We recently held a CPD-accredited webinar on acne management. This webinar was sponsored by Austell and presented by Dr Imraan Jhetam, a specialist dermatologist. The following article is based on his presentation.
To watch a replay of this webinar and still earn a CPD point, go to: https://event.webinarjam.com/replay/817/xq0nqam1miz6zavlxizp2w. Email john.woodford@newmedia.co.za to let him know to allocate your point/ request an attendance certificate for those who don’t fall under the HPCSA.
Acne is a prevalent inflammatory condition affecting the pilo-sebaceous units, primarily seen in adolescents but also persisting into adulthood. This article provides an overview of the epidemiology, pathogenesis, clinical features, and management strategies for acne, with a focus on new technologies
and molecules.
Epidemiology
Acne is the most common skin disease among adolescents, affecting 80% of teenagers aged 12-18 years. It can persist into adulthood, with 3% of men and 12% of women experiencing acne up to 25 years. Notably, 1% of men and 15% of women continue to have acne into their 40s and beyond. Adult-onset acne, first described by Kligman in 1991, predominantly affects older women with high-stress jobs, often related to chronic stress, excessive cosmetic use, certain medications, and hormonal imbalances such as PCOS.P
Athogenesis
Acne development involves five key factors:
- Follicular epidermal proliferation leading to obstruction of the pilosebaceous duct.
- Sebum production regulated by hormones, particularly androgens.
- Comedone formation due to excess sebum and follicular hyperkeratosis.
- Proliferation of Cutibacterium acnes (C. acnes) in the presence of excess sebum.
- Inflammation stimulated by C. acnes. Diet also plays a role, with studies indicating that cow's milk, particularly skim milk, and high glycaemic load diets can exacerbate acne.
Clinical features
Acne presents with various lesions, including comedones, papules, pustules, nodules, and cysts, primarily in sebaceous gland-rich areas like the face, chest, back, and upper arms. The severity of acne can range from mild (comedones and a few papulopustules) to severe (nodulocystic acne with large nodules and scarring). Severe variants like acne fulminans and acne conglobata can be associated with systemic symptoms.
Management
General principles:
- Cleanse the face twice daily with a mild cleanser.
- Avoid overwashing and scrubbing.
- Use oil-free moisturisers.
- Avoid popping or picking pimples.
Skincare:
- Cleansers should effectively cleanse without compromising the skin barrier.
- Moisturisers should counteract the drying effects of acne treatments and provide sun protection.
Medical treatment:
- Mild acne: Topical agents like benzoyl peroxide, retinoids, and antibiotics.
- Moderate acne: Combination of topical agents and systemic antibiotics or hormonal therapy.
- Severe acne: Systemic agents like isotretinoin, antibiotics, and hormonal therapy.
Bacterial resistance:
- Resistance to antibiotics like erythromycin and tetracyclines is common.
- Benzoyl peroxide can prevent bacterial resistance and is recommended alongside antibiotics.
Hormonal therapy:
- Combined oral contraceptives (COCs) are effective for inflammatory acne in females.
- Spironolactone can be used in selected patients.
Isotretinoin:
- Recommended for severe nodular acne and treatment-resistant moderate acne.
- New formulations like lidose and micronised isotretinoin improve bioavailability and reduce food dependency.
New and emerging therapies:
- Adapalene 0.3/BPO 2.5%, clascoterone, tifarotene, IDP-126, and oral sarecycline are promising new treatments.
Acne scarring:
- Early and appropriate management of active acne can prevent scarring.
- Treatments for acne scars include chemical peels, microdermabrasion, microneedling, fillers, laser therapy, and steroid injections.
Conclusion
Effective acne management requires a comprehensive approach, including early intervention, appropriate skincare, and the use of both topical and systemic treatments. New formulations and emerging therapies offer promising options for improving patient outcomes and adherence.
