Management of acne.

CMAJ • APRIL 19, 2011 • 183(7) © 2011 Canadian Medical Association or its licensors E430 Acne vulgaris has a substantial impact on a patient’s quality of life, affecting both self-esteem and psychosocial development.1 Patients and physicians are faced with many over-the-counter and prescription acne treatments, and choosing the most effective therapy can be confusing. In this article, we outline a practical approach to managing acne. We focus on the assessment of acne, use of topical treatments and the role of systemic therapy in treating acne. Acne is an inflammatory disorder of pilosebaceous units and is prevalent in adolescence. The characteristic lesions are open (black) and closed (white) comedones, inflammatory papules, pustules, nodules and cysts, which may lead to scarring and pigmentary changes (Figures 1 to 4). The pathogenesis of acne is multifactorial and includes abnormal follicular keratinization, increased production of sebum secondary to hyperandrogenism, proliferation of Propionibacterium acnes and inflammation.2,3 Lesions occur primarily on the face, neck, upper back and chest.4 When assessing the severity of the acne, one needs to consider the distribution (back, chest, upper arms), type and number of lesions (comedones, papules, pustules, nodules) and the presence or absence of scarring (Table 1).2,3 Different variants of acne exist, including acne conglobata, acne fulminans, acne mechanica, excoriated acne, chloracne, drug-induced acne (e.g., from anabolic steroids, corticosteroids, isoniazid, lithium, phenytoin), neonatal and infantile acne, and occupational acne. These variations have a similar clinical and histologic appearance to acne vulgaris, but they are distinguishable by clinical setting, severity and associated symptoms. The common differential diagnosis of acne includes folliculitis, keratosis pilaris, peri oral dermatitis, seborrheic dermatitis and rosacea.