To understand the different therapies to treat acne vulgaris, we must understand the pathophysiology of acne and why and how it occurs. Acne vulgaris, commonly known as acne, is a prevalent and often distressing skin condition that affects millions of individuals worldwide. Characterized by the formation of various lesions, including pimples, blackheads, whiteheads, and cysts, acne primarily targets the pilosebaceous units, which consist of hair follicles and sebaceous glands. The development of acne is intricately linked to a combination of factors, including hormonal fluctuations, increased sebum production, bacterial colonization (particularly by Propionibacterium acnes), and inflammation. Treatment regimens aim to combat all 4 of these causing factors. Understanding the underlying mechanisms of acne, as well as effective prevention and management strategies, is crucial for addressing this common skin condition.
The treatment regimen revolves around the patients' desired outcomes and encompasses short and long-term goals. Regimens are directed at control, not cure. The goals of treatment are alleviation of symptoms and decrease the number and severity of lesions. The target of treatment is the microcomedone. In addition to pharmacological therapy, nonpharmacological measures are important such as cleansing the skin regularly and reducing triggers. For mild to moderate acne, topical therapy is 1st line, while for moderate to severe systemic therapy is preferred.
I will delve into the most common medications used that belong to these drug classes: topical antimicrobials, topical retinoids, and oral retinoids. All agents used to treat acne take 1-2 months for noticeable signs of improvement. They also can cause redness, dryness, burning, itching, peeling and swelling. The most common topical antimicrobial is Benzoyl Peroxide. It is available over the counter in multiple forms and strengths. Benzoyl peroxide targets the anaerobic bacteria C. acnes, and destroys it through the release of oxygen. Patients are advised to use it continuously to maintain clinical response and to avoid unnecessary sunexposure, and use sunscreen. A common topical retinoid used is adaplene which is now available over the counter as 0.1% gel formulation, being the best choice for those with sensitive skin. Retinoids work by normalizing follicular keratinization, heal comedones, decrease sebum production, and decrease inflammatory lesions (1). Retinoids do have a learning curve to using them as used too much too quickly can cause extreme irritation. When starting retinoids, patients should be advised to apply every other night for the first 2 weeks to adjust, and then they can apply nightly. All acne agents usually require sunscreen as they affect the sensitivity of the skin to the sun. An oral retinoid most commonly prescribed for severe acne is isotretinoin. It reduces sebum production by 90%, production and decreases the production of microcomedones (1). Patients should be aware that the effects are gradual, and acne may worsen before it improves. The aforementioned acne medications were not teratogenic however this one is. Due to its teratogenicity, it is contraindicated in pregnancy and those with childbearing potential must take measures to avoid pregnancy during use. The most common side effects are chapped lips, dry mouth, dry skin, and pruritus.
Acne vulgaris is a common skin condition that affects many and knowing the many different therapies out there to treat it, is crucial for pharmacists.
Reference:
Daniel R. Malcom, (2022), "Chapter 41: Dermatologic Disorders," The APhA Complete Review for Pharmacy, 13th Edition https://doi-org.jerome.stjohns.edu/10.21019/9781582123615.ch41
To understand the different therapies to treat acne vulgaris, we must understand the pathophysiology of acne and why and how it occurs. Acne vulgaris, commonly known as acne, is a prevalent and often distressing skin condition that affects millions of individuals worldwide. Characterized by the formation of various lesions, including pimples, blackheads, whiteheads, and cysts, acne primarily targets the pilosebaceous units, which consist of hair follicles and sebaceous glands. The development of acne is intricately linked to a combination of factors, including hormonal fluctuations, increased sebum production, bacterial colonization (particularly by Propionibacterium acnes), and inflammation. Treatment regimens aim to combat all 4 of these causing factors. Understanding the underlying mechanisms of acne, as well as effective prevention and management strategies, is crucial for addressing this common skin condition.
The treatment regimen revolves around the patients' desired outcomes and encompasses short and long-term goals. Regimens are directed at control, not cure. The goals of treatment are alleviation of symptoms and decrease the number and severity of lesions. The target of treatment is the microcomedone. In addition to pharmacological therapy, nonpharmacological measures are important such as cleansing the skin regularly and reducing triggers. For mild to moderate acne, topical therapy is 1st line, while for moderate to severe systemic therapy is preferred.
I will delve into the most common medications used that belong to these drug classes: topical antimicrobials, topical retinoids, and oral retinoids. All agents used to treat acne take 1-2 months for noticeable signs of improvement. They also can cause redness, dryness, burning, itching, peeling and swelling. The most common topical antimicrobial is Benzoyl Peroxide. It is available over the counter in multiple forms and strengths. Benzoyl peroxide targets the anaerobic bacteria C. acnes, and destroys it through the release of oxygen. Patients are advised to use it continuously to maintain clinical response and to avoid unnecessary sunexposure, and use sunscreen. A common topical retinoid used is adaplene which is now available over the counter as 0.1% gel formulation, being the best choice for those with sensitive skin. Retinoids work by normalizing follicular keratinization, heal comedones, decrease sebum production, and decrease inflammatory lesions (1). Retinoids do have a learning curve to using them as used too much too quickly can cause extreme irritation. When starting retinoids, patients should be advised to apply every other night for the first 2 weeks to adjust, and then they can apply nightly. All acne agents usually require sunscreen as they affect the sensitivity of the skin to the sun. An oral retinoid most commonly prescribed for severe acne is isotretinoin. It reduces sebum production by 90%, production and decreases the production of microcomedones (1). Patients should be aware that the effects are gradual, and acne may worsen before it improves. The aforementioned acne medications were not teratogenic however this one is. Due to its teratogenicity, it is contraindicated in pregnancy and those with childbearing potential must take measures to avoid pregnancy during use. The most common side effects are chapped lips, dry mouth, dry skin, and pruritus.
Acne vulgaris is a common skin condition that affects many and knowing the many different therapies out there to treat it, is crucial for pharmacists.
Reference:
Daniel R. Malcom, (2022), "Chapter 41: Dermatologic Disorders," The APhA Complete Review for Pharmacy, 13th Edition https://doi-org.jerome.stjohns.edu/10.21019/9781582123615.ch41