Acne

Hormonal agents are important, effective therapeutic options for women across the spectrum of acne severity. The three preparations approved in Canada for this indication have safety profiles similar to conventional oral contraceptives.

Educate and counsel. Most patients with acne are teenagers who are very self-conscious about their looks and expect immediate treatment results. However, adult acne is becoming more common, and can be very distressing as well.

Since multiple factors are involved in the pathophysiology of acne, treatment that counteracts the majority of them can be expected to achieve the best results. When considering the options for reducing the P. acnes population, it is best to choose those that do not encourage resistance patterns.

This paper reviews current evidence presented by recent studies on the impact of acne on psychosocial health. Effective treatment of acne was accompanied by improvement in self-esteem, affect, obsessive-compulsiveness, shame, embarrassment, body image, social assertiveness and self-confidence.

Oral isotretinoin, since its introduction more than 20 years ago, has been and still is the 'gold standard' in the treatment of acne and its variants. This is the only approach to acne with the possibility of a permanent “cure” or long term remission.

There is compelling evidence that oral contraceptives (OCs) are effective in the management of mild-moderate acne vulgaris, as well as cumulative evidence that elevated levels of androgens in acne patients, relative to appropriate controls, are an underlying pathophysiological factor in acne.

Acne is a multifactorial disease of the pilosebaceous unit in the skin. Four contributing pathogenic factors need to be elucidated and include excess sebum production, follicular hyperkeratinization, colonization of the pilosebaceous unit by Propionibacterium acnes.

Clindoxyl® Gel (Stiefel) is a combination of 1% clindamycin phosphate and 5% benzoyl peroxide in a gel vehicle that is well tolerated and more efficacious than either active agent alone or the vehicle in reducing lesion counts and improving global scores in patients with moderate acne.

Psoriasis, acne vulgaris and photoaging are common conditions. Tazarotene is a pro-drug of tazarotenic acid, a receptor-selective retinoid, which has shown efficacy in the treatment of these disorders. In the treatment of acne vulgaris, it has greater comedolytic activity than the currently available topical retinoids.

Oral contraceptives (OCs) can reduce acne by lowering the production of adrenal and ovarian androgens, by inhibiting 5- alpha-reductase, which in turn, reduces the levels of dihydrotestosterone, and by stimulating sex hormone binding globulin (SHBG), thus reducing the levels of free testosterone.

There is no drug that has provided as much therapeutic benefit for 12 million acne patients as this retinoid has done in the past 18 years following its introduction. However, it is a retinoid and, therefore, a teratogen.

Treatment objectives and pharmacoeconomic considerations are important when developing guidelines that are effective and rational. Canadian Acne Treatment Guidelines were last published in 1995. New guidelines were recently developed to incorporate therapeutic advances and data from more recent studies.

Topical acne treatment can positively benefit patients with acne. This review summarizes clinical and prescribing information on currently available topical agents. The efficacy of the medications included in this report is supported by properly designed randomized clinical trials.

On the 26th of February 1998, Hoffmann-LaRoche, on the instructions of the FDA, sent out more than 210,000 Dear Dr. warning letters to health care providers communicating new safety information about the prescribing of isotretinoin for acne, and citing isolated reports of drug-induced depression, psychosis and rarely, suicidal thoughts and action.

Benzoyl peroxide 5% plus erythromycin 3% (Benzamycin. gel, Dermik) will be evaluated. Although it is not known how effective it is compared with benzoyl peroxide and erythromycin prescribed separately, Benzamycin® is simpler to use and likely to improve patient compliance.