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Acne treatment ( phamacological and non-pharmacological)

Acne treatment ( phamacological and non-pharmacological)

2009 Global Alliance to Improve Outcomes in Acne consensus statements: Acne should be approached as a chronic disease.
Strategies to limit antibiotic resistance are important in acne management.
Combination retinoid-based therapy is first-line therapy.
Topical retinoids should be first-line agents in maintenance therapy.
Early, appropriate treatment is best to minimize potential for acne scars.
Adherence should be assessed via verbal interview or use of a simple tool.





NONPHARMACOLOGIC THERAPY

Encourage patients to avoid aggravating factors, maintain a balanced diet, and control stress.
Patients should wash no more than twice daily with a mild, nonfragranced opaque or glycerin soap or a soapless cleanser. Scrubbing should be minimized to prevent follicular rupture.
Comedone extraction results in immediate cosmetic improvement but has not been widely tested in clinical trials.

PHARMACOLOGIC THERAPY

Comedonal noninflammatory acne: Select topical agents that target the increased keratinization by producing exfoliation. Topical retinoids (especially adapalene) are drugs of choice. Benzoyl peroxide or azelaic acid can be considered.

Mild to moderate papulopustular inflammatory acne: It is important to reduce the population of P. acnes. Either the fixed-dose combination of adapalene and benzoyl peroxide or the fixed-dose combination of topical clindamycin and benzoyl peroxide is first choice therapy. As alternatives, a different topical retinoid used with a different topical antimicrobial agent could be used, with or without benzoyl peroxide. Azelaic acid or benzoyl peroxide can also be recommended

In more widespread disease, combination of a systemic antibiotic with adapalene is recommended for moderate papulopustular acne. If there are limitations in use of first-choice agents, alternatives include fixed-dose combination of erythromycin and tretinoin, fixed-dose combination of isotretinoin and erythromycin, or oral zinc. In cases of widespread disease, a combination of a systemic antibiotic with either benzoyl peroxide or adapalene in fixed combination with benzoyl peroxide can be considered.

Severe papulopustular or moderate nodular acne: Oral isotretinoin monotherapy is first choice. Alternatives include systemic antibiotics in combination with adapalene, with the fixed-dose combination of adapalene and benzoyl peroxide or in combination with azelaic acid. If there are limitations to use of these agents, consider oral antiandrogens in combination with oral antibiotics or topical treatments, or systemic antibiotics in combination with benzoyl peroxide.

Nodular or conglobate acne: Monotherapy with oral isotretinoin is first choice. An alternative is systemic antibiotics in combination with azelaic acid. If limitations exist to these agents, consider oral antiandrogens in combination with oral antibiotics, systemic antibiotics in combination with adapalene, benzoyl peroxide, or the adapalene-benzoyl peroxide fixed-dose combination.

Maintenance therapy for acne: Topical retinoids are most commonly recommended (adapalene, tazarotene, or tretinoin). Topical azelaic acid is an alternative. Maintenance is usually begun after a 12-week induction period and continues for 3 to 4 months. A longer duration may be necessary to prevent relapse upon discontinuation
Acne treatment ( phamacological and non-pharmacological) Acne treatment ( phamacological and non-pharmacological) Reviewed by gafacom on June 07, 2019 Rating: 5

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