Acne Skin Care Guidelines Quiz

Acne Skin Care Guidelines

• Acne is an inflammatory disease of the pilosebaceous follicle.
• It typically begins in adolescence and can persist into adulthood.
• Acne is more common in females.
• Acne is a common chronic skin disorder.
• Although not physically debilitating, acne can have a significant psychological impact, leading to low self-esteem, depression, and anxiety.

Pathophysiology

• Excessive sebum production: Sebaceous glands produce excessive sebum, a complex mixture of triglycerides, cholesterol, cholesterol esters, fatty acids, wax esters, and squalene. This overproduction occurs particularly during puberty due to increased androgen levels(particularly testosterone).
• Follicular plugging: Excessive shedding of cells within hair follicles, combined with excessive sebum, leads to clogging of the follicle openings, creating comedones (blackheads and whiteheads).
• Bacterial involvement: The bacterium P. acnes thrives in the clogged follicle environments. It produces chemicals and enzymes that cause inflammation.

Acne Lesions

• Comedones: These are clogged pores that can be either open (blackheads) or closed (whiteheads).
• Papules: Small, raised lesions on the skin, typically appearing pink or red.
• Pustules: Elevated lesions containing pus.
• Nodules: Inflammatory lesions deeper in the skin that are larger than papules (greater than 0.5 cm in diameter).
• Cysts: Deeper, inflamed pustular lesions, often painful and leading to scarring.
• Acne scars: Result from the rupturing of follicles during severe acne.

Classification of Acne

• Mild: Limited to the face, with few inflammatory lesions, primarily non-inflammatory comedones.
• Moderate: Increased inflammatory lesions (papules, pustules) on the face, and may extend to other body areas.
• Severe: Characterized by the presence of nodules and cysts, potentially widespread inflammation and scarring on the face and other body areas.

Acne Treatment: Topical Therapies

• Benzoyl peroxide: Non-antibiotic antimicrobial agent that kills bacteria, desquamates the skin, and reduces inflammation. Concentrations up to 2.5% is typically beneficial.

• Topical retinoids: Normalize abnormal desquamation, decrease follicular keratinocyte coherence, prevent new microcomedone formation, and may have anti-inflammatory properties.

• Salicylic acid: OTC option; good for tolerating topical retinoids. Also helpful to address comedones, inflammatory acne, and hyperpigmentation.

• Azelaic acid: Effective for acne and post-inflammatory hyperpigmentation and is a good alternative to retinoids if they cause skin irritation.

Acne Treatment: Systemic Therapies

• Oral antibiotics: Used for moderate to severe acne with inflammation. Commonly tetracycline derivatives (doxycycline, minocycline). Important to use in combination with other topical treatments to prevent bacterial resistance. Must be tapered off when acne shows improvement.
• Hormonal therapy: Useful for women to reduce or prevent acne outbreaks. Not effective against existing lesions, therefore should be used as an adjunct. Side effects can include headaches, breast tenderness, nausea, depression, high blood pressure, risk of heart disease, and blood clots.
• Isotretinoin: Typically reserved for severe, recalcitrant nodular acne. Potent retinoid, reduces sebum, normalizes keratinocyte desquamation, and inhibits P. acnes growth. Known for significant side effects, including severe dryness, and must have strict precautions for women with childbearing potential.

Acne Treatment: Additional Therapies

• Chemical peels: AHA and salicylic acid to improve acne and post-inflammatory hyperpigmentation.
• Comedo extraction: Squeezing or using a comedo extractor to manually remove comedones.
• Optical therapies: Broad spectrum continuous-wave visible light, intense pulsed light, pulsed dye lasers, potassium titanyl phosphate lasers, photodynamic therapy and pulsed diode laser for inflammatory acne.
• Herbal and Alternative Therapies: Aloe vera, fruit derived acids, tea tree oil used for topical application; very limited information available.

Acne Treatment Plan Recommendations for Patient Care

• Patient education: Emphasize realistic expectations, especially concerning timelines for improvement. Explain that acne treatment takes time, and that treatment may involve a combination of therapies.
• Skin care regimens: Focus on patient compliance with a prescribed skincare routine. Gentle facial cleansing and moisturizing is crucial. Encourage patients to use water-based skincare products and to avoid squeezing or picking acne lesions, as these can cause scarring.

Additional Considerations

• Post-inflammatory hyperpigmentation is a particular concern in people of Asian descent.
• Treatment selection depends on the severity (mild, moderate, severe) and type (comedonal, inflammatory, nodular) of acne in the patient.
• Combination therapy is often recommended, targeting different aspects of the acne pathogenesis.
• Drug-drug interactions and specific cautions for use with topical vs. systemic medications should be thoroughly reviewed.
• Specific considerations should be noted for patients with pregnancy or other special healthcare needs.