Acne affects more than 85 percent of teenagers but frequently continues into adulthood. Although there are more than 2 million visits to office-based physicians per year for patients in the age range of 15 to 19 years, the mean age at presentation for treatment is 24 years, with 10 percent of visits taking place when patients are between the ages of 35 and 44 years. Patients evaluated at tertiary care centers are prone to depression, social withdrawal, anxiety, and anger and are more likely to be unemployed than persons without acne. Scarring can lead to lifelong problems in regard to self esteem. The direct cost of acne in the United States is estimated to exceed $1 billion per year, with $100 million spent on over-the-counter acne products.
Classifying Acne (The severity of acne is generally assessed by the number, type, and distribution of lesions.):
Mild Acne(no inflammatory lesions) are the main lesions.
Papules and pustules may be present but are small and few in number (generally
ModerateAcne- numbers of papules and pustules (10–40) are present. Mild disease of the trunk may also be present. Erythematous papules and pustules are the predominant lesions, and disease is limited to the face.
Moderately Severe Acne-numerous papules and pustules are present (40–100), usually with many pimples (40–100) and occasional larger, deeper nodular inflamed lesions (up to 5). Widespread affected areas usually involve the face, chest, and back.
Severe AcneNodulocystic acne and acne conglobated with many large, painfulnodular or pustular lesions are present, along with manysmaller papules, pustules, and comedones.
Topical antimicrobial agents are effective in the treatment of inflammatory disease. Benzoyl peroxide is a bactericide and is an excellent first-line medication. The response to this agent is rapid, with improvement noted as early as five days after treatment has begun, but irritation is common. Water-based products, as compared with alcohol based products, when used at low peroxide concentrations (2.5 to 5 percent) will help to limit this problem and have an efficacy similar to that of other products in this class. Benzoyl peroxide does not induce resistance; when used with topical or oral antibiotics, it protects against the development of this problem.
Oral antibiotics are indicated for moderate-to severe disease, for the treatment of acne on the chest, back, or shoulders, and in patients with inflammatory disease in whom topical combinations have failed or are not tolerated. After control of the acne is achieved and maintained for at least two months, a reduction in the dose can be attempted. Hormonal treatment is especially useful in women who desire contraception or have other manifestations of hyperandrogenism, such as irregular menstrual cycles or hirsute. Oral antibiotics and topical therapy may be used in combination with hormonal treatments.When the use of this agent is being considered, an assessment of the severity of disease should include the effect of the acne on the patient, such as the potential for scarring.
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