Acne

Adjunctive Acne Vulgaris Management

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Adjunctive Acne Vulgaris Management, Oral Contraceptives for Acne Vulgaris, Anti-Androgens for Acne Vulgaris, Acne Vulgaris Hormonal Therapy, Intralesional Corticosteroid Injection for Acne Vulgaris

  • See Also
  1. Acne Vulgaris
  2. Acne Vulgaris Pathophysiology
  3. Acne Vulgaris Management
  4. Moderate Acne Vulgaris Management
  5. Severe Acne Vulgaris Management (includes Cystic Acne)
  • Management
  • Hormonal Options for Women
  1. Change Oral Contraceptive if already taking one
    1. Increase Estrogen (50ug Ethinyl Estradiol minimum)
    2. Decrease to low androgenic Progestin
  2. Oral Contraceptive with low androgenic Progestin
    1. Norgestimate
      1. Ortho-Cyclen
      2. Ortho Tri-Cyclen
    2. Norethindrone
      1. Norlutin
      2. Aygestin
    3. Drospirenone
      1. Yasmin
      2. Beyaz or Safyral (with Levomefolate)
    4. Desogestrel
      1. Desogen
      2. Ortho-Cept
    5. Ethynodiol Diacetate
      1. Demulen
      2. Zovia
  3. Spironolactone
    1. Use with Contraception due to SpironolactoneTeratogenicity
    2. Indications: Women with androgen hypersecretion
      1. Free Testosterone increased
      2. DHEA-S increased
    3. Dose: 50 to 200 mg orally daily
  • Management
  • Topical Androgen Receptor Inhibitor
  1. Winlevi (Clascoterone) 1% cream applied twice daily
    1. Topical Androgen Receptor Inhibitor indicated in acne for males or females
    2. May cause skin irritation
    3. Hypothalamic-Pituitary Axis suppression may be present as of 2 weeks of use
      1. Systemic effects (e.g. Amenorrhea, Hyperkalemia) are rare
    4. Efficacy data against standard, established acne medications is lacking
    5. Expensive (>$500 for 60 grams)
    6. (2021) Presc Lett 28(2): 12
  • Management
  • Inflammatory Acne
  1. Visible Light Therapy decreases inflammatory acne
  2. Topical Corticosteroids
    1. Moderate to high potency agents (Triamcinolone or Clobetasol)
    2. Limit to short-term use (less than 14 days) only
  3. Intralesional Corticosteroid Injection (intralesional Triamcinolone)
    1. Consider for large acne Papules or nodular acne
    2. Consider for those at risk of scarring
    3. Consider for rapid improvement for special occasions (e.g. weddings, modeling, graduation pictures)
    4. Technique
      1. Dilute Triamcinolone 10 mg/ml to 2-3 mg/ml
      2. Inject 0.1 cc into inflammatory acne lesion
      3. May repeat in 3-4 weeks up to one month
  • References
  1. Habif (2004) Dermatology, Mosby, p. 162-94
  2. Kaplan (2001) CMEA Medicine Lecture, San Diego
  3. Parker in Noble (2001) Primary Care p. 758-60
  4. Brown (1998) Lancet 351:1871-6 [PubMed]
  5. Feldman (2004) Am Fam Physician 69:2123-56 [PubMed]
  6. Gollnick (2003) J Am Acad Dermatol 49:S1-37 [PubMed]