ACNE VULGARIS

Pathophysiology--Multifactorial, including:

• Follicular hyperkeratinization (sheets of desquamated keratin plug the follicle)
• Sebum overproduction (stimulated by androgens)
• Bacterial infection (Propionibacerium acnes)
• Inflammatory reaction to same

Treatments:

• Blue light in the 405-420nm wavelength range (15min 2x/wk x 4wks) has been shown to reduce # of acne lesions in uncontrolled studies ("ClearLight Therapy System," Med. Lett. 45:50, 2003)--But expensive!
• Benzoyl Peroxide
• Azelaic acid
• Topical antibiotics (active against Propionibacterium acnes
  • Erythromycin
  • Clindamycin
• Topical retinoids (anti-inflammatory and comedolytic); can cause erythema, dryness, scaling, and pruritis; can be photosensitizine; contraindicated in pregnancy
  • Tretinoin (Retin-A) 0.025%-0.1% gel or cream
  • Adapalene (Differin) 0.1% gel
  • Tazarotene (Tazorac) 0.1% gel or cream QD--More effective than tretinoin 0.025% gel in one comparative trial (Cutis 67s:4, 2001--cited in Med. Lett. 44:52, 2002)
• Systemic antibiotics (tetracyclines, erythromycin)
• Isotretinoin PO (Accutane)-For severe, recalcitrant, nodular acne; usually 0.5-1.0mg/kg/d x 20wks.  Side f/x are dose-related and can be serious including teratogenicity.
• Oral Contraceptives in women may help
• Spironolactone may help