{"id":118,"date":"2019-10-06T13:47:59","date_gmt":"2019-10-06T08:17:59","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=118"},"modified":"2019-10-06T13:47:59","modified_gmt":"2019-10-06T08:17:59","slug":"acne-pharmacotherapy","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/acne-pharmacotherapy\/","title":{"rendered":"Acne: Pharmacotherapy"},"content":{"rendered":"\n<p><strong>PHARMACOTHERAPY OF ACNE<\/strong><\/p>\n\n\n\n<ul><li>Acne is a chronic inflammatory disorder affecting the pilosebaceous unit leading to non-inflammatory and inflammatory lesions.<\/li><li>Affects nearly 10% of the global population<\/li><li>\u00a085% boys % &amp; 83% girls affected in adolescent &amp; young adult life<\/li><li>\u00a0Occurs around puberty<\/li><li>\u00a0Severity peak age 16 to 17 years in females &amp; 17 to 19 years in males<\/li><li>\u00a0<strong>Commonly involved sites<\/strong> \u00e0 face, chest, upper back, upper arms.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"\"><tbody><tr><td>\n  <strong>Preadolescent<\/strong>\n  <\/td><td>   <strong>7 year to 12 years or before   menarche in girls<\/strong>   <\/td><\/tr><tr><td>\n  <strong>Adolescent<\/strong>\n  <\/td><td>   12 year to 19 years or after   menarche in girls   <\/td><\/tr><tr><td>\n  <strong>Persistent<\/strong>\n  <\/td><td>\n  Onset in adolescence and\n  continuing after 25 years\n  <\/td><\/tr><tr><td>   <strong>Late-onset<\/strong>   <\/td><td>\n  Onset after 25 years\n  <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"409\" height=\"312\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-5.png?w=409\" alt=\"\" class=\"wp-image-119\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-5.png 409w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-5-300x229.png 300w\" sizes=\"(max-width: 409px) 100vw, 409px\" \/><\/figure>\n\n\n\n<p>Types \u2013<\/p>\n\n\n\n<ul><li> Non-InflammatoryComedones<ul><li> Open  Closed <\/li><\/ul><\/li><li> Inflammatory <ul><li> \u00a0Papule, pustule, nodule, and cyst <\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Treatment <\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"361\" height=\"341\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-6.png?w=361\" alt=\"\" class=\"wp-image-120\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-6.png 361w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-6-300x283.png 300w\" sizes=\"(max-width: 361px) 100vw, 361px\" \/><\/figure>\n\n\n\n<p><strong>Topical\nAntibiotics<\/strong><\/p>\n\n\n\n<ul><li>Slower acting, less effective than oral antibiotics.<\/li><li><strong>Clindamycin and erythromycin<\/strong> of 1% to 4% with or without the addition of zinc.<\/li><li>\u00a0Dapsone 5% gel (1995)<\/li><li>\u00a0<strong>No monotherapy<\/strong><\/li><li>\u00a0Discontinuation once improvement<\/li><li>\u00a0<strong>No improvement within 6 to 8 weeks, discontinuation and alternate therapy<\/strong><\/li><li>\u00a0Erythema, itching, dryness, and burning.<\/li><\/ul>\n\n\n\n<p><strong>BENZOYL PEROXIDE<\/strong><\/p>\n\n\n\n<ul><li>\u00a0Highly reactive oxygen species<\/li><li>\u00a0Cytotoxicity of PMNLs.<\/li><li>\u00a0Effective <strong>comedolytic and keratolytic agent<\/strong><\/li><li>\u00a0Highly lipophilic<\/li><li><strong>\u00a02.5%, 5% and 10%<\/strong> concentrations as gels, aquagels, creams and lotions.<\/li><li>\u00a0Prevents the development of resistance<\/li><li>\u00a0Oily skin advised to use gels, washes or solutions having a drying effect<\/li><li>\u00a0Dry or sensitive skin \u00e0prefer a cream formulation.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"341\" height=\"222\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-7.png?w=341\" alt=\"\" class=\"wp-image-121\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-7.png 341w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-7-300x195.png 300w\" sizes=\"(max-width: 341px) 100vw, 341px\" \/><\/figure>\n\n\n\n<p><strong>Systemic\nAntibiotics<\/strong><\/p>\n\n\n\n<ul><li>Tetracycline or oxytetracycline 250\u2013500 mg BD for 4\u20136 months<\/li><li>Doxycycline is at 50\u2013100 mg BD or a single daily dose of 100 mg for 4\u20136 months<\/li><li>Minocycline 50\u2013100 mg BD <\/li><li>Erythromycin 500 mg BD for 4\u20136 months.<\/li><\/ul>\n\n\n\n<p><strong>Oral Isotretinoin<\/strong><\/p>\n\n\n\n<ul><li>Start at a dosage of 0.5 mg\u2044 kg daily.<\/li><li>severe papulopustular acne \u2044 moderate nodular acne<\/li><li>Not recommended for patients under 12 years of age.<\/li><li>Monitor liver enzymes and lipids, before treatment, 1 month after starting, every 3 months thereafter.<\/li><li>Duration of therapy should be at least 6 months<\/li><li>Avoid laser treatment, peeling and wax epilation for at least 6 months after stopping therapy.<\/li><\/ul>\n\n\n\n<p><strong>For\nAcne in PCOS<\/strong><\/p>\n\n\n\n<p>FDA approved<\/p>\n\n\n\n<ul><li>Norgestimate 180\/215\/250 mcg + 35mcg Ethinyl estradiol<\/li><li>Norethindrone acetate 1 mg + EE 20\/30\/ 35mcg 7 day<\/li><\/ul>\n\n\n\n<p><strong>Peeling agents<\/strong><\/p>\n\n\n\n<ul><li>Rationale: Controlled chemical-induced injury to the skin promoting regeneration and remodeling<\/li><li>Comedonal, papulopustular:<ul><li>20-30% Salicylic acid,<\/li><li>70% Glycolic acid<\/li><li>40-60% Pyruvic acid<\/li><li>20-25% Mandelic acid<\/li><li>Jessner\u2019s solution<\/li><li>10% Trichloroacetic acid<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>PHOTODYNAMIC THERAPY<\/strong><\/p>\n\n\n\n<ul><li>Photosensitizer, 5-aminolevulinic acid or methyl aminolevulinate<\/li><li>\u00a0Accumulate selectively \u00e0 sebaceous glands<\/li><li>\u00a0Decreases size and function of sebaceous glands<\/li><li>\u00a0Anti-inflammatory effects, and down-regulates immune response<\/li><li>\u00a0Pain with illumination, erythema, and edema. <\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Guidelines<\/strong><\/h2>\n\n\n\n<p><strong>Strategies for\nlimiting antibiotic resistance<\/strong><\/p>\n\n\n\n<ul><li>Combine a topical retinoid plus an antimicrobial<\/li><li>\u00a0Use of antibiotics to short periods<\/li><li>\u00a0Co-prescribe a BPO-containing product or use as the washout<\/li><li>\u00a0<strong>Oral and topical antibiotics should not be used as monotherapy<\/strong><\/li><li>\u00a0Concurrent use of oral and topical antibiotics should be avoided<\/li><li>\u00a0Use topical retinoids for maintenance therapy<\/li><li>\u00a0Avoid the use of antibiotics for maintenance therapy<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"696\" height=\"365\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-9.png?w=696\" alt=\"\" class=\"wp-image-123\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-9.png 696w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-9-300x157.png 300w\" sizes=\"(max-width: 696px) 100vw, 696px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>PHARMACOTHERAPY OF ACNE Acne is a chronic inflammatory disorder affecting the pilosebaceous unit leading to non-inflammatory and inflammatory lesions. Affects nearly 10% of the global population \u00a085% boys % &amp; 83% girls affected in adolescent &amp; young adult life \u00a0Occurs around puberty \u00a0Severity peak age 16 to 17 years in females &amp; 17 to 19[&#8230;]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[6,18],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/118"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=118"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/118\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=118"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=118"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}