Acne

There are five steps for treatment and prevention of acne lesions:

1. Unplugging of the sebaceous follicle, to prevent formation of white heads (closed comedones) and black heads (open comedones), with one of the following topical retinoids, or with oral retinoid:

     —Tretinoin (Avita, Renova, Retin-A, Retin-A Micro™)
     —Adapalene (Differin™), good for sensitive skin
     —Tazarotene (Tazorac™), thougher on acne but also more irritating to the skin
     — Retinol, retinyl linoleate, retinyl palmitate™
     —Oral retinoid: Isoretinoin (Accutane™)

2. Killing the bacteria that cause inflammation and formation of pustules:

    —Topical antibiotics: clindamycin, erythromycin, metronidazole, sulfacetamide
    — Benzoyl peroxide kills bacteria by formation of free radicals and, in combination
         with antibiotics, decreases the chance for bacterial resistance.
    —Azelaic acids
    —Oral antibiotics

3. Removing material that clogs the pores:

      —Retinoids
      —Salicyclic Acid (BHA)
      —Alpha hydroxy acids (glycolic, lactic)
      —Azelaic acid

4. Reducing the inflammatory response (avoid cortisone preparation which can lead to "steroid acne"):

     —Salicylic acid (over-the-counter acne wash)
     —In office BHA peels
     —Oral anti-inflammatory drugs, such as ibuprofen

5. Decreasing level of sebum:

   —oral contraceptives or spironolactone
   —retinoids (see step 1)

Avoid scrubbing the skin with abrasive soaps, or using too much on the skin, such as a combination of toners, masks, exfoliaters, moisturizers. Use only very mild cleansing products. Don't stop with a medication too early. It takes 4 to 6 months to see good results.

Topical retinoids help prevent photo-aging, if used with a sun blocker, and can be used life-long.

Uptodate Info on Acne

 

Example of Acne Prevention Regimen:
       AM
       1. Washing with a mild 2% salicyclic acid cleanser
       2. Applying a topical antibiotic solution or azelaic acid.
       3. Applying a sunscreen SPF 30 with moisturizing cream for dry skin, or for very oily            skin, a lotion or gel

      PM
      1. Washing with the same salicylic acid cleaner
      2. Applying a topical retinoid

In difficult cases may add oral antibiotics and /or oral contraceptives. Some make-up foundations now contain salicylic acid to aid in the prevention of acne.

 

Rosacea

Acneiform condition of unknown cause typically presents in light-skinned adults 25 to 60 years of age, characterized by facial redness, swelling, flushing, papules and pustules, and formation of prominent blood vessels on mid face (nose, cheeks, chin, forehead). Avoid alpha hydroxy acids and retinoids which worsen the condition. Responds well to topical antibiotics, salicylic acid and electrosurgery or laser treatment of prominent blood vessels. Avoid anything that makes face flush, such as spicy foods, alcohol, hot beverages. Use sunscreen.

Vascular Type (facial redness, flushing, prominent blood vessels): Topical steroids may improve the appearance of vascular rosacea in the short term, but probably aggravate the condition eventually. Tetracycline and other antibiotics are not very effective at this stage. Only the pulsed dye laser seems beneficial.

Inflammatory Type (inflammatory papules, pustules, and nodules): The oral tetracyclines are highly effective in reducing inflammatory lesions. Minocycline is more effective than doxycycline or tetracycline, and should be started at 100 mg twice daily, but clearing may be maintained at doses as low as 100 mg every 2-3 days. Topical metronidazole (MetroGel, MetroCreme) is probably the most used topical treatment for rosacea, but other useful topicals include azelaic acid, ketoconazole, terbinafine, and sodium sulfacetamide with sulfur.

Sebaceous Hyperplasia (thickened facial skin with prominent oil glands and enlarged nose): Isotretinoin works well for this form of rosacea, because it shrinks the sebaceous glands. Oral isotretinoin even works well in early rhinophyma, and only low doses are required (10-20 mg per day). Electrosurgery and pulsed dye laser are also useful

Ocular Rosacea: About one half of cutaneous rosacea patients will have some degree of ocular rosacea, which includes dry eyes, discharge, frequent sty formation, sensation of foreign body, and conjunctival redness. Generally, prominent redness of the lid margins and conjunctiva with enlarged bloos vessels will be noted. The mainstays of treatment are the oral tetracyclines, and improvement should be seen in 3-4 weeks.

For more information check the Rosacea.org site

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