Mild to moderate inflammatory acne,treatments of acne,chest acne scar before and after - 2016 Feature

Acne vulgaris, simply referred to as acne, is a multifactorial disorder of the pilosebaceous unit. Acne typically begins at puberty and is often the first sign of increased sex hormone production, particularly testosterone. In addition, acne may emerge in both men and women in the decades beyond adolescence, even manifesting during the 3rd or 4th decades of life and sometimes persisting into the 5th decade. The precursor to the manifestation of visible acne is formation of the microcomedone, a subclinical lesion caused by abnormal regulation of cells within the hair follicle. As the corneocytes continue to accumulate, multiple factors can lead to localized inflammation, as described earlier, resulting in an inflammatory papule (ie, pimple). Patients with mild comedonal acne present to physicians for treatment less frequently because self-treatment with OTC remedies is often sufficient. In our experience, the most common stage at presentation to primary care practices is mild to moderate inflammatory acne; however, differentiating between mild, moderate, and severe inflammatory acne can be subjective.
One possible metric is to consider less than 15 inflammatory lesions as mild to moderate acne, more than 15 lesions as moderate to severe acne, and the presence of multiple nodules and cysts as severe nodulocystic acne.
For example, a patient who has lesions consisting primarily of comedones and only a few papules and pustules (<15) could be classified as having mild to moderate inflammatory acne. Several other skin disorders may be confused with acne, but the differential diagnosis of acne is modest in scope and readily distinguished by patient age, lesion morphology, lesion distribution, and the presence of risk factors for mimickers of acne vulgaris. In general, a 6- to 12-week course of topical retinoid treatment is recommended for mild to moderate acne.
There is extensive evidence for the efficacy of topical retinoids in the treatment of acne. Some clinical trials have suggested a clear association between P acnes resistance to an antibiotic and poor therapeutic response.27 For this reason, monotherapy with topical antibiotics is generally not recommended.
Azelaic acid has been shown to be effective against inflammatory and comedonal acne by inhibiting the growth of P acnes and reversing the altered keratinization of follicles affected by acne.
In addition to suppressing the growth of P acnes, tetracyclines have intrinsic anti-inflammatory properties.
In reality, most combination oral contraceptives are effective in treating acne and there is insufficient evidence to recommend one OCP over another. Significant Efficacy And Safety Of Low Level Intermittent …Significant Efficacy and Safety of Low Level Intermittent Heat in Patients with Mild to Moderate Acne S. Combination Blue (415 Nm) And Red (633 Nm) LED Phototherapy …ORIGINAL ARTICLE Combination blue (415 nm) and red (633 nm) LED phototherapy in the treatment of mild to severe acne vulgaris DAVID J. Acne Treatment – Acne Treatment OptionsGrade I and Grade II (mild to moderate acne) can often be treated with over-the-counter products.
The Diagnosis And Management Of Mild To Moderate Pediatric …A s a chronic, inflammatory skin disorder affecting susceptible pilosebaceous units of the face, neck, shoulders, and upper trunk, acne presents unique challenges for patients and clinicians. BENEFFICIAL EFFECTS OF TOPICAL AGENTS ON MILD TO MODERATE …Significant effect in the treatment of mild to moderate acne by reducing the number of lesions (non-inflamed and inflamed).
It Is Important To Seek And Stick With Treatment!Acne When to see a dermatologist Your family doctor or dermatologist can help with even with mild cases of acne. Over The Counter Acne TreatmentsMild acne, or Grade I acne, can be treated at home with over-the-counter acne treatment products. Poor compliance - this may be due to a long history of acne or side-effects of treatment such as photosensitivity caused by doxycycline (figure 12 below) or irritation to topical treatments (figure 11 below).
The Summary of Product Characteristics in the licence for isotretinoin states that it can be prescribed by, or under supervision of, physicians with expertise in the use of systemic retinoids for the treatment of acne and a full understanding of the risks of isotretinoin and monitoring requirements.
Acne is a common condition affecting persons of almost all ages; it may begin as early as the neonatal period, and peaks between ages of 13-17. Even though it is not a life-threatening disease, acne can have significant impact on a patient’s quality of life, including physical and psychological scars.
Distribution, number, and severity of lesions (especially scarring) should influence the approach to acne treatment.


Expert consensus suggests that a topical retinoid is first-line initial and maintenance therapy for almost all acne patients (except the most severe forms). Antibiotic resistance caused by antibiotic monotherapy is an emerging clinical problem in acne management; antibiotic resistance leads to acne treatment failure. Acne vulgaris is characterized by comedones, papules, and pustules, or a combination of lesions. Inflammatory acne: The lesions of inflammatory acne include erythematous papules and pustules, nodules and cysts.
Nodular acne: Nodules are present on the upper right forehead and bilateral medial cheeks, in addition to inflammatory papules, pustules, and scars.
Neonatal acne: Inflammatory papules and milia on the cheeks of an infant (left) and inflammatory papules and pustules (middle) and crusted papules (right).
Acne with scarring: Atrophic acne scars in the setting of inflammatory papules and pustules (left) and keloid formation (right).
The clinical subtype, severity, prior treatment, psychological impact, and presence of scarring should be considered for all patients with acne. The treatment of acne usually involves initial therapy followed by long-term maintenance therapy.
Topical retinoids used alone or as part of a combination therapy is considered first-line in the initial treatment of all types of acne except for severe nodular disease, which requires systemic retinoid therapy. Use systemic antibiotics when there are numerous inflammatory lesions, involvement of the trunk or any scarring resulting from acne.
Thiboutot D (2011) Dermatologists do not yet fully understand the clinical significance of antibiotic use and bacterial resistance in patients with acne, Arch Derm, 147:921-922. Although patients tend to go to dermatologists to treat their acne, particularly when it progresses and becomes inflammatory, many cases can be just as efficiently managed in the primary care setting. A menstrual and oral contraceptive history is important in determining hormonal influences on acne in women.
In addition to determining the type of skin lesion, acne should be further subtyped to establish proper treatment.
Patients who seek consultation for mild comedonal acne are best treated with a topical retinoid. When making the determination, it is important to ask the patient to characterize his or her acne on this basis, as individual perception is a critical factor when deciding on therapy.
The broad anti-acne activity and safety profile of topical retinoids justifies their use as first-line treatment for mild comedonal acne. During this time, these agents may cause a mild flare of acne before providing any skin improvement. This agent is an organic compound that has been found to be a safe and effective OTC acne treatment.
Also considered safe and effective, these commonly prescribed agents improve acne by acting directly on P acnes colonization and inhibiting the proinflammatory effects of these bacteria on comedogenesis. It is a well-tolerated sulfa-based antibiotic that is thought to restrict the growth of P acnes.
Some other topical agents commonly used to treat acne include salicylic acid and azelaic acid, which may be used alone but are generally more effective when used in combination products. However, the concomitant use of topical and oral antibiotics should be avoided, as this promotes P acnes resistance, has little effect on efficacy, complicates treatment regimens, and is likely to decrease compliance. This refers to the application of medicines to individual inflammatory lesions, sparing uninvolved areas. Although common, it can have a devastating psychosocial impact on patients and present a significant treatment challenge to the clinician; however, many cases of inflammatory and post-adolescent acne can be effectively treated in the primary care setting using the methods described in this article. Learn how to properly care for your young teen's skin and clear mild acne before it can progress. A dermatologist must treat Grade III and Grade IV (moderately severe to severe, or cystic acne).


However, use of combination therapy in many cases is more effective for the treatment of acne and several combination formulations are available.
It can be used in combination with benzoyl peroxide products in previously moderate-to-severe disease. It is important to consider plans for pregnancy in the initial discussion of acne treatment with all female patients.
This article provides an overview of acne vulgaris, with a focus on inflammatory and post-adolescent acne, and outlines a framework that primary care physicians can use to effectively treat these patients. One such method that may be useful for primary care physicians is to classify acne by severity using one of the following categories: mild comedonal, mild to moderate inflammatory, moderate to severe inflammatory, and nodulocystic acne (severe). Other differential diagnoses include rosacea, periorificial dermatitis, pseudofolliculitis barbae, and drug-induced acne.
It works by reducing P acnes numbers, suppressing the growth of these bacteria, and killing them without inducing bacterial resistance. Salicylic acid is a widely used comedolytic and mild anti-inflammatory agent that is available in numerous OTC preparations. Comparison of two concentrations of tretinoin solution in the topical treatment of acne vulgaris. Advancement in benzoyl peroxide-based acne treatment: methods to increase both efficacy and tolerability. Use of a low-dose oral contraceptive containing norethindrone acetate and ethinyl estradiol in the treatment of moderate acne vulgaris.
Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: a randomized, placebo-controlled trial. 2 February 2004 Cosmetic Dermatology Journal The Efficacy and Tolerability of Electrolyzed Oxidized Water in Treating Mild to Moderate Acne Alpesh Desai, DO; Cynthia J. The convenience of combination formulations may also improve patient adherence to their acne skin regimen. Factors involved in the pathogenesis of acne include: alteration of follicular keratinization, presence of bacteria (Propionibacterium acnes), sex hormone production (androgens) and sebum production. Increasing knowledge about the pathogenesis of acne has led to the development of numerous effective treatment regimens that can be tailored to each patient.
The inflammatory lesions of acne originate with comedo formation but then expand to form papules, pustules, nodules, or cysts. At the other end of the spectrum is severe nodulocystic acne, which is better treated by a dermatologist, as these specialists are more experienced in managing severe skin conditions.
Commonly prescribed oral antibiotics include tetracyclines, clindamycin, azithromycin, and erythromycin; however, concerns about antibiotic resistance and associated decreased efficacy with the latter 3 agents make tetracycline the preferred oral antibiotic treatment for acne.
When the condition progresses to mild to moderate inflammatory acne, a topical antibiotic and benzoyl peroxide need to be added. In addition, many clinical trials evaluating acne regimens are designed with 12-week clinical endpoints, making this a reasonable time period to evaluate for improvement in the clinical setting.
A group of patients have persistent acne lasting up to the age of 30 to 40 years, and sometimes beyond. Further studies are necessary before a recommendation can be made to choose subantimicrobial dosing over traditional doses of doxycycline for the treatment of acne vulgaris.
Acne may scar - most of the time this is preventable by using the correct treatment given in a timely fashion.



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