Acne

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Acne is a multifactorial disease primarily of teenagers with follicular plugging and inflammation. 

Clinical presentation 

• Open and closed comedones
• Pustules, papules
• Nodular and cystic lesions involving the face, chest, shoulder and the back

Non-pharmacological Treatment 

• Avoid underlying precipitating factor e.g. stress, nuts, chocolate, overuse of ointments on skin, steroids, anticonvulsant drugs etc.
• Encourage a healthy lifestyle – exercise, sunshine exposure, etc.
• Use  ordinary  soap  (harsh  antibacterial  cleansers  or  iodine-containing  preparations may aggravate the acne)
• Do not manipulate pustules and nodules

Pharmacological Treatment Mild to moderate acne without scarring 

Apply 

A: benzoyl peroxide 2.5%–5% once nocte 

  OR 

S: tretinoic acid cream (topical) 0.05% once nocte 

Moderate acne with scarring- 

A: doxycycline (PO) 100mg 24 hourly for 1–3 month 

     OR 

A: erythromycin (PO) 250mg 6 hourly for 1–3 month 

    AND 

A: benzoyl peroxide or topical retinoid as above. 

Nodulocystic and/or conglobate acne 

S: isotretinoin (PO) 0.025–0.5mg/kg 24hourly for at least 3–6months 

AND 

S: triamcinolone (intralesional) 40mg/ml for cysts stat 

Acne fulminans 

S: isotretinoin (PO) 0.025–0.5mg/kg 24 hourly for at least 4–6 months 

AND 

A: prednisolone (PO) 45mg stat then 5mg reduction daily up to 0mg. 

Note: Isotretinoin is contraindicated in pregnant women.