flashcards_acne_vulgaris
What advice should be given about skin cleaning for acne vulgaris?
Avoid over-cleaning the skin; twice daily washing with gentle soap is adequate.
What type of make-up, emollients, and cleansers are recommended for acne vulgaris?
Non-comedogenic, non-oil based preparations with a pH close to the skin.
Why should persistent picking and scratching of acne lesions be avoided?
To avoid the risk of scarring.
How long do acne treatments usually take to work and what initial effect might they have?
Treatments may take up to 8 weeks to work and may initially irritate the skin.
What is the evidence for specific diets in managing acne vulgaris?
There is insufficient evidence to support specific diets; advise to maintain a balanced diet.
What is the single topical treatment for mild to moderate acne and for how long should it be used?
Single topical treatment for a 12-week course, such as adapalene + benzoyl peroxide, clindamycin (1%) + tretinoin, clindamycin (1%) + benzoyl peroxide, or benzoyl peroxide monotherapy.
What type of preparations are preferable for patients with dry skin?
Creams and lotions.
How should the frequency of topical application be adjusted?
Frequency of application can be increased gradually from once a week if tolerated.
When and how should topical treatments be applied?
Apply a thin layer to clean skin at nighttime.
What should be done if moderate acne does not respond to topical treatments?
Consider adding oral antibiotics (lymecycline or doxycycline) or topical azelaic acid for a maximum of 3 months.
What should be co-prescribed with antibiotics to reduce the risk of resistance in moderate acne?
Topical retinoid or benzoyl peroxide.
What should be done if there is no improvement after 3 months of antibiotic treatment for moderate acne?
Change to an alternative antibiotic.
What oral medications can be considered if there are signs of hyperandrogenism in moderate acne?
Oral antiandrogens such as cyproterone +/- spironolactone.
When should a patient with moderate acne be referred to dermatology?
If not responding after 2 courses of antibiotics or if scarring is present.
What oral contraceptive can be used as an alternative to systemic antibiotics in girls with moderate acne?
Combined oral contraceptive pill (COCP).
What is the recommended management for severe acne?
Refer to a dermatologist, oral isotretinoin, high-dose oral antibiotics for 6 months or longer, and consider adding a course of oral corticosteroids if acne flare occurs when initiating oral isotretinoin.
When should a specialist referral be considered for acne vulgaris?
For severe variant acne, severe acne with scarring or risk of scarring, acne with persistent pigmentary changes, multiple treatment failures, significant psychological distress, or diagnostic uncertainty.
What is the follow-up recommendation for each treatment step in acne vulgaris?
Review each treatment step at 8-12 weeks, continue treatment for at least 12 weeks if there is an adequate response, consider maintenance therapy if acne has cleared or almost cleared, and assess adherence to treatment and adverse effects if there is no response.
