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ACNE VULGARIS

DR RAMINDER SAWHNEY GPR 17/2/05


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ACNE - Goals

Decrease scarring Decrease unsightly appearance Decrease psychological stress Explain long length of treatment may be several months and initial response may be poor but must persevere (poor compliance has been demonstrated in studies at 3/12)
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ACNE What is it?

Disease of pilosebaceous follicle Non-inflammatory Comedones - open blackhead - closed whitehead

Inflammatory

papules, pustules, nodules scarring

Acne vulgaris comedones dominant


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Acne vulgaris- pus dominant

Acne Treatment

Benzoyl peroxide-(cheap+cheerful) Start at low strength 2.5% at night Mild erythema-transient Warn it bleaches clothes Build up to 10% gradually Stop if irritation occurs

Acne treatment

Topical retinoids Start low strength (0.025%)every other night-may cause redness/irritation Increase strength until response Avoid sunlight/uv light,not during pregnancy
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Acne Treatment

Topical Antibiotics-no better than benzoyl peroxide Reduces propionobacterium acnes Less irritation Topical tetracycline the cheapest Glows in UV light (warn patient not to go CLUBBING)
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Acne treatment

Azelaic acid cream-keratolytic Alters composition of fat/decrease bacteria Short term use only May cause irritation/ photosensitivity

Acne Treatment

Oral Antibiotics Oxytetracycline 500mg bd Warn patient can take 6/52 for responsemust be compliant.treat for 6 months Avoid milk,and have 30mins before meals If effective reduce dose to 500mg od and then 250mg od at 3/12 intervals DO NOT GIVE WITH TOPICAL ABXRESISTANCE.CAN COMBINE WITH OTHER TOPICALS

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Acne treatment

Oral abx cont If initially responds but then gets worse could be due to resistance Try erythromycin 500mgbd , trimethoprim 100-200mg bd ,doxycycline 100mg od Minocycline last resort(fears of hepatitis / pneumonitis/ pigmentation) +cost
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Acne treatment

Hormonal In women on OCP consider less androgenic progestogen eg marvelon/cilest, but increased risk of DVT Consider cyproterone acetate with oestrogen(dianette) .NB endorse perscription with OC if patient using as a contraceptive(not licensed as a contraceptive)
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Acne- referrals

Refer if very severe or psychological distress Specialists can prescribe ISOTREIN(Roaccutane)-specialist only prescription.terratogenic+lots of side effects UV light Intralesional steroid injections High dose antibiotics
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