Acne Preparations

8/13/2019 Acne Preparations

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Acne Treatment and Therapeutic Strategies

One of the most common skin diseases

Considerable psychological impact onthe quality of life

No cure, but the disease can becontrolled through medications


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Four important factors

plugging of the hair follicle

hyperactivity of the sebaceous gland

proliferation of Propiono bacterium Acnes

inflammation


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Stages of Development


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Inflammatory Lesions


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Nodulocystic Lesions


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Scarring


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Topical Therapy (Indications)

comedonal acne

mild to moderate inflammatory acne

Management


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Topical Therapy (Treatment Vehicle)cream sensitive or dry skin

lotion any skin type

gel oily skin

solution oily skin

Management


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Topical Therapy(Anti Comedonal Agents)

Topical Retinoids

Azelaic acid

Salicylic acid

Management


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Retonoic acid

Also known as tretinoic acid /all

transretinoic acid

Epithelial effects; stabilises lysosomes,

ribonucleic acid polymerase activity, PG

E , cAMP levels, incorporation of

thymidine into DNA Its decreases cohesion fo epidremal cells

increases epidremal turnover (Rx effect)


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Topical Retinoids 0.025% - 0.1%(side effects)

pustular flare due to exposure of previou

non evident comedones

photosensitivity

skin irritation and erythema

dryness and peelingoptimal improvement 8-12weeks

In animals tumerogenenesis of UV light


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Azelaic Acid

Effective for acne vulgaris

MOA ? Antibacterial to P acnes and in vitro

conversion of testosterone to dihydrosterone


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Azelaic Acid 20%(application and side effects)

applied twice daily, intially OD

for 1 wk

erythema and irritation

decrease in pigmentation

Management


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Salicylic acid

Keratolytic at 3- 6 % > 6% destructive

MOA; ? Desquamation of keratotic cells

If absobed and serum levels are > 30-

50mg/dl salicylism occurs Rx dialysis


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Salicyl ic Acid0.5 - 2%

(application and side effects)

applied twice daily

skin dryness and irritation.

Utricaria, erythema multiformeCare in diabetics or peropheral

vascular disease


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Topical Therapy (Anti I nf lammatory Agents)

Benzoyl Peroxide

Management


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Benzoyl Peroxide 2.5 - 10%(application and side effects)

apply once to twice daily

always apply test dose

avoid use at night

dryness of skin

Management


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Combination therapy

5% Benzoyl Peroxide and 3% Erythromycin

5% Benzoyl Peroxide and 1% Clindamycin

Topical antibiotics and Azelaic acid or Tretinion

Management


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Systemic therapy

Oral Antibiotics

Isotretinoin

Hormonal Therapy

Management


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Oral Antibiotics(used for 3-6 months)Tetracycline 500mg X BD

Doxycycline 100mg X BD

Minocycline 100mg X OD

Eythromycin 500mg X BD

combined with topical therapy

Management


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I sotretinoin (Accutane) indicated in

severe nodulocystic acne

non responsive acne

severe psychological distressOnly to be used by physicians with

exper ience in the therapy of severe

dermatological disorders

Management


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I sotretnoin (RoAccutane) side effectsteratogenic

mucosal dryness

photosensitivityarthralgias

alteration of liver enzymes

hypertriglyceridemia and hypercholesterolemia

Management


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Hormonal Therapy indicated in

acne associated with hirsutism,

menstrual irregularity and alopecia

women desiring contraception

Management


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Hormonal TherapyOral contraceptives containing low

androgenic progesterone

Cyproterone Acetate

Spironolactone

Management

Acne Preparations

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