Acne vulgaris

Tretinoin COOH Topical 0.025-0.1% Gels or creams Acne vulgaris, parakeratosis, hyperkeratosis Photoaging, actinic keratosis... 

Topical antibiotics exert a direct local effect on specific microorganisms and may be bactericidal or bacteriostatic. Bacitracin (Baciguent) inhibits the cell wall synthesis. Bacitracin, gentamicin (G-myticin), erythromycin (Emgel), and neomycin are examples of topical antibiotics. These drugp are used to prevent superficial infections in minor cuts, wounds, skin abrasions, and minor burns. Erythromycin is also indicated for treatment of acne vulgaris. 

Grimes et al. [8] reported substantial efficacy and minimal side effects in 25 patients treated with 20 and 30% salicylic acid peels in darker racial-ethnic groups. Conditions treated included acne vulgaris, melasma and post-inflammatory hyperpigmentation. 

Given these findings, indications for salicylic acid peels include acne vulgaris (inflammatory and non-inflammatory lesions), acne rosacea, melasma, post-inflammatory hyperpigmentation, freckles, lentigines, mild to moderate photodamage, and texturally rough skin. 

When treating acne vulgaris, topical and systemic therapies (if indicated) are initiated 2 to 4 weeks prior to peeling. Topical antibiotics and benzoyl peroxide based products can be used daily and discontinued 1 or 2 days prior to peeling. However, unless a deeper peel is desired, retinoids should be discontinued 7-10 days prior to salicylic acid peeling. Broad-spectrum sunscreens (UVA and UVB) should be worn daily (see Photo damage. Sunscreen section). 

Fig. 6.5a, b. Acne vulgaris before and after four salicylic acid peels... 

An excellent peeling agent in patients with acne vulgaris... 

Lee HS, Kim IH (2003) Salicylic acid peels for the treatment of acne vulgaris in Asian patients. Dermatol Surg 29 1196-1199... 

Burton JL, Cunliffe WJ, Stafford I, Shuster S (1971) The prevalence of acne vulgaris in adolescence. Br J Dermatol 85 119-126... 

Cunliffe3 WJ, Gould DJ (1979) Prevalence of facial acne vulgaris in late adolescence and in adults. BMJ 1 1109-1110... 

Acne vulgaris typically begins around puberty and early adolescence it tends to present earlier in females, usually at about 12 or 13 years, than in males, 14 or 15 years, due to later onset of puberty in males. Acne has been estimated to affect 95-100% of 16- to 17-year-old boys and 83-85% of 16- to 17-year-old girls. Acne settles in the vast majority by 23-25 years of age, persisting for longer in some 7% of individuals 1% of males and 5% of females exhibit acne lesions at 40 years of age. There is a small group of individuals who develop late-onset acne, beyond the age of 25 years. 

Acne vulgaris is the most common type of acne. The individual lesions of acne vulgaris are divisible into three types non-inflamed lesions, inflamed lesions and scars (Table 11.2). 

Chemical peels are usually considered as an adjunct to the basic treatment of acne vulgaris. 

The author has observed enhanced improvement of oily skin, enlarged pores, and acne vulgaris with the use of salicylic acid peels compared with glycolic acid peels. Possible mechanisms for this observation include salicylic acid s effect on lipid solubility and microcome-odone formation. 

Fig. 16.2. a Post-inflammatory hyperpigmentation from acne vulgaris, b After a series of salicylic acid peels and hydroquinone 4%... 

Grimes PE, Callender VD (2003) Tazarotene cream 0.1% in the treatment of facial post-inflammatory hyperpigmentation associated with acne vulgaris a two-center, double-blind, randomized, vehicle-controlled study. Poster presentation at the 61st Annual Meeting of the American Academy of Dermatology, San Francisco, CA, March 21-26,2003... 

Jacyk WK, Mpofu P (2001) Adapalene gel 0.1% for topical treatment of acne vulgaris in African patients. Cutis 68 48-54... 

Ortho Tri-Cyclen (norgestimate/ethinyl estradiol) and Estrostep Fe (norethindrone acetate/ethinyl estradiol) both have an approved indication for treatment of moderate acne vulgaris in females 15 years of age or older desiring contraception who have failed topical antiacne medication. 

The treatment goals for acne vulgaris are to eliminate existing lesions and prevent new lesions from developing, as well as to decrease discomfort and the incidence of scarring. 

With an estimated 40 to 50 million people affected, acne vulgaris is the number one skin disease in the United States.4 While acne affects approximately 85% of adolescents and... 

From West DP, West LE, Musumeci ML, Micali G. Acne vulgaris. In DiPiro JT, Talbert RL, Yee GC, et a I, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 1 757, with permission. 

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