Acne vulgaris

L70.0-5/L70.8-9

DESCRIPTION

Acne is an inflammatory condition of the hair follicle.
It is caused by hormones and sebum gland keratinisation, leading to follicular plugging producing comedomes and proliferation of Propioni bacterium acnes .
Distributed on face, chest and back.
Occurs more commonly in adolescence, but may also occur in adulthood.
May also occur as a result of the inappropriate use of topical steroids or as a side effect of medicine e.g. INH therapy.

Mild acne:

Predominantly consists of non-inflammatory comedones.

Moderate acne:

Consists of a mixture of non-inflammatory comedones and inflammatory papules and pustules.

Severe acne:

It is characterised by the presence of widespread nodules and cysts, as well as a preponderance of inflammatory papules and pustules.

GENERAL MEASURES

  • Do not squeeze lesions.
  • Avoid greasy or oily cosmetics and hair grooming products that block the hair follicle openings.
  • Discourage excessive facial washing.

MEDICINE TREATMENT

Mild inflammatory acne:

  • Benzoyl peroxide 5%, gel, apply in the morning to affected areas as tolerated.
    • Wash off in the evening.
    • If ineffective and tolerated, increase application to 12 hourly.
    • Avoid contact with eyes, mouth, angles of the nose and mucous membranes.

LoEIII [1]

For non-inflammatory acne:

Topical retinoids

The main action is to control comedone formation.
Introduce topical retinoids gradually as a night-time application to limit skin irritant effects, as they are not photo-stable and degrade when exposed to sunlight.

CAUTION

Do not use if pregnant or planning pregnancy.

Limit exposure to sunlight. If sunburn occurs, discontinue therapy until the skin has recovered.

LoEI [2]

  • Tretinoin, topical, apply at night to affected areas for at least 6 weeks.
    • Review patient after 6 weeks' treatment.
    • Minimise exposure to sunlight. If sunburn occurs, discontinue therapy until the skin has recovered.
    • Acne may worsen during the first few weeks.

Moderate inflammatory acne:

  • Benzoyl peroxide 5%, gel, apply in the morning to affected areas as tolerated.
    • Wash off in the evening.
    • If ineffective and tolerated, increase application to 12 hourly.
    • Avoid contact with eyes, mouth, angles of the nose and mucous membranes.

LoEIII [3]

AND

  • Doxycycline, oral, 100 mg daily for 3 months.
    • Review patient after 3 months of treatment.
    • It should be taken with meals.
    • Do not take it together with iron preparations and antacids.

LoEIII [4]

REFERRRAL

  • All severe cases.
  • Poor response to treatment.