Acne vulgaris is a long-term skin condition that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. Severe acne can be present in endocrine diseases like PCOD, Cushing’s syndrome, androgen secreting tumour, acromegaly, etc. It can be also seen variety of non-endocrine diseases and hence a thorough assessment is needed.
Medications:
For mild cases:
- Cream Tretin 025% (Tretinoin 0.025% w/w) – apply at bedtime for 6 weeks (initially apply over a small area to rule out skin irritation) .This is contraindicated in pregnancy.
- Topical gel Percuna 2.5% (Benzoyl peroxide 2.5% w/w) – apply in the morning for 6 weeks. Apply this on cleaned and dry skin and leave it to act for 2 hours and wash it off later.
- Topical cream Ezanic 20% (Azelaic acid 20%) – apply once a day (only for post inflammatory hyperpigmentation areas) for 6 weeks.
For inflammatory acne:
- Ointment Triamaderm 0.1% (Triamcinolone topical 0.1% w/w) – apply twice a day for 14 days. Revert to treatment for mild cases once inflammation is controlled.
For moderate cases:
- Topical gel Peroclin 2.5%/1% (Benzoyl peroxide 2.5% w/w, Clindamycin 1% w/w) – apply in the morning for 6 weeks. Apply this on cleaned and dry skin and leave it to act for 2 hours and wash it off later.
- Topical gel Zinderm BPO 0.1%/2.5% (Adapalene topical 0.1%, Benzoyl peroxide 2.5%) at bedtime for 6 weeks (contraindicated in pregnancy).
For severe cases:
- Cap. Microdox-LBX (Doxycycline 100 mg, Lactobacillus 5 billion spores) – one capsule once a day for 2 months along with treatment for moderate cases.
Supportive treatments:
- For all skin types – Cetaphil gentle skin cleanser.
- For dry skin – Nivea crème soft soap or Dove Cream Beauty Bar and Himalaya Nourishing Cream
- For oily skin: Sebamed cleansing bar or Pears oil clear soap
General advice:
- Discontinue offending agents if possible like oral steroids, phenytoin, lithium, oral contraceptives, isoniazid, oil-based cosmetics.
- Avoid simple sugars and carbohydrates like milk and chocolates.
- Do not squeeze lesions.
- Limit washing face to 2-3 times per day.
Investigations:
- Serum cortisol – raised in Cushing’s syndrome.
- Growth hormones – raised in acromegaly.
- Testosterone and DHEA – levels will be raised in androgen secreting tumour or PCOD.
Referral:
Consider referring to dermatologist if patients fail to respond to the above treatment or present with additional complications. Consider referring to endocrinologist if underlying pathologies are identified.