Fast Facts: Acne Second edition - Karger Publishers
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Fast Facts:
Acne
Second edition
Alison M Layton MB ChB FRCP
Honorary Senior Lecturer
Hull York Medical School
Consultant Dermatologist
Harrogate and District NHS Foundation Trust
Harrogate, UK
Diane Thiboutot MD
Professor of Dermatology
The Pennsylvania State University College of Medicine
Hershey, Pennsylvania, USA
Vincenzo Bettoli MD
Medical Manager, O.U. of Dermatology
Azienda Ospedaliero-Universitaria di Ferrara
Affiliate Professor
Department of Life Sciences and Biotechnologies
University of Ferrara, Italy
Declaration of Independence
This book is as balanced and as practical as we can make it.
Ideas for improvement are always welcome: feedback@fastfacts.com
© 2016 Health Press Ltd. www.fastfacts.com
Fast Facts: Acne
First published 2004
Second edition February 2016
Text © 2016 Alison M Layton, Diane Thiboutot, Vincenzo Bettoli
© 2016 in this edition Health Press Limited
Health Press Limited, Elizabeth House, Queen Street, Abingdon,
Oxford OX14 3LN, UK
Tel: +44 (0)1235 523233
Fast Facts is a trademark of Health Press Limited.
All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the express
permission of the publisher.
The rights of Alison M Layton, Diane Thiboutot and Vincenzo Bettoli to be
identified as the authors of this work have been asserted in accordance with the
Copyright, Designs & Patents Act 1988 Sections 77 and 78.
The publisher and the authors have made every effort to ensure the accuracy of this
book, but cannot accept responsibility for any errors or omissions.
For all drugs please consult the product labeling approved in your country for
prescribing information.
Registered names, trademarks, etc. used in this book, even when not marked as
such, are not to be considered unprotected by law.
A CIP record for this title is available from the British Library.
ISBN 978-1-908541-89-5
Layton, AM (Alison)
Fast Facts: Acne/
Alison M Layton, Diane Thiboutot, Vincenzo Bettoli
Medical illustrations by Dee McLean, London, UK,
and Annamaria Dutto, Withernsea, UK.
Typesetting by User Design, Illustration and Typesetting, Leicester, UK.
Printed by Hobbs the Printer Ltd, Totton, UK.
© 2016 Health Press Ltd. www.fastfacts.com
Introduction 5
Epidemiology 7
Pathophysiology, etiology and modifying factors 13
Diagnosis 19
Psychosocial aspects 43
Topical therapy 50
Oral therapy 59
Physical treatments for acne and scarring 78
Acne care pathway 82
Future trends and areas of need 98
Useful resources 100
Index 102
© 2016 Health Press Ltd. www.fastfacts.com
© 2016 Health Press Ltd. www.fastfacts.com
Introduction
Acne is one of the ten most common diseases worldwide, and the
inflammatory skin disease seen most frequently by community
physicians and dermatologists. It is defined as a chronic disease
because of its characteristic prolonged course and acute or insidious
relapses or recurrences over time, and the associated social and
psychological consequences that negatively affect quality of life.
Confirming the diagnosis is rarely a problem as there are some
important clinical signs that distinguish acne from other similar skin
problems (see Chapter 3).
Over the past decade, knowledge of acne pathophysiology and
etiologic factors has expanded, resulting in the development of novel
treatments. However, the vast number of therapeutic options that are
now available can pose a challenge to the prescribing clinician, and the
emergence of antibiotic-resistant strains of Propionibacterium acnes
(P. acnes) may result in reduced efficacy to treatment. As resistant
P. acnes can be transferred to close contacts, important guidance on
antibiotic use has been developed with the aims of reducing the
likelihood of antimicrobial resistance emerging as well as removing
resistant strains of P. acnes.
• Benzoyl peroxide is able to rapidly reduce both sensitive and
resistant strains of P. acnes and should be used in combination with
all antibiotics prescribed for acne.
• Oral antibiotics should not be used for mild disease.
• Antibiotics should be avoided as monotherapy in acne management.
• Topical retinoids impact on the microcomedones (the precursor of
inflammatory and non-inflammatory lesions) and should be
considered as part of a regimen to expedite improvement and hence
reduce exposure to antibiotics.
While the recent introduction of several new anti-acne agents that
target clinical lesions and improve patient outcomes has afforded
greater flexibility in the treatment of acne, successful management still
relies on careful selection of agents according to clinical presentation,
underlying etiology and individual patient needs. A thorough patient 5
© 2016 Health Press Ltd. www.fastfacts.comFast Facts: Acne
evaluation should take into account acne severity, duration of disease,
predominant lesion type, patient age, skin type, lifestyle, motivation
and the presence of coexisting conditions. Consideration of all these
factors, along with appropriate education when choosing a specific
treatment program, can enhance patient satisfaction and adherence to
medication, both of which are essential to achieve optimum outcomes.
Early effective treatment will reduce the likelihood of scarring.
Primarily aimed at family practitioners, nurse prescribers,
pharmacists and dermatology trainees, this fully updated second
edition of Fast Facts: Acne provides a concise overview of the clinical
features of the condition, reviews available treatments – including
their respective modes of action and potential adverse events – and
advises on treatment selection with the implicit goals of minimizing
the physical and emotional scarring associated with this challenging
disease.
6
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