tears
 Side effects (contd)
Liver
Se lipids
Depression
 INSTRUCTIONS TO PTs
Photoprotection.
Avoid other topical agents especially Retenoids, Benzoyl
Peroxide & Salicylic Acid
 Use oil free moisturiser/ lip balm/ vv mild steroid.
 Use Non Soap Cleansers as opposed to Benzoyl Peroxide or Salicylic
Acid washes
Contraception:
 Mandatory
 No pregnancy for 3m
 Use of 2 methods of contraception
INTENSE PULSE LIGHT
RESULTS
 After 2
Before Treatment Sittings – 6 Weeks
Before Treatment After 2
Sittings – 6 Weeks
atment After 2
Sittings – 6 Weeks
 TREATMENT OF SEQUELAE
Mild to Moderate Depth scars:
Glycolic acid 6-12%
Retinoic acid 0.05-0.1%
Derma Abrasion
Intense Pulse Light
Fraxel Laser (1540 Erbium Glass)
Moderate to Deep Scars:
Fraxel Laser
Fractional CO2 Ablative Laser

Pigmentation:
Hydroquinone
Hydroquinone+Steroid+Tretionoin
Kojic Acid, Magnesium Ascorbyl Phosphate
Kojic Acid, Vit. C, Liquorice Extract & Arbutine
Chemical Peels:
Lactipeel
Salipeel DS
Glicopeel K
Retises CT
These are used to manage mild to moderate scars & pigmentary changes.
WHEN DO I INVESTIGATE?
Usually not necessary.
Investigate for underlying
endocrinopathy (PCOS) only if:
 Menstrual irregularity
 Weight gain
 Hirsutism
Take home…..

Treatment if individualised, is
amazingly gratifying.
Recent trend has been to be a li’l
more aggressive in treating acne
Thank you