The information presented here is not to be used as or interpreted to be advice to treat acne, rather the information presented here is to inform the reader and is in no way intended to be interpreted as medical advice or recommendations for treatment. It is strongly suggested that readers seeking treatment for their acne, or any other health problem, consult a qualified and experienced health care professional for treatment advice of their condition.
Redefining Acne Vulgaris as a Chronic Disease: Implications on Improving Therapy
Author: Diane Berson, MD
Source: Medscape Dermatology. 2009; ©2009 Medscape, Posted 03/04/2009
Question
The Global Alliance to Improve Outcomes in Acne recently recommended that acne be defined as a chronic disease. What would be the advantages and effects of such a redefinition?
Response from Diane Berson, MD - Assistant Clinical Professor, Department of Dermatology, Weill Medical College of Cornell University, New York, NY
Acne is indeed a "chronic" disease.[1] These flares can be due to genetic predisposition, hormonal fluctuations (especially in females), or ongoing elevations in sebum production.
Although we are able to get our patients' acne under control, there can be a tendency for further flares when a patient is not given a maintenance regimen.
We usually treat acne with a topical combination regimen, usually including a topical retinoid in conjunction with a topical antimicrobial.[2] For more severe inflammatory acne, an oral antibiotic can be added to the regimen. Women susceptible to hormonal flares, such as those who flare premenstrually, can also be prescribed an oral contraceptive or spironolactone to help reduce sebum production and prevent these outbreaks.[3]
For those whose acne is severe, nodulocystic, unresponsive to therapy, or has evidence of scarring, isotretinoin may be indicated. Once the acne is "clear" we prescribe medications to use as a "maintenance" regimen, to help prevent further flares. Most patients are prescribed a topical retinoid (tretinoin, adapalene, or tazarotene), which acts as a comedolytic agent and therefore helps prevent the development of new microcomedones, which are the precursor lesions of acne.[4,5]
Topical retinoids may also have anti-inflammatory properties, inhibiting toll-like receptors and the development of inflammation. Patients may also be given a low-dose (sub-antimicrobial) oral antibiotic, either doxycycline or minocycline, especially for those who have inflammatory papules of acne or rosacea.
It is important for patients to understand that acne is an inflammatory condition that can continue to flare and may be characterized by exacerbations and remissions. Therefore, appropriate ongoing skin care may be necessary. Patients should also understand that although antibiotics constitute an integral part of treatment, acne is not an infection (like strep throat) that will clear after a short course of antimicrobials. It is an ongoing condition that may require maintenance treatments. It is also important for insurance carriers to understand this, as adult patients are often denied coverage for treatments, especially topical retinoids, which can also be used for the management of photodamaged skin.
This activity is supported by an independent educational grant from Medicis.
References
1. Gollnick HP, Finlay AY, Shear N, et al. Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol. 2008;9:279-2844.
2. Thielitz A, Gollnick H. Topical retinoids in acne vulgaris: update on efficacy and safety. Am J Clin Dermatol. 2008;9:369-381. Abstract
3. Rich P. Hormonal contraceptives for acne management. Cutis. 2008;81(1 Suppl):13-18.
4. Yan AC, Treat JR. Beyond first-line treatment: management strategies for maintaining acne improvement and compliance. Cutis. 2008;82(2 Suppl 1):18-25.
5. Tschen E. Addressing patient variability: clinical challenges in the initiation of acne treatment. Cutis. 2008;82(2 Suppl 1):9-17.Diane Berson, MD, Assistant Clinical Professor, Department of Dermatology, Weill Medical College of Cornell University, New York, NY
isclosure: Diane Berson, MD, has disclosed that she serves as a consultant to Kao and that she serves on the advisory boards of Galderma, Stiefel, OrthoNeutrogena, and DUSA.
Acne: A holistic view
Sufferers of acne, irrespective of the cause, need to be treated as individual patients, not as a set of symptoms. More often than not, several organ/energy systems are involved and need to be re-balanced before any long-term healing of acne can occur.
Alternative medicine views patients and their health complaints as individuals with a set of individual 'imbalances' that need to be addressed in a holistic way. That is the age, diet, sex, overall constitution, etc., together with any other health issues, all need to be considered. No two patients with acne are the same - therefore, each patient is different and will require a different treatment approach.
Traditional Chinese medicine, Ayurvedic medicine, herbal medicine, etc., all view acne as a result of imbalances existing within an individual's unique body. They also do not ignor the mental and emotional elements of the patient, but include this aspect of every patient in the overall treatment approach.
Only by taking a holistic approach to disease can a long-term positive outcome be achieved.