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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 15. Acne Vulgaris.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Acne is a highly prevalent disorder affecting many adolescents and adults.

  • Image not available. The etiology of this complex disease originates from multiple causative and contributory factors. The diagnosis is based on the patient’s history and clinical presentation.

  • Image not available. Elements of pathogenesis involve defects in epidermal keratinization, androgen secretion, sebaceous function, bacterial growth, inflammation, and immunity.

  • Image not available. Acne vulgaris is a chronic disorder which cannot be “cured.” Goals of treatment and prevention include control and alleviation of symptoms by reducing the number and severity of lesions, slowing progression, limiting disease duration and recurrence, prevention of long-term disfigurement associated with scarring and hyperpigmentation and avoidance of psychologic suffering. Targeting goals may increase patient adherence to therapy.

  • Image not available. The most critical target for treatment is the microcomedone. Minimizing or reversing follicular occlusion will arrest the pathogenic acne cascade and involves combining treatment measures to target all pathogenic elements.

  • Image not available. Nondrug measures are aimed at long-term prevention and treatment. Patients should eliminate aggravating factors, maintain a balanced, low-glycemic load diet, and control stress. Cleanse twice daily with mild soap or soapless cleanser, and use only oil-free cosmetics. Comedone extraction in approximately 10% of patients produces immediate cosmetic improvement. Shave infrequently as possible, using a sharp blade or electric razor.

  • Image not available. First-, second-, and third-line therapies should be appropriate for the severity and staging of the clinical presentation and directed toward control and prevention.

  • Image not available. Treatment regimens should be tapered over time, adjusting to response. Combine the smallest number of agents at the lowest possible dosages to ensure efficacy, safety, avoidance of resistance, and patient adherence.

  • Image not available. Once control is achieved, maintenance regimens should be simplified to continue with some suppressive therapy. Therapy must be continued beyond 8 weeks: efficacy is assessed through comedonal and inflammatory lesion (IL) count, control or progression of severity, and management of associated anxiety or depression. Safety end points include monitoring for treatment adverse effects.

  • Image not available. Motivate the patient to continue long-term therapy through empathic and informative counseling.

In this chapter, I review the latest developments in understanding acne vulgaris and its treatment. The contents provide an analysis of the physiology of the pilosebaceous unit; the epidemiology, etiology, and pathophysiology of acne; relevant treatment with nondrug measures; and comparisons of pharmacologic agents, including drugs of choice recommended in best-practice guidelines. Options include a variety of alternatives such as retinoids, antimicrobial agents, hormones, and light therapy. Formulation principles are discussed in relation to drug delivery. Patient assessment, general approaches to individualized therapy plans, and monitoring evaluation strategies are presented.

EPIDEMIOLOGY

Image not available. Acne vulgaris is a chronic disease and the most common one treated by dermatologists. The lifetime prevalence of acne approaches 90%, with the highest incidence in adolescents. Prevalence data available from the European Union, United States, Australia, and New Zealand show that ...

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