Acne

Question 1

Management of Acne

Answer 1

Mild
1 - OTC products - Benzoyl peroxide, Salicylic Acid, Azelaic Acid, niacinamide
+ General measures for acne

Above not effective? Treat with topical according to dominant type of acne present
- Comedomal with minimal inflammation? Topical Retinoid (Adapalene, Tretinoin, Trifarotene)
- Comedomal with some inflammation? Benzoyl Peroxide + Retinoid e.g. Epiduo (Benz + Adapalene)
- Inflammatory with some comedomes? Benzoyl Peroxide + Antibiotic (e.g. Duac (Clindamycin + Benzoyl peroxide)
- Comedomal and Inflammatory? Combination Retinoid and antibiotic.

note: Once inflammation is controlled, cease antibiotic and continue with retinoid.

Moderate to Severe Acne?
- If comedomal mainly - consider referral to dermatologist for Isotretinoin. Consider COCP or Spironolactone for females
- If Inflammatory as well as comedomal.
- Trial Doxycycline / Minocycline / Erythromycin + Topical Benzac+Tretinoin

Question 2

Isotretinoin Patient Education

Answer 2

• Typical course is 6-9/12
• Potent teratogen requiring two methods of contraception while being taken and for one menstrual cycle after medication is completed.
  
  • Oral POP is unsuitable during isotretinoin use due to increased risk of poor compliance.
• Skin and mucosal irritation (Dry skin, eyes, mucosa, lips, nose-bleeds)
• Increased UV senstivity. Ensure adequate sun protectoin
• Can cause myalgia and joint stiffness.
• Regular follow up required to monitor liver function.

Question 3

Infantile Acne

Answer 3

Starts at 3/12
- Comedomes, papules and pustules on cheeks and chin.
- Comedomes must be present for diagnosis
- Will mostly resolve by 1yo.

Treatment
- Evidence of potential scarring?
- Benzac 5% TOP OD
- Numerous comedomes with minimal inflammation?
- Adapalene 0.1% / tretinoin 0.025% cream Nocte

Question 4

Neonatal cephalic pustulosis

Answer 4

Transient eruption
- Age 3-6 weeks
- Temporary overgrowth of Malassezia species -> Inflammation
- Tiny monomorphic Pustules on an erythematous base
- No comedomes present

Management
- Reassure - Will resolved in a few weeks without treatment
- Can consider Clotrimazole 1% TOP BD / Ketoconazole 2% TOP BD if appearance is concerning.