Treatment (table of topical/oral tx at bottom)

Antibiotics

         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

Oral retinoids

         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

 Patient education

 Follow-up visits

 

Color Textbook of Pediatric Dermatology. 3rd edition.