Acne Vulgaris

Overview: Acne Vulgaris

• Acne vulgaris, known by most as acne, represents the most common disease of the skin as it affects approximately 45 million individuals in the United States and as many as 80% to 90% of adolescents.

• Worldwide spending on prescription and over-the-counter acne treatments is estimated to be tens of billions of dollars each year, making it one of the fasting growing markets in the dermatologic industry to date.

• Although the majority of cases are seen through the teen- age years and in young adulthood, acne may be manifested at any time during the life span.

• Whereas it is not typically associated with significant physical comorbidity, acne may have severe social and psychological sequelae, necessitating a multidimensional approach to care.

• Acne vulgaris is a disease of the pilosebaceous unit of the skin, where the hair follicle meets the sebaceous gland in the dermis. The sebaceous gland functions to facilitate desquamation and lubrication of the skin.

Important Points to Consider

• Vitamin A: Given its questionable therapeutic effect and demonstrated potential for toxicity, oral supplementation with vitamin A is not recommended.

• High doses appear to be required for symptomatic control, and hypervitaminosis A has short- and long-term health risks.

• These risks include headaches, myalgias, fatigue, nausea and vomiting, dry skin and mucous membranes, hair loss, hepatitis, reduced bone mineral density, and teratogenicity.

• The topical antimicrobial benzoyl peroxide is unique in that it serves to reduce rather than to increase the antibiotic resistance of P. acnes.

  • When it is prescribed in combination with other topical antimicrobials, such as erythromycin and clindamycin, benzoyl peroxide is noted to elevate treatment efficacy significantly and to decrease antibiotic resistance.

  • In turn, given the rising antibiotic resistance of P. acnes, patients with acne vulgaris should not be prescribed antibiotics as monotherapy.

  • Instead, the use of topical or oral antibiotics should be accompanied by topical benzoyl peroxide, a topical retinoid, and a continuing dialogue on lifestyle modifications and adjuvant therapies as outlined earlier

Oral Medications That Induce or Exacerbate Acne Vulgaris

Prevention Prescription

• Maintain proper skin care: rinse gently, twice daily with warm water and a non–soap-based cleanser.

• Avoid scrubbing with abrasive materials, oil-based lotions and cosmetics, and picking at acne lesions.

• Reduce psychoemotional stress by getting adequate amounts of sleep and engaging in regular relaxation practices, such as meditation, guided imagery, breathing exercises, and massage therapy.

• Maintain a diet with a low glycemic load, rich in protein and omega-3 fatty acids and low in carbohydrates and saturated fats.

• Eat USDA-certified organic meats and dairy to limit consumption of animal products treated with exogenous androgenic hormones.

• Limit exposure to pharmaceutical medications that may cause eruption of acne vulgaris

• Avoid potential environmental triggers such as extremes in temperature as well as dietary triggers that may best be identified by way of a dedicated elimination diet.

Therapeutic Review

Mind-Body Medicine (for acne vulgaris and rosacea)

• Practice stress management and relaxation techniques

Nutrition

• Maintain a diet low in glycemic load

• Limit or eliminate dairy consumption

• Maintain a diet high in omega-3 fatty acids with the option of flaxseed or fish oil supplementation

Supplements

• Brewer's yeast: 2 g three times daily

• Zinc gluconate: 30 mg daily

Botanicals

• Tea tree oil: 5% to 15% solution or gel, applied topically once daily

Pharmaceutical Preparations

• Azelaic acid: 20% cream or 15% gel, applied topically twice daily for acne vulgaris or rosacea

• Salicylic acid: applied topically one or two times daily for acne vulgaris

• Retinoids: applied topically once nightly for acne vulgaris

• Topical antibiotics (benzoyl peroxide, clindamycin, erythromycin, sulfacetamide, metronidazole) for acne vulgaris and rosacea

• Oral antibiotics (erythromycin, tetracycline, doxycycline, minocycline) for acne vulgaris and rosacea

• Isotretinoin: 0.5 to 1 mg/kg/day, taken orally once or in two divided doses daily for acne vulgaris

Key Web Sources

• www.rosacea.org

• www.glycemicindex.com

• www.ipledgeprogram.com