Acne

Introduction
Acne vulgaris is a chronic inflammatory skin disorder of the pilosebaceous unit, characterized by comedones, papules, pustules, nodules, and in severe cases, cysts and scarring. It commonly affects adolescents but may persist into adulthood. Treatment is tailored to acne severity, lesion type, and patient response, combining topical and systemic therapies with supportive measures to improve outcomes and prevent recurrence.

1. Topical Therapies

• Retinoids (adapalene, tretinoin, tazarotene): Normalize keratinization, reduce comedones, and have anti-inflammatory effects.

• Benzoyl peroxide: Antibacterial and keratolytic; used alone or in combination with topical retinoids or antibiotics to prevent resistance.

• Topical antibiotics (clindamycin, erythromycin): Effective for inflammatory lesions; always combined with benzoyl peroxide to limit resistance.

• Azelaic acid: Anti-inflammatory and comedolytic, useful in patients with sensitive skin or post-inflammatory hyperpigmentation.

• Salicylic acid: Keratolytic agent for mild acne, often used in over-the-counter preparations.

2. Systemic Antibiotics

• Tetracyclines (doxycycline, minocycline, tetracycline): First-line oral antibiotics for moderate to severe inflammatory acne.

• Macrolides (azithromycin, erythromycin): Alternatives when tetracyclines are contraindicated (e.g., in pregnancy or young children).

• Trimethoprim–sulfamethoxazole: Reserved for resistant or severe cases.

• Duration should be limited (generally 3–4 months) to reduce resistance, and always combined with topical therapy.

3. Hormonal Therapies

• Combined oral contraceptives (COCs): Reduce androgen-mediated sebum production; effective for women with acne, especially with premenstrual flares.

• Spironolactone: Anti-androgenic properties; useful in adult females with hormonal acne.

• Cyproterone acetate: Available in some regions for androgen suppression.

4. Oral Isotretinoin

• Indicated for severe nodulocystic acne, scarring acne, or refractory cases.

• Dosage: Typically 0.5–1 mg/kg/day, continued for a cumulative dose of 120–150 mg/kg.

• Monitoring: Requires regular liver function tests, lipid monitoring, and strict pregnancy prevention programs due to teratogenicity.

5. Adjunctive and Supportive Measures

• Gentle skin cleansing with non-comedogenic products.

• Avoidance of over-washing and harsh scrubs that worsen irritation.

• Non-comedogenic moisturizers and sunscreens.

• Intralesional corticosteroids for large nodules or cysts.

• Light and laser therapies as adjuncts in selected cases.

6. Lifestyle and Preventive Measures

• Healthy diet (low glycemic index foods may help reduce acne severity).

• Stress reduction strategies.

• Avoidance of comedogenic cosmetics or skincare products.

7. Multidisciplinary Care

• Dermatology input for severe, refractory, or scarring acne.

• Psychological support in patients with acne-related depression, anxiety, or low self-esteem.