Virtual Lecture: Spot-On Acne Treatment Options - Mital Patel-Cohen, MD - 6.2.2020

While most common in teens, the onset of acne can be troubling at any age. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems. Learn about the causes of acne and effective treatment options for adolescents and adults.

1. Understanding Acne Mital Patel-Cohen, MD Dermatology

2. Who Gets Acne? Acne is one the most common skin conditions Acne affects up to 90% of adolescents Women can have initial acne present in 20-40s Males = Females All races Family history

3. How Does Acne Form? Step 1: Hair follicles become clogged with shedding skin cells and oil (sebum) Oil glands enlarge during puberty increasing oil production Step 2: Increase in sebum allows for bacteria to overgrow (P. acnes) Step 3: Inflammation occurs due to extra bacteria (and possibly other factors) Photos: gskpro.com

4. Acne Triggers: Hormonal changes/shifts External factors : cosmetics, hair products, sweat, head gear/sporting equipment Stress Medications Diet : ??? (dairy, sugars, trans-fats)

5. Types of Acne: Comedonal Papular/pustular Nodulocystic Photos: DermNet NZ

6. Acne Skin Care: Skin Hygiene: Wash face 1-2x per day with gentle cleansers and warm water Avoid harsh scrubs Avoid picking/popping pimples Moisturizer/Make-up: oil free or “non-comedogenic” Sun protection

7. Treatments: Options, Options, Options!! Topical : salicylic acid, glycolic acid, benzoyl peroxide, azelaic acid, topical antibiotics, retinoids, dapsone gel, sulfacetamide Oral : antibiotics, spironolactone, oral contraceptives, isotretinoin Alternative supplements : zinc gluconate, Vitamin D, Green tea, Vitamin B complex, Fish oils

8. Mild Acne Management: Follow an acne skin care regimen Topical treatments are most often used for mild disease Topicals can take up to 12 weeks before improvement is seen Topicals can be irritating and can cause dry skin therefore consider beginning on alternate days and using moisturizer Most common agents: Benzoyl peroxide : Antibacterial and comedolytic properties Common adverse effects include skin irritation and bleaching of hair and colored fabric Topical antibiotics (clindamycin, erythromycin): Reduce number of P. acnes and reduce inflammation Topical retinoids (tretinoin, adapalene): Decreases oil production and clogged pores Common adverse effects include dryness, redness, itch, sun sensitivity

9. Moderate Acne Management : Topical treatments +/- oral antibiotics +/- oral contraception Most common agents: Oral antibiotics : doxycycline, minocycline -Improvement is seen in 2-3 months -Contraindicated in pregnancy and in children < 8 years old - Take with food and full glass of water -May cause GI upset and photosensitivity Oral contraceptive pills or spironolactone : used for women with hormonally induced acne (most often acne along the jaw line)

10. Severe Acne Management: All before mentioned options to be tried, if no improvement consider isotretinoin Oral isotretinoin: Used for severe or refractory cases of acne Can cause birth defect therefore female patients must use two forms of contraception Bloodwork before and during the treatment will be needed to follow cholesterol and liver tests Mainstay side effects: dry skin and dry lips Rarely causes depression, severe headaches, vision changes, inflammatory bowel disease

11. Treatment Take Home Points: There is no single best treatment for acne Most often combination treatments are needed Dermatologists create treatment protocols based on the patient’s skin type, acne lesion type, and severity Acne treatments take 8-12 weeks

12. Hyperpigmentation: Brown Discoloration Time Sun protection/SPF Lightening creams: hydroquinone, retinoids azelaic acid, kojic acid, vitamin C Chemical peels Microneedling Photos: DermNet NZ

13. Post-inflammatory Erythema: Redness Time Sun protection/SPF Laser therapy to remove redness: pulse dye laser, KTP laser, IPL Photos: DermNet NZ

14. Acne Scarring: Texture Change Time Retinoids Chemical peels Microneedling Laser Resurfacing

15. Hypertrophic Scarring: Raised Scars Topical steroid creams Intralesional injection of steroid Photos: DermNet NZ

16. Take Home Points Acne is a VERY common inflammatory skin condition Acne is caused by multiple factors Acne comes in several different forms We have many treatment options Each patient is unique and needs their own treatment plan

17. This Photo by Unknown Author is licensed under CC BY-SA

18. Thank You! Dr. Patel-Cohen Please feel to reach out to our office for any dermatologic concerns. We see patients of all ages! 150 Park Avenue, Florham Park 973-775-5156 34 Mountain Blvd, Bldg. B, Warren 908-769-2510 1 Diamond Hill Road, Berkeley Heights 908-277-8668