Management of Acne

    February 2011 in “ Canadian Medical Association Journal ”
    John Kraft, Anatoli Freiman
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    TLDR Acne treatment varies, with topical and systemic therapies effective, and more research needed on treatment order and long-term effects.
    The 2011 document reviews acne management strategies, detailing the assessment of acne severity, topical treatments, and systemic therapies. It explains that acne vulgaris is an inflammatory condition affecting pilosebaceous units, primarily during adolescence, and can cause scarring and pigmentation changes. The pathogenesis involves abnormal keratinization, increased sebum production, bacterial proliferation, and inflammation. Treatment effectiveness varies, with topical retinoids and antimicrobials being standard for mild to moderate acne, reducing lesions by 40% to 70%. Combination therapy is often more effective, and systemic therapies are used for moderate to severe cases. Hormonal treatments, including oral contraceptives and antiandrogens like spironolactone, are effective, particularly in women, but may have side effects. A study with 128 women showed significant lesion reduction using certain hormonal combinations. Isotretinoin is effective against all acne causes but has serious side effects, including teratogenicity. Alternative therapies and physical treatments have limited evidence. The document calls for more research on treatment sequencing and long-term quality of life impacts.
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