indian j dermatol-1sadas

8/9/2019 Indian J Dermatol-1sadas

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Indian J Dermatol. 2011 Jan-Feb; 56(1): 7–13.

doi: 10.4103001!-5154.77543

"#$ID: "#$30%%!40

ACNE VULGARIS TREATMENT : THE

CURRENT SCENARIO

&an'a *at+i

,t+or inormation / ,rtile note / $ori+t and iene inormation /+i artile +a been ited b ot+er artile in "#$.

o to:

Abstract

,ne lari i one o t+e mot ommon 8in diorder 9+i+ dermatoloit +ae to treat.

It mainl aet adoleent t+o+ ma reent at an ae. In reent ear de to better

ndertandin o t+e at+oenei o ane ne9 t+eraeti modalitie and ario

ermtation and ombination +ae been deined. In toial aent; ben+ile

temi t+era inlde oral antibioti +ormonal t+era and iotretinoin deendin

on t+e need o atient it +a to be eleted. "+ial treatment in t+e orm o leion

remoal +oto-t+era i alo +ell in e9 o t+em. &ine ario old and ne9 toial and

temi aent are aailable to treat ane it ometime one treatin dermatoloit. o

oerome t+i anel o +iian and reear+er 9or8ed toet+er a a lobal alliane and

ta8 ore to imroe otome in ane treatment. +e +ae tried to ie onen

reommendation or t+e treatment o ane. &el manaement o ane need arel

eletion o anti-ane aent aordin to linial reentation and indiidal atient need.

Keywords: Acne treatment consensus recommendation

o to:

Introducton

,ne lari i one o t+e ommonet 8in diorder 9+i+ dermatoloit +ae to treat

mainl aet adoleent t+o+ it ma reent at an ae. ,ne b deinition i

mltiatorial +roni inlammator dieae o iloebaeo nit.?1@ ario linial

reentation inlde eborr+oea omedone ert+emato ale and tle le

reAentl nodle dee tle or edot and ltimate arrin in e9 o t+em. ,ne

+a or main at+oeneti me+animBinreaed ebm rodtion ollilar

+er8eratini


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In reent ear de to better ndertandin o t+e at+oenei o ane ne9 t+eraeti

modalitie are deined.?3@ ,ailabilit o ne9 treatment otion to omliment t+e e=itin

armamentarim +old +el to a+iee t+e el t+era o reater nmber o ane

atient enre imroed tolerabilit and lil atient e=etation. &el manaement

o ane need arel eletion o anti-ane aent aordin to linial reentation and

indiidal atient need.

+e roe o t+i artile i to reie9 t+e treatment otion aailable 9it+ in t+e reent

enario.

To!ca" t#era!y

oial t+era i el in mild and moderate ane a monot+era in ombination and alo

a maintenane t+era.

A$ %en&oy" !ero'de

It i an eetie toial aent ine man ear and i aailable in dierent ormlation

(9a+e lotion ream and el) and onentration (2.5–10C).?46@

+e tabilit i er deendent on it e+ile. el are enerall more table and atie and

9ater-baed el bein le irritant i more reerred oer ream and lotion.? 7%@ en


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retinoin adaalene ta


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Salicylic acid: It +a been ed or man ear in ane a a omedolti aent bt i le

otent t+an toial retinoid.?3%@

Azelaic acid: It i aailable a 10–20C toial ream 9+i+ +a been +o9n to be eetie in

inlammator and omedonal ane.?3!40@

Lactic acid/Lactate lotion: It i ond to be +ell in reentin and redtion o ane leion

ont.?41@

Tea tree oil 5: Initial linial reone 9it+ t+i rearation i ineitabl lo9er omared

to ot+er treatment modalitie.?42@

Picolinic acid !el "#: It i an intermediate metabolite o t+e amino aid trto+an. It +a

antiiral antibaterial and immnomodlator roertie. >+en alied t9ie dail or 12

9ee8 ond to be eetie in bot+ te o ane leion bt rt+er trial are needed to

onirm it aet and eia.?43@

$apsone !el 5: It i a lone 9it+ anti-inlammator and antimirobial roertie. +e

trial +ae onirmed t+at toial daone el 5C i eetie and ae a monot+era and in

ombination 9it+ ot+er toial aent in mild-to-moderate ane lari.?44@

o to:

Syste+c T#era!y

Syste+c antbotcs

0ral antibioti are indiated in mainl moderate-to-eere inlammator ane.?5@

etraline and deriatie till remain t+e irt +oie. #arolide o-trimo=a


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tretooi in t+e oral ait.?5253@ +ere i a iniiant aoiation bet9een antibioti

ed in ane and t+e inidene o er reirator trat inetion.?54@

%ptimizin! antibiotic therapy: *eear+ +a demontrated t+at roblem o antibioti-reitant

P. acne i inreain and it i mot ommon 9it+ ert+romin. +ereore t+ere i need to

onider or antibioti reribin oliie and to adoate t+e e o nonantibioti rearation 9+ereer oible.

• ,ntibioti monot+era i to be aoided and it an be ombined 9it+ toial retinoid

or ben+ereer oible t+e dration o t+era +old be limited. +e al minimm

dration o t+era i 6–% 9ee8 bt an be ien to 12–1% 9ee8 and more.

• It i adiable to e t+e ame antibioti i retreatment i neear and e ben


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It i alo ombined (2 m) 9it+ et+inl etradiol (35 or 50 L) a an oral ontraetie

ormlation to treat ane.

d, ."uta+de

It i el in ane 9+en ien in emale 9it+ +iritim.?6061@

Ora" sotretnon

ral retinoid i indiated in eere moderate-to-eere ane or leer deree o ane

rodin +ial or +oloial arrin nreonie to adeAate onentional t+era.

?6263@ It i t+e onl dr t+at aet all or at+oeni ator imliated in t+e etiolo o

ane.

,lt+o+ t+ere are man tdie bt er lare eidene-baed td i la8in to onirm

t+e doin +edle. +e aroed doe i 0.5–2 m8da 9+i+ i all ien or 20

9ee8.?64 – 66@ ,lternatiel lo9er doe an be ed or loner eriod 9it+ a total

mlatie doe o 120 m8.?65@ Me9 deeloment and tre trend are lo9-doe lon-

term iotretinoin reimen and ne9 iotretinoin ormlation (mironi


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a, Vsb"e "*#t

+e are indiated or mild-to-moderate inlammator ane. &n 'itro and in 'i'o e=ore o

ane bateria to 405–420 nm o ltraiolet ree blue li!ht relt in t+e +oto-detrtion

t+ro+ t+e eet on t+e or+rin roded natrall b P. acne.?71@ Ne o limited

etrm 9aelent+ + a ble li+t (ea8 at 415 nm) and mi=ed ble and red li+t (ea8 at 415 and 660 nm) +ae been ond to be eetie in redin ane leion ater 4–12

9ee8.?7273@

b, /#otodyna+c t#era!y

(9it+ addition o O-aminolelini aid) and led de laer (5%5 nm) 9ere alo eetie in

ane bt rt+er trial are needed to onirm t+e ame.?74 – 76@

/#ysca" treat+ent o0 scars

,ne ar an be broadl diided into t9o ro t+oe inolin tie loe (Ie i8 ar

o= ar *ollin ar and Follilar malar atro+) and t+oe inolin tie e=e

(+ertro+i ar or 8eloid). $rrentl aailable treatment or ar inlde imle

e=iion and trin eit+er alone or ombined 9it+ n+ ratin and laer rerain

dermabraion ario te o laer +emial eel and iller. For +ertro+i ar

treatment inlde rere t+era I ortioteroid 5-lororail and bleomin

in'etion rial e=iion radiot+era laer t+era and rot+era.

,ll t+e roedre +ae t+eir o9n merit and demerit; to be +oen arell eein t+e

merit.?77 – 7!@

Acne and det

Dietar retrition +a not been demontrated to be beneit in t+e treatment o ane.? %0%1@

+e mt+ t+at diet aet ane i 9ideread bt reio tdie are not ortin it.

late ario at+or aain laimin t+at t+ere i t+e deinite role o diet in ane bt to

onlde t+at rt+er ontrolled trial are needed.?%2 – %4@ It +a been +o9n t+at t+e

realene o ane i lo9er in rral nonindtriali


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treatment.?%7 – %!@ +e +ae tried to ie onen reommendation or t+e treatment o

ane motl eidene-baed and int rom ario ontrie. &imilar alliane +a alo been

ormed in India reentl 9it+ t+eir reommendation.?!0@

To!ca" retnod

• It +old be rimar treatment or mot orm o ane lari.

• o be alied to entire aeted area.

• ,ntimirobial to be added or inlammator leion.

• ential art o maintenane t+era.

Co+bnaton t#era!y

• It 9or8 better and learin o leion i ater.

• &to antibioti i inlammator leion bide.

• I 9it+dra9al i not oible 9it+ to ben


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It i aroed in eere realitrant nodloti ane. It an alo be ed in moderate-to-

eere ane lari reitant to onentional t+era reAentl relain 9it+ eere

+oloial and +ial arrin de to ane. "re-treatment onellin atient eletion

and monitorin are ritial de to it ide eet li8e teratoeniit and adere +iatri

eent.

o to:

Ac1now"ed*+ents

&inere t+an8 to Dr. *a'e+ mar #mbai or roidin e9 o t+e reerene artile.

o to:

.ootnotes

Source o0 Su!!ort: Mil

Con0"ct o0 Interest: Mil.

o to:

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