Acne Stages and Treatment

V. Dimov, MD

3 stages = CIN:
C omedonal -> black / white-head, open / closed
I nflammatory -> pimples/zits
N odulo-cystic

Treatment flow chart:
1. Topical
2. Systemic with ABx
3. Systemic with Retinoic acid

Treatment flow chart corresponds to the stages CIN - TAR (Topical, ABx, Retinoic acid)

Topical Treatment:
-Differin gel, better ~ Retin A
Use it as CCC-F-> Cheek, Chin, Cheek, Forehead
-Sulfacet-R-> zits

Systemic Treatment:
-Doxycycline 1 mo -> sun -> "bad sunburn"
-Erythromycin 250 po tid

Acne surgery (mechanical extraction) can be helpful in comedonal and inflammatory stages.

Nodulo-cystic acne:
Use Abx for 6 mo -> if no effect -> Retinoic acid po
Retinoic acid~chemo-tx

Effective but SE:
-Teratogenic – use 2 methods of contraception (pill + condoms), hCG test 1 mo before starting, then monthly and 1 mo after the end of treatment
-Dry eyes (contact lenses user have to switch to glasses), vaginal dryness – discomfort, dry lips (cheilitis)

Kenalog (steroid) SC injections of the inflammatory nodules are also helpful.

Resources:
Diagnosis and Treatment of Acne - AFP 5/2004
Use of Systemic Agents in the Treatment of Acne Vulgaris - AFP 10/2000