Acne vulgaris, Pathogenesis and its clinical features

Acne vulgaris, Pathogenesis and its clinical features

Management Acne can have serious psychological effects and should notbe ignored on the basis that it will get better sooner orlater. Mild cases often respond to topical agents alone, e.g.benzoyl peroxide 2.5-10% gel, or topical retinoic acid. Thelatter is more irritant, but often more effective when comedonesare the predominant feature. If there is insufficientresponse after a few weeks' treatment, or if the acne is ofmoderate severity, an oral antibiotic should be used inaddition (or instead, if topical therapy proves too irritant).Tetracyclines and erythromycin are equally effective,usually in a dose of 0.5 g twice daily for several months.Topical antibiotics, e.g. 1 % clindamycin, can also be effective.For females with moderate acne, hormonal modulationwith the antiandrogen cyproterone acetate may bemore effective. This drug must be given with an oestrogenin the form of a low-dose oral contraceptive pill. Patientswith severe and destructive acne usually need treatmentwith oral isotretinoin. This vitamin A analogue is highlyeffective but has a number of adverse effects, notablyteratogenicity, and in the UK is restricted to hospital use.Other measures sometimes used include intralesionalcorticosteroids for inflammatory nodules and cysts, anddermabrasion, a surgical technique to improve scarring.

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