Acne Vulgaris Management: What's New and What's Still True?: Review Article
Acne Vulgaris Management: What's New and What's Still True?: Review Article
Acne Vulgaris Management: What's New and What's Still True?: Review Article
DOI: 10.5455/2349-3933.ijam20150201
Review Article
ABSTRACT
Acne vulgaris is one of the commonest skin disorders that can affect individuals from childhood to adulthood, most
often occurring in the teenage years. Regarding its management, whats still true is that a wide range of treatment
options are available, ranging from the commonly used topical treatments like benzoyl peroxide, azelaic acid, sulfur,
antibiotics, retinoids and superficial chemical peels while the systemic treatments available include the use of
systemic antibiotics, retinoids, and antiandrogens. Whats new in the management of acne vulgaris is the use of laser
and light devices and other newer technologies. The present article reviews the use of above mentioned agents in the
current scenario.
Keywords: Acne, Pimples, Tretinoin, Benzoyl peroxide, Antibiotics, Retinoids
INTRODUCTION
Acne vulgaris is the most common disorder of human
skin that affects up to 80% of adolescents. 1 Acne by
definition is multifactorial chronic inflammatory disease
of pilosebaceous unit.2
Various clinical presentations include seborrhea,
comedones, erythematous papules and pustules, less
frequently nodules, deep pustules or pseudocysts and
ultimate scarring in few of them. Acne has a negative
effect on the quality of life; although this can be
improved with effective treatment.3
Acne has four main pathogenic mechanisms: increased
sebum
production,
hyperkeratinization,
propionibacterium acne colononization and the
inflammatory reaction.4 Therapeutic modalities are
designed now due to better understanding of the
pathogenesis of acne (Figure 1).5
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SULFUR
SYSTEMIC ANTIBIOTICS
Sulfur has been used for acne since the time of Cleopatra.
It is available in washes, leave-on lotions, creams, foam
formulations and as masks. It is useful as a drying and
antibacterial agent.6 Sulfur could be more useful in
patients also having acne rosacea and seborrheic
dermatitis. Sodium sulfacetamide is often combined with
sulfur and has anti-inflammatory properties.
BENZOYL PEROXIDE
Benzoyl peroxide has long been the main agent in the
treatment of acne. It is one of the most effective and
widely used drug, present in many over-the-counter
preparations; as a wash (soap or face wash) or leave-on
product (gel or cream). Benzoyl peroxide acts because of
its comedolytic (keratolytic) as well as antibacterial
properties. Adding a topical antibiotic like clindamycin or
erythromycin could add to its efficacy, as in many cases
monotherapy is often less successful.7 Benzoyl peroxide
could also be an effective addition to the oral antibiotics,
as it is shown to reduce the number of antibiotic resistant
organisms.8 In treatment of mild acne vulgaris, generally
benzoyl peroxide along with topical antibiotic or a
retinoid is recommended. For moderate cases of acne,
however, an oral antibiotic is to be added.
Common side effects of benzoyl peroxide include contact
sensitivity, irritation, excessive dryness, scaling,
erythema and bleaching of skin. One should avoid
contact with eyes, lips, mucous membranes and denuded
skin.
AZELAIC ACID
Azelaic acid is useful in the treatment of acne as well as
in post-inflammatory pigment changes. Patients often
report local burning or stinging sensation but it generally
resolves in one to four weeks. Azelaic acid is applied
once or twice a day and has been shown to be effective
especially in combination with benzoyl peroxide,
tretinoin, erythromycin and clindamycin.9
TOPICAL ANTIBIOTICS
Clindamycin, erythromycin and tetracyclines are
appropriate for inflamed papules rather than noninflamed
comedones.10
These
agents
inhibit
propionibacterium acne by inhibiting their protein
synthesis. These antibiotics may be lesser effective than
benzoyl peroxide but have the advantage of not causing
skin irritation. Antibiotics may also be combined with
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