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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
Contents:
  1. Back acne: How to see clearer skin
  2. Acne - Symptoms and causes - Mayo Clinic
  3. European Evidence‐based (S3) Guidelines for the Treatment of Acne
  4. Overview of the Types and Stages of Acne

The dosage will start high and reduce as the acne clears. Acne is more likely to become resistant to topical rather than oral antibiotics. Oral contraceptives can help control acne in women by suppressing the overactive gland.

Back acne: How to see clearer skin

They are commonly used as long-term acne treatments. It is important to check with a gynecologist first. Topical antimicrobials also aim to reduce P. Examples are clindamycin and sodium sulfacetamide. Topical retinoids are a derivative of vitamin A. They unclog the pores and prevent whiteheads and blackheads from developing. Examples of topical retinoids prescribed in the U. This is a strong, oral retinoid, used for the treatment of severe cystic acne and severe acne that has not responded to other medications and treatments. It is a strictly controlled medication with potentially serious side effects.

The patient must sign a consent form to say that they understand the risks. Adverse effects include dry skin, dry lips, nosebleeds, fetal abnormalities if used during pregnancy, and mood swings. Patients who take isotretinoin must avoid vitamin A supplements, as these could lead to vitamin A toxicity. Acne pimples vary in size, color, and level of pain.

Here are some tips for looking after skin that has acne or is prone to it. Acne is a common problem. It can cause severe embarrassment, but treatment is available, and it is effective in many cases. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you.

We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link s above. Article last updated by Yvette Brazier on Mon 27 November Visit our Dermatology category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Dermatology.

All references are available in the References tab. Azelaic acid topical. Chularojanamontri, L. Moisturizers for Acne. What are their Constituents? Journal of Clinical and Aesthetic Dermatology, 7 5 : 36— Enshaieh, S. Indian Journal of Dermatology, Venereology, and Leprology, 73 1 Fitz-Gibbon, S. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. Journal of investigative dermatology, 9, Gene array research contributes to understanding of acne.

Hormonal factors key to understanding acne in women. Kucharska, A. Significance of diet in treated and untreated acne vulgaris. Lin, C.

INTRODUCTION

Intralesional steroid injection. Morrison, C. Antibiotics for acne. Ozuguz, P. S, Ekiz, O. Evaluation of serum vitamins A and E and zinc levels according to the severity of acne vulgaris. Cutaneous and ocular toxicology, 33 2 Over the counter acne products: What works and why?

Russell, J. Topical therapy for acne. American family physician, 61, 2, Saric, S. Green tea and other tea polyphenols: Effects on sebum production and acne vulgaris. Antioxidants Basel 6 1 : 2. Thielitz, A. Topical retinoids in acne — an evidence-based overview. Journal der Deutschen Dermatologischen Gesellschaft, 8 1, What is Acne? Fast facts: An easy-to-read series of publications for the public. MLA Nordqvist, Christian. MediLexicon, Intl. APA Nordqvist, C.

MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Privacy Terms Ad policy Careers. Visit www. All rights reserved. More Sign up for our newsletter Discover in-depth, condition specific articles written by our in-house team. Search Go. Please accept our privacy terms We use cookies and similar technologies to improve your browsing experience, personalize content and offers, show targeted ads, analyze traffic, and better understand you.

Scroll to Accept. Get the MNT newsletter. Enter your email address to subscribe to our most top categories Your privacy is important to us. Email an article. You have chosen to share the following article: How elderberries can help you fight the flu To proceed, simply complete the form below, and a link to the article will be sent by email on your behalf. Optional Comments max. Send securely. Message sent successfully The details of this article have been emailed on your behalf. Fast facts on acne Here are some facts about acne. More detail is in the main article.

Acne - Symptoms and causes - Mayo Clinic

Acne is a skin disease involving the oil glands at the base of hair follicles. It affects 3 in every 4 people aged 11 to 30 years. Treatment depends on how severe and persistent it is. Risk factors include genetics, the menstrual cycle, anxiety and stress , hot and humid climates, using oil-based makeup, and squeezing pimples. Acne is a common skin problem. A variety of steroidal and non-steroidal creams and gels are available to treat acne, and many are effective.

Minocycline LE 3 and tetracycline LE 3 both show superior efficacy compared with zinc. This, however, can be influenced by the dosage used.

European Evidence‐based (S3) Guidelines for the Treatment of Acne

There is insufficient evidence regarding the efficacy of all other light and laser interventions compared with placebo. In addition, an individual global assessment was performed. Data on the safety and tolerabilities of combination therapies with topical antibiotics are not described, since topical antibiotics are not recommended as monotherapy. Topical treatments usually result in local side effects whereas systemic treatments cause, among others, mostly gastrointestinal effects.

No reasonable conclusion seems justified with the available evidence, however, no immediate superiority of either systemic or topical treatment is apparent. Smith and Leyden performed a systemic review analysing case reports on adverse events with minocycline and doxycycline between and As a result, they suggest that adverse events may be less likely with doxycycline than with minocycline. More severe adverse events seem to appear during treatments with minocycline. Doxycycline, however, leads to photosensitivity, which is not seen with minocycline.


  • Napoli I.A.: Immondizia Astrale! (Italian Edition).
  • What you need to know about acne;
  • What Is It?.

See also Chapter 9. For a discussion of isotretinoin depression, see Chapter 9. For further discussion on the use of isotretinoin as a first line treatment for severe papulopustular acne, see Chapter 9. The expert group feels strongly that the effectiveness seen in clinical practice is highest with systemic isotretinoin, although this can only be partly supported by published evidence. However, the dose response rates, the relapse rates after treatment and the pharmacoeconomic calculations strongly favour systemic isotretinoin. Monotherapy with azelaic acid, BPO or topical retinoids all showed comparable efficacy when compared with each other.

Systemic monotherapy with antibiotics shows no superiority to topical treatments, therefore combining systemic therapy with a topical agent should always be preferred. For severe cases, a systemic treatment with isotretinoin is recommended based on the very good efficacy seen in clinical practice. The available evidence on safety and tolerability is extremely scarce and was considered insufficient to be used as a primary basis to formulate treatment recommendations.

The lack of standardized protocols, experience and clinical trial data mean there is insufficient evidence to recommend the treatment of papulopustular acne with laser and light sources other than blue light. General comment: Very few of the included trials described below looked specifically at patients with nodular or conglobate acne. As a source of indirect evidence, studies of patients with severe papulopustular acne were used and the percentage in the reduction of nodules NO and cysts CY in these studies was used. In case of use of such indirect evidence, the strength of recommendation was downgraded for the considered treatment options.

However, there are multiple trials comparing different dosage without a placebo group and following expert opinion, there is no doubt about its superior efficacy. There are eight trials comparing different dosage regimens of systemic isotretinoin. Most of these used 0. Systemic isotretinoin shows comparable efficacy against deep IL indirect evidence to systemic tetracycline in combination with topical adapalene LE 4. Due to there being insufficient evidence, it is not currently possible to make a recommendation for or against treatment with IPL, laser or PDT in conglobate acne.

See also Chapter 7. From the trials specifically investigating conglobate acne, very little information is available to compare the different treatment options. Almost all patients suffer from xerosis and cheilitis during treatment with isotretinoin, whereas systemic antibiotics more commonly cause gastrointestinal adverse events LE 4. The expert group considers that greatest effectiveness in the treatment of conglobate acne in clinical practice is seen with systemic isotretinoin, although this can only be partly supported by published evidence, because of the lack of clinical trials in conglobate acne.

Patient benefit with respect to treatment effect, improvement in quality of life and avoidance of scarring outweigh the side effects. There is a lack of standard protocols, experience and clinical trial data for the treatment of papulopustular acne with laser and light sources other than blue light. All topical retinoids show comparable efficacy against IL see Chapter 7. Patient preference favours adapalene over tretinoin see Chapter 7.

Doxycycline, lymecycline, minocycline and tetracycline all seem to have a comparable efficacy against IL see Chapter 7. The review showed no significant difference in the number of dropouts due to adverse events when comparing minocycline with doxycycline, lymecycline or tetracycline. Overall, an adverse drug reaction ADR was experienced by Two analyses of reported ADRs have shown lower incidence rates and lower severity of ADRs with doxycycline compared with minocycline.

The most frequent ADRs for doxycycline are manageable sun protection for photosensitivity and water intake for oesophagitis , whereas the most relevant side effects of monocycline hypersensitivity, hepatic dysfunction, lupus like syndrome are not easily managed. The phototoxicity of doxycycline is dependent on dosage and the amount of sun light.

Overview of the Types and Stages of Acne

There is little information on the frequency of ADRs with lymecycline. Its phototoxicity has been reported to be lower than with doxycycline and its safety profile is comparable to that of tetracycline. Doxycycline, lymecycline and minocycline have superior practicability compared with tetracycline due to their requirement for less frequent administration. The use of systemic clindamycin for the treatment of acne is generally not recommended as this treatment option should be kept for severe infections. Tetracycline has a lower practicability and patient preference compared with doxycycline, lymecycline and minocycline.

More severe drug reactions are experienced during treatment with minocycline compared with doxycycline, lymecycline and tetracycline. The evidence on the best dosage, including cumulative dosage, is rare and partly conflicting. Attempts to determine the cumulative dose necessary to obtain an optimal treatment response and low relapse rate have not yet yielded sufficient evidence for a strong recommendation.

The following recommendation is based more on expert opinion, than on existing published trials. The current European Directive for prescribing oral isotretinoin differs from the recommendations given in this guideline with respect to indication. Although comparative trials are missing, clinical experience confirms that the relapse rates after treatment with isotretinoin are the lowest among all the available therapies. Theoretically, in EU countries clinicians are free to prescribe drugs, such as oral isotretinoin, according to their professional experience.

However, in the event of any medical problems, they could be deemed liable if they have failed to follow recommended prescribing practice. A systematic literature search to investigate the risk of depression during treatment with isotretinoin was not conducted. Overall, trials comparing depression before and after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend towards fewer or less severe depressive symptoms after isotretinoin therapy.

No correlation between isotretinoin use and suicidal behaviour was reported, although only one retrospective trial presented data on this topic. The current literature does not support a causative association between isotretinoin use and depression; however, there are important limitations to many of the trials. The available data on suicidal behaviour during isotretinoin treatment are insufficient to establish a meaningful causative association.

Prior symptoms of depression should be part of the medical history of any patient before the initiation of isotretinoin and during the course of the treatment. Patients should be informed about a possible risk of depression and suicidal behaviour. The first relevant changes in P. The molecular basis of resistance, via mutations in genes encoding 23S and 16S rRNA, are widely distributed. There have been an increasing number of reports of systemic infections caused by resistant P.

Studies on P. As a consequence, the use of systemic antibiotics should be limited both indication and duration and topical antibiotic monotherapy should be avoided. This chapter is based on expert opinion and a narrative literature review only. These recommendations were not generated by systematic literature search with formalized consensus conference.

Acne lesions typically recur for years, and so acne is nowadays considered to be a chronic disease. Therefore, a maintenance therapy to reduce the potential for recurrence of visible lesions should be considered as a part of routine acne treatment. However, it is important to emphasize the lack of definitions surrounding the topic. Since it has clearly been shown that, after a controlled intervention phase with oral antibiotic and topical tretinoin, patients continuing to receive the topical retinoid in a controlled maintenance phase experience a significantly lower relapse rate.

Several controlled trials have now been performed with topical retinoids to show the value of maintenance treatment, with a topical retinoid decreasing the number and preventing the development of microcomedones in different severity grades of acne. To date, adapalene regimens have been most extensively studied as maintenance treatments for acne in four controlled trials one on micro comedones and two uncontrolled trials.

One clinical trial evaluating tazarotene and one involving maintenance treatment with tretinoin after oral tetracycline and tretinoin topical treatment have also been published. This suggests that a longer duration of maintenance therapy is likely to be beneficial. Topical azelaic acid is an alternative to topical retinoids for acne maintenance therapy. If an antimicrobial effect is desired, the addition of BPO to topical retinoid therapy is preferred. In future studies, it would be useful to present data on the proportion of patients who were able to maintain a defined level of improvement e.

Other issues that should be addressed include creating a standardized definition of successful maintenance, determining the most appropriate patient populations for maintenance therapy and identifying the ideal length of observation of patients. Ongoing research will help to define the optimal duration of therapy and, perhaps, refine patient selection.

Acne vulgaris - causes, symptoms, diagnosis, treatment, pathology

Some patients with significant inflammation may need to be treated with a combination of topical retinoid and antimicrobial agents. This should be further studied. Education about the pathophysiology of acne can enhance patient adherence to maintenance therapy. However, the psychosocial benefits of clearer skin may be the most compelling reason for consistent maintenance therapy.

Finally, it may also be helpful to explain to patients that acne is often a chronic disease that requires acute and maintenance therapy for sustained remission. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries other than missing content should be directed to the corresponding author for the article. Volume 26 , Issue s1. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

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Objectives of the guidelines Improvement in the care of acne patients The idea behind this guideline is that recommendations based on a systematic review of the literature and a structured consensus process will improve the quality of acne therapy in general. Reduction of serious conditions and scarring As a result of the detailed description of systemic therapies for patients with severe acne, reservations about these interventions should be overcome to ensure that patients receive the optimal therapy.

Promotion of adherence Good therapeutic adherence is key to treatment success. Reduction of antibiotic resistance The use of topical and systemic antibiotics should be optimized by using appropriate combinations for a predefined duration, to reduce the development of antibiotic resistance. Patients The recommendations of the guideline refer to patients who suffer from acne.

Pharmacoeconomic considerations European guidelines are intended for adaptation to national conditions. It has used the following simple clinical classification: 1 Comedonal acne 2 Mild—moderate papulopustular acne 3 Severe papulopustular acne, moderate nodular acne 4 Severe nodular acne, conglobate acne Other already existing systems are very difficult to compare with one another. B Randomized clinical trial of lesser quality e. C Comparative trial with severe methodological limitations e. IV Epidemiology and pathophysiology IV.

V Therapeutic options 5. VI Treatment of comedonal acne VI. Choice of topical vs. The best efficacy was found for azelaic acid, BPO and topical retinoids. Additional pathophysiological considerations favour the use of topical retinoids. There is conflicting evidence regarding the efficacy of red light compared with placebo. There are insufficient data on the efficacy of other treatment options for conglobate acne.

IX General considerations IX. XII References. Google Scholar. PubMed Google Scholar. Crossref Google Scholar. Crossref PubMed Google Scholar. Citing Literature. Figures References Related Information. Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure. Email or Customer ID. Forgot password? Old Password. New Password. Password Changed Successfully Your password has been changed. Returning user. Request Username Can't sign in? Forgot your username?

Enter your email address below and we will send you your username. Pillsbury Michaelsson Cook Wilson Allen Burke Leeds 5. Pochi Dreno Lehmann 7. Gollnick Layton Tan Topical antibiotics are not recommended for the treatment of comedonal acne. Artificial ultraviolet UV radiation is not recommended for the treatment of comedonal acne. A recommendation for or against treatment of comedonal acne with visible light as monotherapy, lasers with visible wavelengths and lasers with infrared wavelengths, with intense pulsed light IPL and photodynamic therapy PDT cannot be made at the present time.

Azelaic acid can be recommended for the treatment of mild to moderate papulopustular acne. BPO can be recommended for the treatment of mild to moderate papulopustular acne. In case of more widespread disease, a combination of a systemic antibiotic with adapalene can be recommended for the treatment of moderate papulopustular. Blue light monotherapy can be considered for the treatment of mild to moderate papulopustular acne. Oral zinc can be considered for the treatment of mild to moderate papulopustular acne.

In case of more widespread disease, a combination of a systemic antibiotic with either BPO or with adapalene in fixed combination with BPO can be considered for the treatment of moderate papulopustular. Topical antibiotics as monotherapy are not recommended for the treatment of mild to moderate papulopustular acne. Treatment of mild to moderate papulopustular acne with artificial UV radiation is not recommended for the treatment of mild to moderate papulopustular acne. Due to a lack of sufficient evidence, it is currently not possible to make a recommendation for or against treatment with red light, IPL, Laser or PDT in the treatment of mild to moderate papulopustular acne.

Oral isotretinoin monotherapy is strongly recommended for the treatment of severe papulopustular acne. Single or combined topical monotherapy is not recommended for the treatment of severe papulopustular acne. Oral antibiotics as monotherapy are not recommended for the treatment of severe papulopustular acne. Visible light as monotherapy is not recommended for the treatment of severe papulopustular acne. Artificial UV radiation sources are not recommended as a treatment of severe papulopustular acne. Due to a lack of sufficient evidence, it is currently not possible to make a recommendation for or against treatment with IPL and laser in severe papulopustular acne.

Oral isotretinoin is strongly recommended as a monotherapy for the treatment of conglobate acne. Systemic antibiotics can be recommended for the treatment of conglobate acne in combination with azelaic acid. Topical monotherapy is not recommended for the treatment of conglobate acne. Oral antibiotics are not recommended as monotherapy for the treatment of conglobate acne. Artificial UV radiation sources are not recommended for the treatment of conglobate acne.

Visible light as monotherapy is not recommended for the treatment of conglobate acne. Due to lack of sufficient evidence, it is currently not possible to make a recommendation for or against treatment with IPL, or laser in conglobate acne.