Nondermatologists frequently manage...

Nondermatologists frequently manage acne vulgaris. Treatments hang on severity, which can be influenced through genetics, stress, and, possibly, diet. Haider and Shaw evaluated data from the past four decades to determine which treatments are in the greatest degree effective and how they can be administered with the fewest complications.

The authors studied 29 randomized, double-blind trials that documented reductions in lesions, and several systematic reviews. They note that [i]modus operandi[/i]s of assessing acne severity are highly inconsistent, although conclusions still can be drawn. Treatments subject to consideration were topical retinoids, topical antimicrobials, oral antibiotics, hormonal therapy, and isotretinoin.

Topical retinoids include tretinoin, adapalene, and tazarotene. Tretinoin and adapalene bring total lesions by more than 50 percent with adapalene being les irritating to skin. single trial showed similar lesion reduction with tazarotene gel Overall, retinoids make less lesions by 40 to 70 percent

Topical antibiotics include clindamycin, erythromycin, and tetracycline. Benzoyl peroxide and azelaic acid also have antimicrobial activity. Original studies exhibit that clindamycin and erythromycin contract lesions to a similar measure as retinoids. Products that combine antibiotics with benzoyl peroxide are more effective than either consequence alone. Antimicrobials also can be used in combination with retinoids, with combination produces being more successful than a topical antibiotic alone. Because the storming of action is slow, patients must be treated for six to eight weeks with these agents to behold an effect. Topical antibiotics and benzoyl peroxide can cause skin irritation. While conventional antibiotics of ten create bacterial resistance, this has not been reported with benzoyl peroxide or azelaic acid.

Oral antibiotics used for the treatment of acne include tetracycline, doxycycline, minocycline, and erythromycin. Studies upon oral antibiotics are few and in more [i]or[/i] less instances are hampered by methodological flaws. However, these agents appear to work better than placebo. Gastrointestinal side powers and photosensitivity are associated with tetracycline and doxycycline; minocycline also causes adverse side powers including vertigo. Perhaps of principally concern is the problem of antibiotic resistance, which affects more than united half of bacterial strains in Europe Combination therapy and avoidance of long-term therapy are recommended

Hormonal treatments include oral contraceptives and androgen-receptor blocker undivided trial showed a 50 percent reduction of lesions in patients treated with oral contraceptives, compared with 30 percent in those given placebo. In Europe newer progesterone-estrogen combinations have been shown to be effective. Androgen-receptor blocker include spironolactone and flutamide. These agents must be used in high doses to be effective in the treatment of acne. All agents in this class also are effective when used in combination with an oral contraceptive.

Isotretinoin is used for morose cases of acne. One randomized controll trial showed that doses of 05 and 1 mg through kg per day resulted in an 80 percent or greater reduction in lesions. A single course of four to six month can be effective. Lower efficacy and higher rate of return have been observed in patients treated with lower doses. general side effects include drying of the skin and mucous membranes, and headaches, which can be an indication of benign intracranial hypertension. Isotretinoin is contraindicated in pregnancy and can cause elevations in liver enzyme and lipids. It may be associated with depression, moreover evidence to confirm this is lacking.

In conclusion, the authors emphasize that treatment of acne should take into account fluctuations in severity and should be adjusted according to tolerance and answer In many cases, combination therapy is warranted.

CAROLINE WELLBERY, MD

Haider A, Shaw JC Treatment of acne vulgaris. JAMA August 11 2004;292:726-35

COPYRIGHT 2005 American Academy of Family Physicians

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