24 Questions
What are the four pathogenic factors that contribute to the development of acne lesions?
Excess sebum production, keratinization, bacterial growth, and inflammation
What is the result of the accumulation of epithelial cells and sebum in the follicular opening?
Creation of a comedo
What is the type of organism that is found in the normal flora of the skin and contributes to the development of acne lesions?
Anaerobic bacteria
What is the consequence of inadequate treatment of inflammatory acne lesions?
Development of scarring
What is the precursor to non-inflammatory acne lesions called comedos?
Microcomedo
What is the term for a closed comedo?
Whitehead
What is the term for an open comedo?
Blackhead
What is the result of the proliferation of Propionibacterium acnes in the mixture of sebum and keratinocytes?
Production of an inflammatory response
What is the primary goal of acne therapy?
Reduce the number and severity of existing lesions
What is the typical timeframe for improvement of symptoms following induction therapy?
6 to 8 weeks
What is the preferred approach for inflammatory acne lesions?
Combination therapy with topical retinoids and benzoyl peroxide or topical antibacterial agents
When should maintenance therapy typically begin?
After 12 weeks of induction therapy
What is the recommended duration of maintenance therapy in most clinical trials?
3 to 4 months
Why is a longer duration of maintenance therapy often beneficial for most patients?
Due to frequent acne recurrences
What is the foundation of first-line therapy for induction and maintenance regimens in all forms of acne?
Topical retinoids
What is the primary focus of acne treatment regimens?
Severity and type of acne lesion
What property of azelaic acid makes it effective in treating mild-to-moderate acne?
All of the above
What is the novel mechanism of clascoterone cream in reducing acne?
Decreasing sebum production
What is the advantage of using dapsone gel as an alternative agent for inflammatory acne?
It has antimicrobial and anti-inflammatory properties
What is the limitation of using sulfur, resorcinol, and salicylic acid in the treatment of acne?
They have limited evidence to support efficacy
What is the indication for using oral antibiotics in the treatment of acne?
Moderate-to-severe acne and forms of inflammatory acne that are resistant to topical therapy
What is the potential disadvantage of using sulfur preparations in the treatment of acne?
They produce an unpleasant odor when applied to the skin
What is the mechanism of action of azelaic acid in treating acne?
It has antibacterial and anti-inflammatory properties
What is the advantage of using clascoterone cream in the treatment of acne?
It can be used in both males and females
Study Notes
Acne Vulgaris
- Acne is a common, usually self-limiting disease involving inflammation of the sebaceous follicles of the face and upper trunk.
- It can result in long-term physical complications, such as extensive scarring and psychological distress.
Pathophysiology
- The development of acne lesions results from four pathogenic factors: excess sebum production, keratinization, bacterial growth, and inflammation.
- A closed comedo or “whitehead” appears when accumulation of epithelial cells and sebum partially obstruct the follicular opening.
- An open comedo or “blackhead” forms if the follicular opening is dilated, and keratin buildup darkens.
- Propionibacterium acnes, an anaerobic organism, proliferates in the mixture of sebum and keratinocytes, resulting in an inflammatory response and more severe acne lesions.
Treatment
- Desired outcomes and goals of therapy include:
- Reduce the number and severity of existing lesions
- Prevent the development of new lesions and recurrence
- Prevent long-term disfigurement and permanent scarring
- Encourage treatment adherence
- Treatment regimens should be based on acne severity and type of acne lesion.
- Topical therapy is considered first line for mild acne, with oral therapies added to topical therapy in moderate-to-severe acne.
General Approach to Treatment
- Optimal management includes aggressive induction treatment and maintenance therapy to prevent recurrence.
- Improvement of symptoms following induction therapy occurs gradually, sometimes taking 6 to 8 weeks.
- Maintenance therapy should begin after 12 weeks of induction therapy and is continued for 3 to 4 months in most clinical trials.
Pharmacologic Therapy
Topical Agents
- Retinoids are the foundation of first-line therapy for induction and maintenance regimens in all forms of acne.
- Topical retinoids in combination with benzoyl peroxide or oral antibacterial agents is preferred for inflammatory acne lesions.
Azelaic Acid
- Azelaic acid has antibacterial and anti-inflammatory properties, and the ability to stabilize keratinization.
- It is an effective alternative in the treatment of mild-to-moderate acne in patients who cannot tolerate benzoyl peroxide or topical retinoids.
Dapsone
- Dapsone gel has antimicrobial and anti-inflammatory properties.
- It may be used as an alternative agent for inflammatory acne as monotherapy or in combination with topical or oral agents.
Clascoterone
- Clascoterone cream decreases sebum production and inflammation, reducing follicular plugging.
- It is the first antiandrogen therapy that can be used in both males and females.
Keratolytics
- Sulfur, resorcinol, and salicylic acid have limited evidence available to support efficacy.
- They can be used as second-line therapies in the treatment of mild-to-moderate acne.
Oral Agents
- Antibacterials, such as oral antibiotics, are indicated for use in patients with moderate-to-severe acne and forms of inflammatory acne that are resistant to topical therapy.
Understand the common skin condition, acne vulgaris, including its symptoms, causes, and effects on physical and mental health.
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