What causes acne?
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| image source :Science photo library |
Chronic inflammatory skin condition affecting the pilosebaceous unit (hair follicles and oil glands).
Most common causative organism : Propionibacterium acnes
Usually affects face, chest and back.
Diagnosis
- History
- Examination = Comedones must be present for diagnosis otherwise consider a differential diagnosis.]
Treatment
Advise + Education + Reassurance
1st line = Topical treatment – Topical retinoid alone or + benzoyl peroxide (Retinoids contradicted in pregnany + breast feeding)
or
Topical antibiotic (eg. clindamycin 1%) + topical benzoyl peroxide / or benzoyl peroxide + topical erythromycin ( safe in pregnancy)
2nd line = Inadequent response to topical prep = consider oral antibiotics eg . tetracyclines, such as lymecycline or doxycycline (for a maximum of 3 months).
- If the person does not respond to two different courses of antibiotics, or if they are starting to scar, refer to a dermatologist for consideration of treatment with isotretinoin.
- Combined oral contraceptives (if not contraindicated) in combination with topical agents can be considered as an alternative to systemic antibiotics in women.
references
https://cks.nice.org.uk/acne-vulgaris#!scenarioRecommendation
https://dermnetnz.org/topics/acne-vulgaris/
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