Acne vulgaris treatment : the current scenario

Sanjay K Rathi, Sanjay K Rathi

Abstract

Acne Vulgaris is one of the most common skin disorders which dermatologists have to treat. It mainly affect adolescent, though may present at any age. In recent years, due to better understanding of the pathogenesis of acne, new therapeutic modalities and various permutation and combinations have been designed. In topical agents; benzoyl peroxide, antibiotics, retinoids, etc are the mainstay of treatment; can be given in combinations. While systemic therapy includes oral antibiotics, hormonal therapy, and isotretinoin, depending upon the need of patients it has to be selected. Physical treatment in the form of lesion removal, photo-therapy is also helpful in few of them. Since various old and new topical and systemic agents are available to treat acne, it sometime confuse treating dermatologist. To overcome this, panel of physicians and researchers worked together as a global alliance and task force to improve outcomes in acne treatment. They have tried to give consensus recommendation for the treatment of acne. Successful management of acne needs careful selection of anti-acne agents according to clinical presentation and individual patient needs.

Keywords: Acne; consensus recommendation; treatment.

Conflict of interest statement

Conflict of Interest: Nil.

References

    1. Simpson NB, Cunliffe WJ. Disorders of the sebaceous glands. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Text book of Dermatology. 7th ed. Vol. 43. Blackwell Science; 2004. pp. 43.1–43.75.
    1. Gollnick HP, Zouboulis CC, Akamatsu H, Kurokawa I, Schulte A. Pathogenesis and pathognesis-related treatment of acne. J Dermatol. 1991;18:489–99.
    1. Leyden JJ. New understanding of the pathogenesis of acne. J Am Acad Dermatol. 1995;32:515–25.
    1. Plewig G, Kligman AM. Acne and Rosacea. 3rd ed. New York: Springer-Verlag; 2000.
    1. Cunliffe WJ, Gollnick HP. Acne: Diagnosis and management. 1st ed. London: Martin Dunitz Ltd; 2001.
    1. Packman AM, Brown RH, Dunlap FE, Kraus SJ, Webster GF. Treatment of acne vulgaris: Combination of 3% erythromycin and 5% benzoyl peroxide in a gel compared to clindamycin phosphate lotion. Int J Dermatol. 1996;35:209–11.
    1. Yang DJ, Quan LT, Hsu S. Topical antibacterial agents. In: Wolverton SE, editor. comprehensive dermatologic drug therapy. 2nd ed. Philadelphia: Saunders Elsevier; 2007. pp. 525–46.
    1. Fyrand O, Jakobsen HB. Water-based versus alcohol-based benzoyl peroxide preparations in the treatment of acne vulgaris. Dermatologica. 1986;172:263–7.
    1. Mills OH, Jr, Kligman AM, Pochi P, Comite H. Comparing 2.5%, 5% and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol. 1986;25:664–7.
    1. Bojor RA, Cunliffe WJ, Holland KT. The short term treatment of acne vulgaris with benzoyl peroxide: Effects on the surface and follicular cutaneous microflora. Br J Dermatol. 1995;132:204–8.
    1. Eady EA, Cove JH, Joanes DN, Cunliffe WJ. Topical antibiotics for the treatment of acne vulgaris: A critical evaluation of the literature on their clinical benefit and comparative efficacy. J Dermatol Treat. 1990;1:215–26.
    1. Krishnan G. Comparison of two concentrations of tretinoin solution in the topical treatment of acne vulgaris. Practitioner. 1976;216:106–9.
    1. Shalita A, Weiss JS, Chalker DK, Ellis CN, Greenspan A, Katz HI, et al. A comparison of the efficacy and safety of adapalene gel 0.1% and tretinoin gel 0.025% in the treatment of acne vulgaris: A multicentric trial. J Am Acad Dermatol. 1996;34:482–5.
    1. Leyden JJ, Shalita A, Thiboutot D, Washenik K, Webster G. Topical tretinoin in inflammatory acne: A retrospective, investigator-blinded, vehicle-controlled, photographic assessment. Clin Ther. 2005;27:216–24.
    1. Kang S. The mechanism of topical retinoids. Cutis. 2005;75:14–24.
    1. Njar VC, Gedia L, Purushottam P, Chopra P, Vasaitis TS, Khandelwal A, et al. Retinoic acid metabolism blocking agents (RAMBAs) for treatment of cancer and dermatological disease. Bioorg Med Chem. 2006;14:4323–40.
    1. Krautheim A, Gollnick H. Acne; topical treatment. Clin Dermatol. 2004;22:398–407.
    1. Jain S. Topical tretinoin or adapalene in acne vulgaris: An overview. J Dermatol Treat. 2004;15:200–7.
    1. Galvin SA, Gilbert R, Baker M, Guibal F, Tuley MR. Comparative tolerance of adapalene 0.1% gel and six different tretinoin formulations. Br J Dermatol. 1998;139:34–40.
    1. Shalita A, Weiss JS, Chalker DK, Ellis CN, Greenspan A, Katz HI, et al. A comparison of the efficacy and safety of adapalene 0.1% and tretinoin gel 0.025% in the treatment of acne vulgaris: A multicentric trial. J Am Acad Dermatol. 1996;34:482–5.
    1. Percy SH. Safety and efficacy of adapalene gel 0.1% in acne vulagaris: Results of post-marketing surveillance study. Indian J Dermatol Venereol Leprol. 2003;69:277–80.
    1. Wolfe JE. An update of recent clinical trials examining adapalene and acne. J Eur Acad Venereol. 2001;15:23–9.
    1. Johnson BA, Nunley JR. Topical therapy for acne vulgaris.How do you choose the best drug for each patient? Postgrad Med. 2000;107:73.
    1. Dobson RL, Belknap BS. Topical erythromycin solution in acne.Results of multicentric trial. J Am Acad Dermatol. 1980;3:478–82.
    1. Shalita AR, Smith EB, Bauer E. topical erythromycin vs clindamycin therapy for acne-A multicenter, double blind comparison. Arch Dermatol. 1984;120:351–5.
    1. Kurokawa I, Nishijima S, Kawabata S. Antimicrobial susceptibility of Propionibacterium acne isolated from acne vulgaris. Eur J Dermatol. 1999;9:25–8.
    1. Bojar RA, Eady EA, Jones CE, Cunliffe WJ, Holland KT. Inhibition of erythromycin- resistant propionibacteria on the skin of acne patients of topical erythromycin with and without zinc. Br J Dermatol. 1990;130:329–36.
    1. Cochrane RJ, Tucker SB, Flannigan SA. Topical zinc therapy for acne vulgaris. Int J Dermatol. 1985;24:188–90.
    1. Sardesai VR, Kambli VM. Comparison of efficacy of topical clindamycin and nicotinamide combination with plain clindamycin for the treatment of acne vulgaris and acne resistant to topical antibiotics. Indian J Dermatol Venereol Leprol. 2003;69:138–9.
    1. Parry MF, Rha CK. Pseudomembranous colitis caused by topical clindamycin phosphate. Arch Dermatol. 1986;122:583–4.
    1. Lyon RE. Comparative effectiveness of benzoyl peroxide and tretinoin in acne vulgaris. Int J Dermatol. 1978;17:246–51.
    1. Chu A, Huber FJ, Plott RT. The comparative efficacy of benzoyl peroxide 5%/ erythromycin 3% gel and erythromycin 4%/ zinc 1.2% solution in the treatment of acne vulgaris. Br J Deramtol. 1997;136:235–8.
    1. Leyden JJ, Berger RS, Dunlap FE, Ellis CN, Connolly MA, Levy SF. Comparison of the efficacy and safety of a combination topical gel formulation of benzoyl peroxide and clindamycin with benzoyl peroxide, clindamycin and vehicle gel in the treatment of acne vulgaris. Am J Clin Dermatol. 2001;2:33–9.
    1. DelRosso JQ. Combination topical therapy in the treatment of acne. Cutis. 2006;78:5–12.
    1. Handojo I. The combined use of topical benzoyl peroxide and tretinoin in the treatment of acne vulgaris. Int J Dermatol. 1979;18:489–96.
    1. Zouboulis CC, Derumeaux L, Decroix J, Maciejewska-Udziela B, Cambazard F, Stuhlert A. A multicentric, single- blind, randomized comparison of fixed clindamycin phosphate/tretinoin gel formulation (Velac) applied once daily and a clindamycin lotion formulation (Dalacin T) applied twice daily in the treatment of acne vulgaris. Br J Dermatol. 2000;143:498–505.
    1. Katsamba A, Dessinioti C. New and emerging treatments in dermatology: Acne. Dermatol Ther. 2008;21:86–95.
    1. Shalita AR. Treatment of mild and moderate acne vulgaris with salicylic acid in an alcohol-detergent vehicle. Cutis. 1981;28:556–8, 561.
    1. Cunliffe WJ, Holland KT. Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne. Acta Derm Venereol Suppl (Stockh) 1989;143:31–4.
    1. Iraji F, Sadeghinia A, Shahmoradi Z, Siadat AH, Jooya A. Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris. Indian J Dermatol Venereol Leprol. 2007;73:94–6.
    1. Garg T, Ramam M, Pasricha JS, Verma KK. Long term topical application of lactic acid/ lactate lotion as a preventive treatment for acne vulgaris. Indian J Dermatol Venereol Leprol. 2002;68:137–9.
    1. Enshaieh S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: A randomized, double-blind placebo controlled study. Indian J Dermatol Venereol Leprol. 2007;73:22–5.
    1. Heffernan MP, Nelsoa MM, Anadkat MJ. A pilot study of the safety and efficacy of picolinic acid gel in the treatment of acne vulgaris. Br J Dermatol. 2007;136:548–52.
    1. DelRosso JQ. New topical therapies for the treatment of acne vulgaris. Cutis. 2007;80:400–10.
    1. Mernadier J, Alirezai M. Systemic antibiotics for acne. Dermatology. 1998;196:135–9.
    1. Harrison PV. A comparison of doxycycline and minocycline in the treatment of acne vulgaris. Clin Exp Dermatol. 2003;139:459–64.
    1. Goulden V, Glass D, Cunliffe WJ. Safety of long term high dose minocycline in the treatment of acne. Br J Dermatol. 1996;134:693–5.
    1. Parsad D, Pandhi R, Nagpal R, Negi KS. Azithromyin monthly pulse vs daily doxycyline in the treatment of acne vulgaris. J Dermatol. 2000;;28:1–4.
    1. Singhi MK, Ghiya DC, Dhabai RK. Comparison of oral azithromycin pulse with daily doxycycline in the treatment of acne vulgaris. Indian J Dermatol Venereol Leprol. 2003;69:274–6.
    1. Bardazzi F, Savoia F, Parente G, Tabanelli M, Balestri R, Spadola G, et al. Azithromycin, a new therapeutic strategy for acne in adolscents. Dermatol Online J. 2007;13:4.
    1. Del Rosso JQ. Recently approved systemic therapies for acne vulgaris and rosacea. Cutis. 2007;80:113–20.
    1. Espersen F. Resistance to antibiotics used in dermatological practice. Br J Dermatol. 1998;139:4–8.
    1. Eady EA, Jones CE, Tipper JL, Cove JH, Cunliffe WJ, Layton AM. Antibiotic resistant propionibacterium in acne: Need for policies to modify antibiotic usage. Br Med J. 1993;306:555–6.
    1. Margolis DJ, Bowe WP, Hoffstad O, Berlin JA. Antibiotis treatment of acne may be associated with upper respiratory tract infection. Arch Dermatol. 2005;141:1132–6.
    1. Thorneycroft H, Gollnick H, Schellschmidt I. Superiority of combined contraceptive containing drospirenone to a triphasic preparation containing norgestimate in acne treatment. Cutis. 2004;74:123–30.
    1. Huber J, Walch K. Treating acne with oral contraceptives use of lower doses. Contraception. 2006;73:23–9.
    1. Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: An effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115:227–32.
    1. Hatwal A, Bhatt RP, Agrawal JK, Singh G, Bajpai HS. Spironolactone and cimetidine in treatment of acne. Acta Derm Venereol. 1988;68:84–7.
    1. Fugère P, Percival-Smith RK, Lussier-Cacan S, Davignon J, Farquhar D. Cypoterone acetate/ ethinyl estradiol in the treatment of acne.A comparative dose-response study of estrogen component. Contraception. 1990;42:225–34.
    1. Shaw JC. Hormonal therapy in acne. Dermatol Clin. 2001;19:169–78.
    1. Cunliffe WJ, van de Kerkhof PC, Caputo R, Cavicchini S, Cooper A, Fyrand OL, et al. Roaccutane treatment guidelines: Results of an international survey. Dermatology. 1997;197:351–7.
    1. Dhir R, Gehi NP, Agarwal R, More YE. Oral isotretinoin is as effective as a combination of oral isotretinoin and topical anti-acne agents in nodulocystic acne. Indian J Dermatol Venereol Leprol. 2008;74:187.
    1. Sheth R. Isotretinoin: An Indian experience. Indian J Dermatol Venereol Leprol. 2001;67:180–2.
    1. Layton AM, Knaggs H, Taylor J, Cunliffe WJ. Isotretinoin for acne vulgaris-10 years later: A safe and successful treatment. Br J Dermatol. 1993;129:292–6.
    1. Amichai B, Shemar A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006;54:644–6.
    1. Di Giovanna JJ. Systemic retinoid therapy. Dermatol Clin. 2001;19:161–7.
    1. Milchell AA, Van Bennekom CM, Louik C. A pregnancy prevention programme in women of child bearing age receiving isotretinoin. N Eng J Med. 1995;333:101–6.
    1. Dai WS, LaBraivo JM, Stern RS. Epidemiology of isotretinoin exposure during pregnancy. J Am Acad Dermatol. 1992;26:599–606.
    1. Pepall LM, Cosgrove MP, Cunliffe WJ. Ablation of white-heads by cautery under topical anaesthesia. Br J Dermatol. 1991;125:256–9.
    1. Levine RM, Rasmussen JE. Intralesional corticostaeroids in the treatment of nodulo-cystic acne. Arch Dermatol. 1983;119:480–1.
    1. Elman M, Lebzelter J. Light therapy in the treatment of acne vulgaris. Dermatol Surg. 2004;30:139–46.
    1. Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415 nm) and red (660nm) light in the treatment of acne vulgaris. Br J Dermatol. 2000;142:973–8.
    1. Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris. Br J Dermatol. 2000;142:855–6.
    1. Itoh Y, Ninomiya Y, Tajima S, Ishibashi A. Photodynamic therapy of acne vulgaris with topical delta-aminolaevulinic acid and incoherent light in Japanese patients. Br J Dermatol. 2001;144:575–9.
    1. Seaton ED, Charakida A, Mouser PE, Grace I, Clement RM, Chu AC. Pulsed- dye laser treatment for inflammatory acne vulgaris: Randomized controlled trial. Lancet. 2003;362:1347–52.
    1. Gold MH. Acne vulgaris: Lasers, light sources and photodynamic therapy- an update 2007. Expert Rev Anti Infect Ther. 2007;5:1059–69.
    1. Jemec GBE, Jemec B. Acne: Treatment of scar. Clin Dermatol. 2004;22:434–8.
    1. Drino B. Acne: Physical treatment. Clin Dermatol. 2004;22:429–33.
    1. Goodman G. Postacne scarring: A review. J Cosmet Laser Ther. 2003;5:77–95.
    1. Bett DG, Morland J, Yudkin T. Sugar consumption in acne vulgaris and seborrhoeic dermatitis. Br Med J. 1967;3:153–5.
    1. Fulton JE, Jr, Plewig G, Kligman AM. Effects of chocolate on acne vulgaris. JAMA. 1969;210:2071–4.
    1. Cordain L. Implications for the role of diet in acne. Semin Cutan Med Surg. 2005;24:84–91.
    1. Treloar V. Diet and acne redux. Arch Dermatol. 2003;139:941.
    1. Danby FW. Acne and milk, the diet myth, and beyond. J Am Acad Dermatol. 2005;52:360–2.
    1. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator marked, controlled trial. J Am Acad Dermatol. 2007;57:247–56.
    1. Logan AC. Dietary fat, fibre, and acne vulgaris. J Am Acad Dermatol. 2007;57:1092–3.
    1. Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: A report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003;49:s1–38.
    1. Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56:651–63.
    1. Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: An update from the Global Alliance to improve outcomes in Acne Group. J Am Acad Dermatol. 2009;60:S1–50.
    1. Kubba R, Bajaj AK, Thappa DM, Sharma R, Vedamurthy M, Dhar S, et al. Acne in India: Guidelines for management - IAA Consensus Document. Indian J Dermatol Venereol Leprol. 2009;75:1–64.

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