All about Acne

• Clinical Type and Severity of Acne: To determine the necessary types of treatment.
• Type of Skin: Dry or oily, helping to choose a topical pharmacological vehicle. This choice is important because it conditions the effectiveness of treatment by affecting absorption and duration of action. Topical vehicles are the different forms adopted by the active ingredient (the medication), such as ointment, cream, gel, lotion, spray or powder.
• Presence of Acne Scars: This will indicate the need to consider a more aggressive therapy and treatment for acne.
• Presence of Post-Inflammatory Erythema or Hyperpigmentation: This leads to consider the possibility of treatments for this type of signs.
• Periodicity of the Menstrual Cycle and History of Signs of Hyperandrogenism in Women: To help determine the need of additional lab tests and prescription of hormone treatments.
• Skin Care Habits and Previous Acne Treatments: To identify potential issues in skin care and previous treatments that may have worked or not.
• Cosmetic Products or Other Medications: To identify products that may favor the occurrence of acne.
• Psychological Impact of Acne on the Patient: It helps to determine the need of a more aggressive treatment approach or psychological support.

Principles of Treatment:

Acne treatment is mainly intended for key factors promoting the development of acne lesions: follicular hyperproliferation and abnormal desquamation of epithelial cells (keratinocytes), increase in sebum production, excessive growth of Cutibacterium acnes, and presence of inflammation.

The first choice for most cases of acne. Topical retinoids may cause redness in the skin and, during its use, it is recommended to apply sun protection factor (SPF) of 30 or higher.

Approach to Treatment:

An example of a general approach to the initial treatment of acne based on the 2016 American Academy of Dermatology would depend on the patients' type of acne and their medical history (table).

General approach to treatment based on patient's type of acne.

Maintenance of Treatment:

In general acne recurs over the years, so maintenance treatment is an important component. Patients need to keep in mind that it usually takes at least from two to three months of constant treatment to see results. Sometimes it may be necessary to make readjustments in the medication.