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Acne Vulgaris Management
Aka: Acne Vulgaris Management, Acne Vulgaris Non-Pharmacologic Management, Acne Vulgaris Exacerbating Factors
- See Also
- Acne Vulgaris
- Acne Vulgaris Pathophysiology
- Adjunctive Acne Vulgaris Management
- Moderate Acne Vulgaris Management
- Severe Acne Vulgaris Management (includes Cystic Acne)
- Management: Exacerbating factors to avoid
- Medications that exacerbate acne
- Androgenic steroids (e.g. Danazol, Testosterone
- Corticosteroids
- Lithium
- Oral Contraceptives
- Isoniazid
- Phenytoin (Dilantin)
- Environment
- Hot
- Greasy (fast-food kitchen, garage)
- Tobacco smoke exposure
- Oil based Cosmetics (Acne cosmetica)
- Cosmetics with Lanolin or petroleum jelly
- Oil based Shampoos or Sunscreens
- Emotional Stress
- Physical Pressure (acne mechanica)
- Tight chinstrap
- Helmet
- Refined Carbohydrates (high Glycemic Index foods)
- Sweets, chocolate and pizza do in fact worsen Acne Vulgaris, despite prior dogma
- fiedler (2017) acta derm venereol 97(1):7-9 +PMID:27136757 [PubMed]
- mahmood (2014) J Drugs Dermatol 13(4): 428-35 +PMID:24719062 [PubMed]
- Management: Myths (non-causes of Acne Vulgaris)
- Acne is not a result of poor hygiene
- Constant washing does not improve acne
- Scrubbing dries and irritates skin further
- Management: General recommendations
- Do not squeeze lesions
- Forces pus into Dermis
- Causes inflammation and scarring
- Limit washing face to 2-3 times per day
- Avoid abrasive soaps
- Gear soap to skin condition
- Skin dry: Purpose soap
- Skin oily: Dial soap
- Change cosmetics from oil-based to water-based products (prevent Acne cosmetica)
- Management: Medications
- See Topical Acne Vulgaris Management (Moderate Acne Vulgaris Management)
- See Systemic Acne Vulgaris Management (Severe Acne Vulgaris Management including Cystic Acne)
- See Adjunctive Acne Vulgaris Management
- Comedones
- Patients often present already having used Benzoyl Peroxide (OTC)
- Start with topical Retinoids (e.g. Retin A) at bedtime
- Mild Inflammatory Papules and Pustules
- Start with Benzoyl Peroxide in am AND Topical Retinoids (e.g. Retin A) at bedtime
- Moderate Inflammatory Papules and Pustules
- Start with Benzoyl Peroxide in am AND Topical Retinoids (e.g. Retin A) at bedtime AND Oral antibiotics
- If effective, then maintenance with topical Retinoids with or without Benzoyl Peroxide (and antibiotics if severe)
- If ineffective, then advance to Isoretinoin (Accutane)
- Moderate to Severe Inflammatory Acne with Nodules
- Start with Benzoyl Peroxide in am AND Topical Retinoids (e.g. Retin A) at bedtime AND Topical antibiotic
- If effective, then maintenance with topical Retinoids (with Benzoyl Peroxide and antibiotics if severe)
- If ineffective, then advance to Isoretinoin (Accutane)
- Other measures
- Combined Oral Contraceptives with Spironolactone
- See Adjunctive Acne Vulgaris Management
- Consider if Menstrual Cycle associated acne or Hyperandrogenism related findings
- Management: Skin of Color (e.g. black, asian, hispanic)
- Skin of Color is more susceptible to scarring, Keloids and Postinflammatory Hyperpigmentation
- Be aware of skin and hair products (e.g. cocoa butter, olive oil) that may exacerbate acne
- Many of these products are used more commonly in Skin of Color communities
- Start acne Topical Medications at less irritating, lower concentrations
- Increase dose slowly to reduce Postinflammatory Hyperpigmentation
- Retin A 0.025% cream every other day (instead of 0.05% gel daily)
- Benzoyl Peroxide 2.5% (instead of 5-10%)
- Azelaic Acid (Azelex, Finacea) may be indicated if Postinflammatory Hyperpigmentation is already present
- References
- Habif (2004) Dermatology, Mosby, p. 162-94
- Parker in Noble (2001) Primary Care p. 758-60
- Brown (1998) Lancet 351:1871-6 [PubMed]
- Feldman (2004) Am Fam Physician 69:2123-56 [PubMed]
- Gollnick (2003) J Am Acad Dermatol 49:S1-37 [PubMed]
- James (2005) N Engl J Med 352(14):1463-72 [PubMed]
- Oge (2019) Am Fam Physician 100(8): 475-84 [PubMed]
- Strauss (2007) J Am Acad Dermatol 56(4): 651-63 [PubMed]
- Titus (2012) Am Fam Physician 86(8): 734-40 [PubMed]