Top Ten Clinical Pearls in the Treatment of Acne Vulgaris
April 2016
in “
Dermatologic Clinics
”
topical retinoids benzoyl peroxide Propionibacterium acnes macrocomedones oral isotretinoin spironolactone oral contraceptives antiandrogen therapy dapsone sulfacetamide tretinoin adapalene/BPO gel oral doxycycline antihistamines gram-negative folliculitis anabolic steroids nutritional supplements vitamin supplements Accutane Retin-A BPO Proactiv Aczone Sulfacet-R Differin Aldactone Doryx
TLDR Start acne treatment early to prevent scarring, consider antibiotic resistance, use maintenance therapy, and manage side effects carefully.
The document from 2016 provides clinical recommendations for treating acne vulgaris, stressing the importance of early intervention to prevent scarring and the consideration of antibiotic resistance when prescribing antibiotics. It suggests maintenance therapy with topical retinoids and benzoyl peroxide, and addresses the issue of antibiotic resistance in Propionibacterium acnes. The document recommends treating macrocomedones before starting oral isotretinoin, which is better absorbed with fatty food. Spironolactone is presented as an alternative to oral contraceptives for antiandrogen therapy in women. It also covers the management of adverse effects and interactions of topical agents, such as discoloration from dapsone or sulfacetamide when used with benzoyl peroxide, and the inactivation of tretinoin by benzoyl peroxide. A multicenter randomized controlled trial with 266 subjects showed that a combination of topical adapalene/BPO gel plus oral doxycycline was highly efficacious and safe, with rapid onset of action but less effective than isotretinoin at 20 weeks. A study with 40 patients found that antihistamines can reduce adverse effects of oral isotretinoin and aid in treating moderate to severe acne. A small study confirmed the efficacy and tolerability of spironolactone as an antiandrogen therapy in female patients. The document also warns of gram-negative folliculitis from long-term antibiotic use and acne triggers like anabolic steroids, and nutritional and vitamin supplements.
