Module 4: Acne Tx

Question 1

What is the indication for treatment of mild acne vulgaris?

Answer 1

Assess for complications warranting more aggressive tx:
- scarring
- disfiguring postinflammatory hyperpigmentation or postinflammatory erythema
- significant psychological distress

If absent then treat as mild.

Assess lesion type.

Question 2

What is the recommended treatment for comedonal lesions only? (small bump or pimple)

Answer 2

Topical retinoid.

increase conc. or change to alternate retinoid if unsatisfactory response.

Cont. therapy as maintenance or tx as mod to severe if unsatisfactory results persist.

Question 3

What is recommended for the tx of papulopustular +/- comedonal lesions?

Answer 3

Topical retinoid and benzoyl peroxide.

If stable improvement for 3-6 months, transition to retinoid monotherapy as maintenance

Question 4

What is the next step for papulopustular acne if unsatisfactory response to topical retinoid and benzoyl peroxide?

Answer 4

Add topical clindamycin or topical dapsone

If satisfactory transition to retinoid monotherapy as maintenance

If not satisfactory, consider alternative topical therapies or manage as mod - severe.

Question 5

When might a topical antibiotic be used?

Answer 5

When retinoids are not tolerated.
e.g. clindamycin used in conjunction with benzoyl peroxide to prevent abx resistance

Question 6

What is a risk of simultaneous application of dapsone and benzoyl peroxide?

Answer 6

Temporary orange discolouration of the skin

Question 7

What is the drug formulary for all these medications?

Answer 7

All partially covered.

Question 8

What are special prescribing considerations?

Answer 8

The following populations may need adjustments to regimen:
- Preadolescent children
- people with skin of colour
- pregnancy
- mild acne assoc with significant psychologic distress
- Severe variants of acne