Acne Vulgaris (for professionals)

Acne is common but can be psychologically devastatating. It is important to see a dermatologist whose role is:

-to confirm the diagnosis of acne vulgaris.

-to determine the type of acne: retentional (non inflammatory) or inflammatory.

-to determine the psychological impact to determine aggressivity of treatment.

-to monitor the effects of treatment.

Retentional Acne Vulgaris: open and closed comedones (whiteheads and blackheads)

Some advice for the patient:

-use a wash three times a day.

-only use non comedogenic substances on the face (indicated on the products).

-do not go for any lasers, peelings if you still have outbreaks on the skin. Such appearance enhancing treatments may be tried if no outbreak is present in a 6 month period using a wash only. If on isotretinoin, the waiting time after the treatment is stopped is one year.

For the treatment algorythm:

-start by using a wash such as triclosan three times a day.

-if non inflammatory (determined by a dermatologist), use benzoyle peroxide, or tretinoin (both are available at different percentages). If irritant adapalene may be used instead of tretinoin or evening applications may be spaced. Topical antibioics such as erythromycin and clindamycin may me tried.

-if the acne is inflammatory (determined by a dermatologist), add antibiotics such as doxycycline, minocyline. If intending to be pregnant, only use erythromycin.

-if it gets worse with menstruation, a gynaecologist may be consulted for antiandrogen contraceptives (Diane 35-acetate of cyproterone 2mg, ethinylestradiol 35 mg ).

-if nothing works-isotretinoin may be tried but under strict medical supervision as it is a teratogen, can have effects on the mood, liver and lipid metabolism. Drugs for inflammatory acne may not be associated.

This advice is for informational purposes  only and does not replace therapeutic judgement done by a skin doctor.