Wednesday, March 30, 2016

Treatment of Acne

Acne medications
Medications
Dose
Select adverse effects

Topical retinoids

Tretinoin
Once daily, at bedtime
Local skin irritation, dryness, and flaking; sun sensitivity
NOTE: Micronized gel tretinoin 0.05% (Atralin) contains soluble fish proteins, use with caution in patients with known sensitivity or allergy to fish


Adapalene
Once daily, at bedtime
Local skin irritation, dryness, and flaking; sun sensitivity

Tazarotene
Once daily, at bedtime
Contraindicated in pregnancy; local skin irritation, dryness, and flaking; sun sensitivity

Isotretinoin (not available in United States)
Once daily, at bedtime or twice per day
Contraindicated in pregnancy and lactation; local skin irritation, dryness and flaking; sun sensitivity

Topical antimicrobials*

Benzoyl peroxide (BPO)
Twice daily
Local skin irritation; may bleach hair or clothing

Clindamycin
Twice daily
Once daily (foam)
Rare risk of pseudomembranous colitis; usually prescribed with BPO to decrease resistance

Erythromycin
Twice daily
Usually prescribed with BPO to decrease resistance

Dapsone
Twice daily


Topical combination products

Benzoyl peroxide 5%/Clindamycin 1%
Twice daily
Local skin irritation; may bleach hair or clothing

Benzoyl peroxide 2.5%/Adapalene 0.1%
Once daily
Local skin irritation; may bleach hair or clothing

Benzoyl peroxide 2.5%/Adapalene 0.3%
Once daily
Local skin irritation; may bleach hair or clothing



Azelaic acid
Twice daily
Local skin irritation

Salicylic acid
Once to three times daily
Local skin irritation; potential for salicylate absorption

Oral antibiotics¶Δ

Tetracycline
500 mg twice daily
Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children

Doxycycline
50 to 100 mg twice daily or 100 mg once daily or Delayed release formulation: 100 mg every 12 hours for one day, then 100 mg per day
Subantimicrobial dosing: 20 mg twice daily or Delayed release formulation given as 40 mg once daily
Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children

Minocycline
50 to 100 mg twice daily or
Extended release formulation: 1 mg/kg/day (round to nearest available strength)
Dizziness, drug-induced lupus, skin discoloration; contraindicated in pregnancy and young children

Erythromycin
500 mg twice daily (base)
Gastrointestinal distress

Trimethoprim-sulfamethoxazole
160 mg/800 mg once to twice daily
Stevens-Johnson syndrome, toxic epidermal necrolysis

Azithromycin
Intermittent dosing due to long drug half-life; optimum regimen unknown
Gastrointestinal distress

Hormonal agents¶◊

Combination oral contraceptives (estrogen/progestin)
Once daily
Nausea, breast tenderness, weight gain, thromboembolic events


Spironolactone
25 to 200 mg/day in one or two equally divided doses; doses of 50 to 100 mg/day may be as effective as higher doses and reduce side effects
Contraindicated in pregnancy; menstrual irregularity, breast tenderness, minor gastrointestinal symptoms, orthostatic hypotension, hyperkalemia, dizziness, headaches, fatigue

Oral retinoid§

Oral isotretinoin
0.5 mg/kg/day, increasing to 1 mg/kg/day in one or two equally divided doses; total dose 120 to 150 mg/kg over 20 weeks
Teratogenicity (absolutely contraindicated in pregnancy), mucocutaneous effects, hypertriglyceridemia, others


%: percent; BPO: Benzoyl peroxide (topical).
* Topical sulfacetamide (eg, gels, creams, lotions, other) with and without sulfur are also available but not typically used and have limited data; refer to topic.
¶ Usual oral dose for adult or adolescent.
Δ BPO may be prescribed with oral antibiotics to reduce resistance.
◊ For additional information refer to topic review of hormonal therapy for acne vulgaris.
§ For additional information refer to topic review of oral isotretinoin therapy for acne vulgaris.

References:
  1. www.uptodate.com
  2. http://www.dermnetnz.org/treatments/isotretinoin.html
  3. http://www.nhs.uk/conditions/acne/pages/treatment.aspx
  4. http://www.nps.org.au/publications/health-professional/health-news-evidence/2013/oral-antibiotics-for-acne
  5. http://emedicine.medscape.com/article/1069804-medication#1

1 comment:

Note: Only a member of this blog may post a comment.