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you know u r going ques about this topic, can someone tell us treatment of all common acne.... it would helpfull for everyone, when to use topical, or oral isotretinion or when to use topical antibiotic, it will be nice discussion question
An 18-year-old female presents for evaluation of
facial acne. On examination, she has multiple comedones,
papules, and pustules on her forehead, nose,
cheeks, and chin. She also has several distinct nodules,
each greater than 5 mm in diameter.
153. Which of the following is most appropriate for
initial inclusion in a regimen to treat this
patient’s acne?
(A) erythromycin gel
(B) tretinoin 0.025% cream
© clindamycin lotion
(D) oral tetracycline
(E) oral isotretinoin
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I think for nodules you need isotrentoin! E
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Wait 6-8 weeks before trying another regimen or add another agent.
Mild to moderate.
Topical Benzoyl peroxide.
Topical Tretinoin or Adaplene.
Topical Erythromycin or Clindamycin.
Moderate to severe nodule.
Systemic antibiotic
(Tetracycline, Minocycline,
Demeclocycline, Erythromycin, Clindamycin,
TMP-SMZ)
Severe Cystic
Oral Retinoid
Isotretnoin
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Classification of Acne
Mild acne. few erythematous papules and occasional pustules mixed with comedones.
Moderate acne. This patient has many erythematous papules and pustules, as well as prominent scarring.
Severe acne. This patient has extensive pustules, erythematous papules, and multiple deepseated nodules within an extremely inflamed background.
Correct me If wrong..
Read and see pics at this link...
http://www.aafp.org/afp/2004/0501/p2123.html
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For treatment purpose
Mild to moderate
Use 1 and 2, if does not help add 3,and if does not get better add
systemic antibiotics..i.e Tetracycline
Moderate and severe has just same treatment as above.
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thank u swani, this is exactly what i am looking for, you must know these everyone
answer is D
This patient has nodulocystic acne which is
characterized by the presence of multiple
comedones, inflammatory papules, pustules,
and large nodules. Characteristically, the nodules
measure greater than 5 mm in diameter.
Initial therapy should include a systemic antibiotic
such as tetracycline or erythromycin. Use
of local therapy alone may be adequate in individuals
with comedonal acne. In cases of acne
which feature more of an inflammatory component
(with papules and pustules), topical
and oral antibiotics are useful. Oral isotretinoin
is indicated for severe nodulocystic acne that is
unresponsive to other therapies.
Use of isoretinoin is tightly regulated due
to the severity of its primary adverse effect, teratogenicity.
Health care providers prescribing
isotretinoin must receive specialized education
and training as well as certification from the
manufacturer prior to being able to prescribe
or administer the medication to their patients.
Female patients must receive contraception
counseling and must have two negative pregnancy
tests prior to initiation of therapy. They
must also have an additional negative pregnancy
test prior to each subsequent refill.
Recipients of oral isotretinoin should also be
warned of the risk of mood changes and
depression which have been anecdotally associated
with therapy. Other side effects of oral
isotretinoin therapy include hypertriglyceridemia
and development of dry skin with
cheilitis
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