Acne is a disease of the pilosebaceous unit that can affect males and females of all ethnicities. The four main pathogenic factors include: excess sebum production, inflammation, P. acnes bacteria, and follicular hyperproliferation. This can lead to post inflammatory hyperpigmentation, scarring, and psychologic distress.
There are several kinds of topical, oral, and procedural treatments for acne. Each are targeted towards the four pathogenic factors. Common treatment modalities include:
Follicular hyperproliferation – topical retinoids, oral isotretinoin, azelaic acid, salicylic acid
Sebum production – oral isotretinoin, oral contraceptives, spironolactone, clascoterone
P. acnes bacteria – benzoyl peroxide, topical and oral antibiotics, azelaic acid
Inflammation – oral isotretinoin, oral tetracyclines, topical retinoid, azelaic acid, topical dapsone
It is important to encourage the use of gentle cleansers. Patients need to avoid harsh scrubbing of the skin as this can aggravate inflammatory acne and lead to more breakouts. Using “noncomedogenic” products can be beneficial, however this labeling is not regulated. Encourage patients not to pick at lesions. This can lead to increased scarring.
It is important to discuss with patients that it generally takes two to three months of consistent use of an acne regimen to assess the initial response to treatment. Without this discussion, there is risk of early discontinuation of treatment by the patient. Secondly, it is important to notify patients that acne treatments are suppressive, not curative, so long-term maintenance therapy is often needed.
Written by Sara Doherty, APRN