Some Tid-Bits

  • Four factors lead to acne formation: increased sebum production, hyperkeratinization, propionibacterium acnes colonization, and inflammatory reaction.

Treatment Steps (from mild to severe)

  1. Comedones – Rx Topical Retinoids (Tretinoin, Adapalene, Tazarotene) – generally works about the same. For the following additional symptoms:
  2. Inflammation РAdd Topical Non-Abx (Benzoyl Peroxide, Azelaic Acid) +/- Topical Abx (Clindamycin, Erythromycin)
  3. Nodules – Add Oral Abx (Erythromycin, Minocycline, Tetracycline)
  4. Last Resort – Rx Isotretinoin – Pregnancy category X
    • Patients and providers need to register with iPledge (both males¬†and females)
    • For females, must be on 2 contraceptives for 1 month before, during, and 1 month after treatment.
    • For females, must have 2 negative pregnancy test before starting therapy, one of which must be done at a CLIA-certified lab. During therapy, must have monthly pregnancy tests at a CLIA-certified lab.