Acne

  • Acne = an inflammation and eruption of the pilosebaceous organs in the skin
    • Ex. Hair follicles & the organs associated with it that lubricate the hair follicle
  • Most common in teenagers
  • Distribution = mostly on the face > upper chest/back > anywhere with hair
  • Acne lesions are exposed or easily accessible
    • Theoretically you should only treat acne OTC if there is less than 10 simultaneously active lesions
  • White heads = newer lesions
  • Black heads = older, oxidized lesions
  • Inflammatory or cystic/nodular acne is deeper into the dermis, more severe & aren’t treatable OTC
  • Precipitating factors:  stress, humidity, hormone changes, greasy hair
  • Non-drug treatments:  wash gently w/ mild soaps, avoid rough treatment/dryness of skin, don’t squeeze pimples
  • Gels are the best OTC dosage form for treating acne
    • Ointments clog pores, soaps need to have adequate contact time in order to be effective, scrubs can be effective if only used gently
  • Aggressiveness of therapy:   (mildest)  sulfur <  sulfur-resorcinol combo < salicylic acid < benzoyl peroxide (most aggressive)
    • Different MOA:  remove oil/breakup lipids, unplug pores, stimulate new skin generation, peel skin, kill/remove bacteria
    • Sulfur-resorcinol combo is almost always used in combo (sulfur by itself isn’t used that much)
      • Sulfur smells bad                                                           resorcinol can darken the skin or cause scaling/patterning of skin
    • Salicylic acid can dry skin or cause peeling
    • Benzoyl peroxide:  most potent OTC agent, not GRASE (generally recognized as safe & effective)
      • Can bleach hair, all other irritating side effects
  • NMCD rated Possibly effective nutraceuticals
    • Zinc (oral), saccharomyces Boulardii (oral), Guggul (oral)
    • Alpha hydroxy acids  (possibly effective for acne, likely effective for dry/wrinkled skin)–work by shedding the top layers of dead skin cells
      • Well tolerated when used in concentrations < 10%
      • Increase sensitivity to sun & UV light
    • Bovine Cartilage is thought to have anti-inflammatory, immuno-promoting effects (cure-all)
      • Possibly effective for: acne, anal pruritis, poison oak/ivy dermatitis, psoriasis  (topical agent used several times/day)
    • Tea tree oil:  possibly safe if used topically, apply BID for up to 6 months
  • Ipledge is used for isotretenoin (clavaris, accutane) acne medication & is used to ensure that this drug isn’t taken by someone who is prego or planning on becoming prego due to the high risk of birth defects
    • Isotretenoin = oral for severe acne, teratogenic
  • Retin-A = tretinoin is used topically for moderate-severe acne
  • Erythromycin & tetracyclines are antibiotics used both orally & topically for acne

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