SECTION 3

DERMATOLOGIC DISORDERS
Edited by Terry L. Schwinghammer

CHA P TE R

Acne
15 Acne Vulgaris

PATHOPHYSIOLOGY

microcomedone

Propionibacterium acnes
P. acnes

noninflammatory acne

P. acnes P. acnes

CLINICAL PRESENTATION

DIAGNOSIS

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TREATMENT

GENERAL APPROACH (FIG. 15–1)

✓
✓
✓
✓
✓
✓
NONPHARMACOLOGIC THERAPY

PHARMACOLOGIC THERAPY
Comedonal noninflammatory acne

Mild to moderate papulopustular inflammatory acne

P. acnes

Benzoyl peroxide Abnormal Salicylic acid

Topical/oral keratinization Benzoyl peroxide
antibiotics of follicle Topical retinoids
Isotretinoin Isotretinoin

Acne
pathogenesis Abnormal
P. acnes sebum
proliferation &
drug
mechanisms
Intralesional Antiandrogens
corticosteroids Isotretinoin
Oral Topical/oral
Inflammatory
corticosteroids antibiotics
response
Topical/oral Corticosteroids
antibiotics Estrogens

© Debra Sibbald

FIGURE 15–1. Acne pathogenesis and drug mechanisms.

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Severe papulopustular or moderate nodular acne

Nodular or conglobate acne

Maintenance therapy for acne

Exfoliants (Peeling Agents)

Resorcinol

Salicylic acid P. acnes

Sulfur

Topical Retinoids

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Tretinoin

Adapalene

Tazarotene

Topical Antibacterial Agents

Benzoyl peroxide

Topical erythromycin clindamycin

P. acnes

Azelaic acid

Dapsone

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Oral Antibacterials

Erythromycin

Ciprofloxacin trimethoprim-sulfamethoxazole
trimethoprim

Tetracyclines minocycline doxycycline)

Antisebum Agents
Isotretinoin P. acnes

Oral contraceptives
norgestimate with ethinyl
estradiol norethindrone acetate with ethinyl estradiol

Spironolactone

Cyproterone acetate

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Oral corticosteroids

EVALUATION OF THERAPEUTIC OUTCOMES

See Chapter 77, Acne Vulgaris, authored by Debra J. Sibbald, for a more detailed discus-
sion of this topic.
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