Management

• Follicular hyperkeratinization - keratinocytes inside follicles shed abnormally and clump together

  • Retinoids - increase cell turnover - speed up the process of shedding dead skin cells, preventing them from clogging pores
  • Keratolytics - disrupts bonds between keratinocytes making it easier for them to slough off so they don't clog pores
• Increased sebum production - further plugging the follicle

  • Retinoids - reduce the amount of sebum produced by the sebaceous glands
• Proliferation of bacteria causing inflammation

  • Antiseptic - topical agents that make the environment they're applied to unfavourable to bacteria
  • Antibiotic - targets cutibacterium acnes bacteria
• Management of mild to moderate:

  • one of the following topical first line options to be applied once a day in the evening:
  • Adapalene (retinoid and keratolytic) with benzoyl peroxide (antiseptic and keratolytic)
  • Tretinoin (retinoid) with clindamycin
  • Benzyl peroxide with clindamycin
• Management of moderate to severe acne:

  • 12 week course of one of the following to be applied OD in the evening:
  • Topical adapalene with topical benzoyl peroxide
  • Topical tretinoin with topical clindamycin
  • Topical adapalene with topical benzoyl peroxide + oral lymecycline or oral doxycycline
  • Topical azelaic acid BD + oral lymecycline or oral dozycycline
• For moderate to severe acne in women:

  • Consider combined oral contraceptive in combination with topical agents as an alternative to systemic antibiotics
  • Dianette (co-cyprindiol)
• When discussing treatment choices with a person with childbearing potential, cover:

  • That topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy. 
  • That they will need to use effective contraception, or choose an alternative treatment to these options.