Treatment (table of topical/oral tx at bottom)
∑ Topical abx: most useful for maintenance therapy after improvement from the use of oral antibiotics is observed; oral abx can be dcíed and improvement maintained with topical abx plus topical keratolytics
o Most effective: Clindamycin phosphate 1% (diarrhea and colitis may occur rarely due to percutaneous absorption). Clinda/benzoyl, erythro/benzoyl (benzamycin) combo available.
o Quite effective: topical erythromycin solution 1%, 1.5%, 2%, ointment 2%, gel 3%, meclocycline cream 1%
o Minimally effective: topical tetracycline 1%, 2.2%
∑ Oral abx that are concentrated in sebum are very effective in inflammatory acne (tetracycline, minocycline, doxycycline, erythromycin); continue 1-3 months until all acne lesions are suppressed; use in combination with topical keratolytics; routine lab monitoring is unnecessary
o Erythromycin, Tetracycline (take on empty stomach): 500 to 1000 mg divided bid
o Minocycline, doxycycline (most photosensitizing): 100-200 mg div bid
∑ Isotretinoin: very effective in nodulocystic acne resistant to standard therapeutic regimens
o Not recommended as 1st line therapy
o 40 mg once or twice daily (0.5 to 1 mg/kg/day) for 4 mos (longer is not recommended); at least a 4 month rst is recommended before a 2nd treatment course.
o Not effective for comedonal or other mild forms of acne
o Side effects: dryness, scaliness of skin, dry eyes and nose, 10% with mild hair loss (reversible); rarely, elevation of LFTs, blood lipids
o Teratogenic Ė malformations of CNS in 25% of women who become pregnant. Usage in young women of childbearing age is not recommended. Do pregnancy test, and monthly contraceptive counseling and pregnancy tests.
Other acne treatments
∑ No convincing evidence that dietary management, mild drying agents, abrasive scrubs, oral vit A, UV light, cryotherapy or I&D have any beneficial effects
∑ OCPs have been shown to be effective
also see Pityrosporum Folliculitis
Factors that aggravate acne
Color Textbook of Pediatric Dermatology. 3rd edition.