Acne Vulgaris Management

1. See Also
   1. Acne Vulgaris
   2. Acne Vulgaris Pathophysiology
   3. Adjunctive Acne Vulgaris Management
   4. Moderate Acne Vulgaris Management
   5. Severe Acne Vulgaris Management (includes Cystic Acne)
2. Management: Exacerbating factors to avoid
   1. Medications that exacerbate acne
      1. Androgenic steroids (e.g. Danazol, Testosterone
      2. Corticosteroids
      3. Lithium
      4. Oral Contraceptives
      5. Isoniazid
      6. Phenytoin (Dilantin)
   2. Environment
      1. Hot
      2. Greasy (fast-food kitchen, garage)
   3. Oil based Cosmetics
      1. Cosmetics with Lanolin or petroleum jelly
      2. Oil based Shampoos or Sunscreens
   4. Emotional Stress
   5. Physical Pressure (acne mechanica)
      1. Tight chinstrap
      2. Helmet
3. Management: Myths (non-causes of Acne Vulgaris)
   1. Foods DO NOT worsen acne
      1. Pizza
      2. Nuts
      3. Sweets
      4. Chocolate
   2. Acne is not a result of poor hygiene
      1. Constant washing does not improve acne
      2. Scrubbing dries and irritates skin further
4. Management: General recommendations
   1. Do not squeeze lesions
      1. Forces pus into Dermis
      2. Causes inflammation and scarring
   2. Limit washing face to 2-3 times per day
      1. Avoid abrasive soaps
      2. Gear soap to skin condition
         1. Skin dry: Purpose soap
         2. Skin oily: Dial soap
   3. Change cosmetics to water based products
5. Management: Skin of Color (e.g. black, asian, hispanic)
   1. Skin of Color is more susceptible to scarring, Keloids and Postinflammatory Hyperpigmentation
   2. Be aware of skin and hair products (e.g. cocoa butter, olive oil) that may exacerbate acne
      1. Many of these products are used more commonly in Skin of Color communities
   3. Start acne topical medications at less irritating, lower concentrations
      1. Increase dose slowly to reduce Postinflammatory Hyperpigmentation
      2. Retin A 0.025% cream every other day (instead of 0.05% gel daily)
      3. Benzoyl Peroxide 2.5% (instead of 5-10%)
      4. Azelaic Acid (Azelex, Finacea) may be indicated if Postinflammatory Hyperpigmentation is already present
6. References
   1. Habif (2004) Dermatology, Mosby, p. 162-94
   2. Parker in Noble (2001) Primary Care p. 758-60
   3. Brown (1998) Lancet 351:1871-6 [PubMed]
   4. Feldman (2004) Am Fam Physician 69:2123-56 [PubMed]
   5. Gollnick (2003) J Am Acad Dermatol 49:S1-37 [PubMed]
   6. James (2005) N Engl J Med 352(14):1463-72 [PubMed]
   7. Strauss (2007) J Am Acad Dermatol 56(4): 651-63 [PubMed]
   8. Titus (2012) Am Fam Physician 86(8): 734-40 [PubMed]