- September 2, 2022
- Newsletter
- 617-430-5616
Menu
ADVERTISEMENT
ADVERTISEMENT
Background
Acne vulgaris is a chronically recurring, self-limiting inflammatory condition of the pilosebaceous unit. Cutibacterium acnes causes acne vulgaris to appear throughout adolescence when dehydroepiandrosterone is naturally circulating in the blood.
It is a relatively typical skin condition that can manifest as both inflammatory and non-inflammatory blisters, mostly on the face but also on the forearms, back and trunk.
Epidemiology
Adolescence is when acne may first emerge, and it can last into the early 30s. Males are more likely than females to develop acne. Populations in urban areas are much more influenced than those in rural areas. 20 percent of those who have been impacted experience extreme acne that leaves scars.
It appears that certain races are more impacted than others. Extreme acne is much more frequent in Asians and Africans, whereas moderate acne is more prevalent in white people. People with a darker complexion, in general, also tend to acquire hyperpigmentation. Neonates can also get acne, although it typically goes away on its own.
Anatomy
Pathophysiology
As a result of androgens, 5-alpha reductase changes testosterone throughout puberty into more effective DHT, which attaches to specific targets in the sebaceous glands and increases sebum secretion. Sebum is retained as a result of the follicular epidermis’ enhanced hyperproliferation.
Inflammation is triggered when distended follicles burst and discharge pro-inflammatory substances into the epidermis. Staphylococcus epidermis, Malassezia furfur, and C. acnes all cause inflammation and promote the growth of follicular epidermal tissue.
Acne-causing factors include:
Etiology
Acne is caused by the sebaceous glands being oversensitive to a normal level of androgens in the blood, which P. acnes and inflammation exacerbate.
Acne can result from the following factors:
Genetics
Prognostic Factors
Although it may not be life-threatening, acne has psychosocial repercussions that last a lifetime. Acne sufferers and those with breakouts frequently experience anxiety and sadness. It’s almost impossible to remove acne scars.
According to a Swedish study, teenage guys’ acne might be at a higher risk for developing prostate cancer later in life. Overall, acne therapy has a good prognosis.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Apply a thin layer of the product on the affected area each day in the evening
An initial dose of 1 gm/day orally
After the gradual improvement, reduce the dose to 125-500 mg/day
Indicated as topical administration for acne vulgaris
After washing the face, apply the dosage form as a thin film on the affected area of the skin every evening
A warm sensation may occur on the skin after applying the same
In case of apparent worsening, do not discontinue the treatment
Massage the topical dosage form on the affected area every 12 hours
Massage the topical dosage form on the affected area every 12 hours
Massage the topical dosage form on the affected area every 12 hours
Cleansers- Apply the product through gentle massage onto the wet face & neck until lather formation
Rinse thoroughly
Utilize it twice daily
Scrub- Use it the same way as the cleanser, but once daily
Cream/gel/foam- After clean-up, apply the product to the affected area thrice daily
Wipes/pads- After clean-up, wipe off the face & neck with them, do not rinse
Shower soaps/gels- utilize the product once daily, massage over the affected body, and rinse well
Administer the medication topically twice daily, in the morning and evening, to the affected regions of the skin, following a thorough cleansing and gentle drying
erythromycin topical/benzoyl peroxide
Acne Vulgaris
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried
drospirenone/ethinyl estradiol
1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days
Dosage Modifications
Renal impairment: not recommended
Hepatic impairment: not recommended
Dosing considerations
For females it is recommended to utilize extra non-hormonal contraception throughout the initial 7 days of treatment.
Elevated possibility of venous thromboembolism (VTE) when using combined hormonal contraceptives after childbirth; chance decreases swiftly after 21 days but does not reach the usual level until 42 days after delivery.
For women who have given birth but do not breastfeed or have undergone a second trimester abortion: It is recommended to wait for at least four weeks before beginning therapy.
For women who have had a caesarean section delivery: It is recommended to wait for at least six weeks before beginning therapy.
It is recommended to apply a topical 5% gel daily topical 100% solution should be applied twice a day for six months
Following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day
Cream: Administer a thin layer of the cream as required, either once daily or up to three times daily
Foam: This should be done once a day or twice a day
If necessary, rinse off the foam after 1-2 minutes
Cleanser: Apply the cleanser to damp skin and gently massage it either once a day or twice a day
Afterward, rinse your skin thoroughly and pat it dry
Cleansing Pads: Take a wet pad and apply it to wet skin
Work the pad into a full lather, excluding the eye area, for 10-20 seconds
To cure potential dryness, it is advisable to commence with a single daily application and progressively recommend it to 2-3 times per day as deemed necessary
Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day
Bar/Cleanser: Apply cleanser to a damp face and the neck, massaging it until lather forms. Rinse completely
Use once or twice daily
Altreno, Avita,Tretin-X, Retin-A, Atralin, Retin-A Micro
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.
drospirenone/ethinyl estradiol/levomefolate
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.
benzoyl peroxide and tretinoin topical
Indicated for the treatment of acne vulgaris
Apply a bit of cream on the affected area each day
Spread a thin layer of the medication topically to the impacted regions twice daily
cyproterone and ethinyl estradiol
Administer one tablet daily once for 21 days, then skip the dosing for 7 days.
A new cycle should also begin when a woman's period initially begins.
Regardless of whether bleeding is associated with withdrawal, subsequent dose cycles should start around the same day of the week as the initial cycle did.
After 3–4 cycles, if your symptoms have improved enough, you may stop treatment.
1.5 mg of diazolidinylurea cream applied on the affected area once or twice a day
408 mg per day for at least eight weeks is the dosage represented in terms of lymecycline (i.e., 408 mg of lymecycline equals 300 mg of tetracycline base)
benzoyl peroxide, clindamycin phosphate, adapalene
A newly approved topical gel by the name Cabtreo is compounded by using three drugs, namely benzoyl peroxide (3.1%), which shows antibiotic action; clindamycin phosphate (1.2%), which shows antibacterial property; adapalene (0.15%) which is a retinoid
Cabtreo is a fixed dose FDA-approved topical treatment for Acne Vulgaris
This topical gel is applied to the affected skin areas as a thin layer daily once. It is only used on the skin as a topical agent
Apply a thin layer of the product on the affected area each day in the evening
Apply the product onto the affected skin twice or thrice daily
adapalene and benzoyl peroxide
<9 years: Safety and efficacy not established
>9 years: Apply a thin layer to the affected areas of the face and trunk every night after washing
Children >8 years and adolescents: 50 to 100 mg orally once or twice a day (depends on the severity of infection and symptoms)
Apply the dosage form as a film on the affected area of the skin every evening
Not for children below 12 years
For >12 years
Massage the topical dosage form on the affected area every 12 hours
Apply the product gently and thoroughly on washed and dried skin
erythromycin topical/benzoyl peroxide
Acne Vulgaris
Age >12 years
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried
Age >12 years
Safety and efficacy not established
drospirenone/ethinyl estradiol
Safety and efficacy not determined in less than 14 years old
≥14 years
1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days
Adolescents: following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day
Cream: Administer a thin coat of the cream to the impacted regions once per day or as required, with the option to increase the frequency up to three times daily
Foam: Massage the foam gently into the affected area once a day or twice a day
If you need to remove the foam, rinse it off after 1-2 minutes
Cleanser: Apply the cleanser to wet skin and gently massage it into the skin once a day or twice a day
Rinse your skin thoroughly and pat it dry afterward
Cleansing Pads: Take a wet pad and apply it to wet skin
Work the pad into a full lather for 10-20 seconds, making sure to avoid the eye area
Rinse your skin thoroughly and pat it dry
Dispose of the used pad properly
To minimize the potential dryness
It is advised to initiate with a single utilization per day and progressively escalate it to 2-3 instances on a daily basis, as deemed necessary
Adults
Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day
Bar/Cleanser: Use once or twice daily; Apply cleanser to a damp face and neck, massaging it until lather forms. Rinse completely
<9 years: Safety and efficacy not established (Altreno)
<10 years: Safety and efficacy not established (Atralin)
<12 years: Safety and efficacy not established (Retin-A Micro, Avita, Retin-A)
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.
drospirenone/ethinyl estradiol/levomefolate
<14 years: Safety and efficacy not established
≥14 years:
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.
benzoyl peroxide and tretinoin topical
Indicated for the treatment of acne vulgaris
For <9 years: Safety and efficacy are not seen in pediatrics
For >9 years: Apply a small amount of cream on the affected area each day
Safety and efficacy not determined in less than twelve years
≥12 years: Spread a thin layer of the medication topically to the impacted regions twice daily
Future Trends
References
https://www.ncbi.nlm.nih.gov/books/NBK459173/
ADVERTISEMENT
Acne vulgaris is a chronically recurring, self-limiting inflammatory condition of the pilosebaceous unit. Cutibacterium acnes causes acne vulgaris to appear throughout adolescence when dehydroepiandrosterone is naturally circulating in the blood.
It is a relatively typical skin condition that can manifest as both inflammatory and non-inflammatory blisters, mostly on the face but also on the forearms, back and trunk.
Adolescence is when acne may first emerge, and it can last into the early 30s. Males are more likely than females to develop acne. Populations in urban areas are much more influenced than those in rural areas. 20 percent of those who have been impacted experience extreme acne that leaves scars.
It appears that certain races are more impacted than others. Extreme acne is much more frequent in Asians and Africans, whereas moderate acne is more prevalent in white people. People with a darker complexion, in general, also tend to acquire hyperpigmentation. Neonates can also get acne, although it typically goes away on its own.
As a result of androgens, 5-alpha reductase changes testosterone throughout puberty into more effective DHT, which attaches to specific targets in the sebaceous glands and increases sebum secretion. Sebum is retained as a result of the follicular epidermis’ enhanced hyperproliferation.
Inflammation is triggered when distended follicles burst and discharge pro-inflammatory substances into the epidermis. Staphylococcus epidermis, Malassezia furfur, and C. acnes all cause inflammation and promote the growth of follicular epidermal tissue.
Acne-causing factors include:
Acne is caused by the sebaceous glands being oversensitive to a normal level of androgens in the blood, which P. acnes and inflammation exacerbate.
Acne can result from the following factors:
Although it may not be life-threatening, acne has psychosocial repercussions that last a lifetime. Acne sufferers and those with breakouts frequently experience anxiety and sadness. It’s almost impossible to remove acne scars.
According to a Swedish study, teenage guys’ acne might be at a higher risk for developing prostate cancer later in life. Overall, acne therapy has a good prognosis.
Apply a thin layer of the product on the affected area each day in the evening
An initial dose of 1 gm/day orally
After the gradual improvement, reduce the dose to 125-500 mg/day
Indicated as topical administration for acne vulgaris
After washing the face, apply the dosage form as a thin film on the affected area of the skin every evening
A warm sensation may occur on the skin after applying the same
In case of apparent worsening, do not discontinue the treatment
Massage the topical dosage form on the affected area every 12 hours
Massage the topical dosage form on the affected area every 12 hours
Massage the topical dosage form on the affected area every 12 hours
Cleansers- Apply the product through gentle massage onto the wet face & neck until lather formation
Rinse thoroughly
Utilize it twice daily
Scrub- Use it the same way as the cleanser, but once daily
Cream/gel/foam- After clean-up, apply the product to the affected area thrice daily
Wipes/pads- After clean-up, wipe off the face & neck with them, do not rinse
Shower soaps/gels- utilize the product once daily, massage over the affected body, and rinse well
Administer the medication topically twice daily, in the morning and evening, to the affected regions of the skin, following a thorough cleansing and gentle drying
erythromycin topical/benzoyl peroxide
Acne Vulgaris
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried
drospirenone/ethinyl estradiol
1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days
Dosage Modifications
Renal impairment: not recommended
Hepatic impairment: not recommended
Dosing considerations
For females it is recommended to utilize extra non-hormonal contraception throughout the initial 7 days of treatment.
Elevated possibility of venous thromboembolism (VTE) when using combined hormonal contraceptives after childbirth; chance decreases swiftly after 21 days but does not reach the usual level until 42 days after delivery.
For women who have given birth but do not breastfeed or have undergone a second trimester abortion: It is recommended to wait for at least four weeks before beginning therapy.
For women who have had a caesarean section delivery: It is recommended to wait for at least six weeks before beginning therapy.
It is recommended to apply a topical 5% gel daily topical 100% solution should be applied twice a day for six months
Following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day
Cream: Administer a thin layer of the cream as required, either once daily or up to three times daily
Foam: This should be done once a day or twice a day
If necessary, rinse off the foam after 1-2 minutes
Cleanser: Apply the cleanser to damp skin and gently massage it either once a day or twice a day
Afterward, rinse your skin thoroughly and pat it dry
Cleansing Pads: Take a wet pad and apply it to wet skin
Work the pad into a full lather, excluding the eye area, for 10-20 seconds
To cure potential dryness, it is advisable to commence with a single daily application and progressively recommend it to 2-3 times per day as deemed necessary
Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day
Bar/Cleanser: Apply cleanser to a damp face and the neck, massaging it until lather forms. Rinse completely
Use once or twice daily
Altreno, Avita,Tretin-X, Retin-A, Atralin, Retin-A Micro
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.
drospirenone/ethinyl estradiol/levomefolate
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.
benzoyl peroxide and tretinoin topical
Indicated for the treatment of acne vulgaris
Apply a bit of cream on the affected area each day
Spread a thin layer of the medication topically to the impacted regions twice daily
cyproterone and ethinyl estradiol
Administer one tablet daily once for 21 days, then skip the dosing for 7 days.
A new cycle should also begin when a woman's period initially begins.
Regardless of whether bleeding is associated with withdrawal, subsequent dose cycles should start around the same day of the week as the initial cycle did.
After 3–4 cycles, if your symptoms have improved enough, you may stop treatment.
1.5 mg of diazolidinylurea cream applied on the affected area once or twice a day
408 mg per day for at least eight weeks is the dosage represented in terms of lymecycline (i.e., 408 mg of lymecycline equals 300 mg of tetracycline base)
benzoyl peroxide, clindamycin phosphate, adapalene
A newly approved topical gel by the name Cabtreo is compounded by using three drugs, namely benzoyl peroxide (3.1%), which shows antibiotic action; clindamycin phosphate (1.2%), which shows antibacterial property; adapalene (0.15%) which is a retinoid
Cabtreo is a fixed dose FDA-approved topical treatment for Acne Vulgaris
This topical gel is applied to the affected skin areas as a thin layer daily once. It is only used on the skin as a topical agent
Apply a thin layer of the product on the affected area each day in the evening
Apply the product onto the affected skin twice or thrice daily
adapalene and benzoyl peroxide
<9 years: Safety and efficacy not established
>9 years: Apply a thin layer to the affected areas of the face and trunk every night after washing
Children >8 years and adolescents: 50 to 100 mg orally once or twice a day (depends on the severity of infection and symptoms)
Apply the dosage form as a film on the affected area of the skin every evening
Not for children below 12 years
For >12 years
Massage the topical dosage form on the affected area every 12 hours
Apply the product gently and thoroughly on washed and dried skin
erythromycin topical/benzoyl peroxide
Acne Vulgaris
Age >12 years
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried
Age >12 years
Safety and efficacy not established
drospirenone/ethinyl estradiol
Safety and efficacy not determined in less than 14 years old
≥14 years
1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days
Adolescents: following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day
Cream: Administer a thin coat of the cream to the impacted regions once per day or as required, with the option to increase the frequency up to three times daily
Foam: Massage the foam gently into the affected area once a day or twice a day
If you need to remove the foam, rinse it off after 1-2 minutes
Cleanser: Apply the cleanser to wet skin and gently massage it into the skin once a day or twice a day
Rinse your skin thoroughly and pat it dry afterward
Cleansing Pads: Take a wet pad and apply it to wet skin
Work the pad into a full lather for 10-20 seconds, making sure to avoid the eye area
Rinse your skin thoroughly and pat it dry
Dispose of the used pad properly
To minimize the potential dryness
It is advised to initiate with a single utilization per day and progressively escalate it to 2-3 instances on a daily basis, as deemed necessary
Adults
Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day
Bar/Cleanser: Use once or twice daily; Apply cleanser to a damp face and neck, massaging it until lather forms. Rinse completely
<9 years: Safety and efficacy not established (Altreno)
<10 years: Safety and efficacy not established (Atralin)
<12 years: Safety and efficacy not established (Retin-A Micro, Avita, Retin-A)
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.
drospirenone/ethinyl estradiol/levomefolate
<14 years: Safety and efficacy not established
≥14 years:
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.
benzoyl peroxide and tretinoin topical
Indicated for the treatment of acne vulgaris
For <9 years: Safety and efficacy are not seen in pediatrics
For >9 years: Apply a small amount of cream on the affected area each day
Safety and efficacy not determined in less than twelve years
≥12 years: Spread a thin layer of the medication topically to the impacted regions twice daily
https://www.ncbi.nlm.nih.gov/books/NBK459173/
Acne vulgaris is a chronically recurring, self-limiting inflammatory condition of the pilosebaceous unit. Cutibacterium acnes causes acne vulgaris to appear throughout adolescence when dehydroepiandrosterone is naturally circulating in the blood.
It is a relatively typical skin condition that can manifest as both inflammatory and non-inflammatory blisters, mostly on the face but also on the forearms, back and trunk.
Adolescence is when acne may first emerge, and it can last into the early 30s. Males are more likely than females to develop acne. Populations in urban areas are much more influenced than those in rural areas. 20 percent of those who have been impacted experience extreme acne that leaves scars.
It appears that certain races are more impacted than others. Extreme acne is much more frequent in Asians and Africans, whereas moderate acne is more prevalent in white people. People with a darker complexion, in general, also tend to acquire hyperpigmentation. Neonates can also get acne, although it typically goes away on its own.
As a result of androgens, 5-alpha reductase changes testosterone throughout puberty into more effective DHT, which attaches to specific targets in the sebaceous glands and increases sebum secretion. Sebum is retained as a result of the follicular epidermis’ enhanced hyperproliferation.
Inflammation is triggered when distended follicles burst and discharge pro-inflammatory substances into the epidermis. Staphylococcus epidermis, Malassezia furfur, and C. acnes all cause inflammation and promote the growth of follicular epidermal tissue.
Acne-causing factors include:
Acne is caused by the sebaceous glands being oversensitive to a normal level of androgens in the blood, which P. acnes and inflammation exacerbate.
Acne can result from the following factors:
Although it may not be life-threatening, acne has psychosocial repercussions that last a lifetime. Acne sufferers and those with breakouts frequently experience anxiety and sadness. It’s almost impossible to remove acne scars.
According to a Swedish study, teenage guys’ acne might be at a higher risk for developing prostate cancer later in life. Overall, acne therapy has a good prognosis.
https://www.ncbi.nlm.nih.gov/books/NBK459173/
Founded in 2014, medtigo is committed to providing high-quality, friendly physicians, transparent pricing, and a focus on building relationships and a lifestyle brand for medical professionals nationwide.
USA – BOSTON
60 Roberts Drive, Suite 313
North Adams, MA 01247
INDIA – PUNE
7, Shree Krishna, 2nd Floor, Opp Kiosk Koffee, Shirole Lane, Off FC Road, Pune 411004, Maharashtra
Founded in 2014, medtigo is committed to providing high-quality, friendly physicians, transparent pricing, and a focus on building relationships and a lifestyle brand for medical professionals nationwide.
MASSACHUSETTS – USA
medtigo, LLC
60 Roberts Drive, Suite 301
North Adams, MA 01247
MAHARASHTRA – INDIA
medtigo India, Pvt. Ltd.
7, Shree Krishna, 2nd Floor
Opp Kiosk Koffee
Shirole Lane, Off FC Road
Pune 411004, Maharashtra