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Prescribing Antibiotics to Patients with Acne
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Shannon Humphrey, MD, FRCPC, FAAD, Clinical Assistant Professor, Director of Continuing Medical Education, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.
Abstract
The pathogenesis of acne is tied to Propionibacterium acnes (P. acnes), an anaerobic bacteria. There has been a dramatic rise in resistance to antibiotics that are usually prescribed to treat acne. Given resistance to antibiotic therapy can occur in more pathogenic bacteria than P. acnes, and the fact that a rise in pathogenic P. acnes has been reported, the development of antibiotic resistance in acne is a public health matter globally. Clinical practice guidelines are aiming to curb the further development of antibiotic resistance without detracting from effective management of both inflammatory and non-inflammatory acne. Key Words: acne vulgaris, antibiotic resistance, benzoyl peroxide, anti-inflammatory, sub-antimicrobial dosing.
Human skin is covered in hundreds of thousands of microscopic hair follicles, called pores. These are particularly prominent on the face, neck, back, and chest. These pores are connected to oil glands under the skin that make a substance called sebum. Sometimes these follicles produce too many cells and become blocked. As a result, sebum (oil) gets trapped and bacteria (P. acnes) begin to grow.1,2,4
Acne is the most common skin condition.1,4
Cleanse your skin gently. Do not scrub – this can aggravate acne.1
Wash your skin twice a day with a mild cleanser and water. More frequent washing will not improve your acne, and it might irritate your skin and make the acne worse.2
The 81st Annual Meeting of the Canadian Dermatology Association was held June 27 - July 2, 2006 in Winnipeg, Manitoba.
Issues and Advances in Acne Management: A Special Report from the Annual Meeting of the Canadian Dermatology Association.
Dr Neil Shear, MD; John Wolf, MD; Richard Thomas, MD
Please note that the online, video portions of this report require the most recent version of Adobe Flash Player, which can be obtained as a free download by clicking here.
This multi-media conference report was made possible by an unrestricted educational grant from Galderma Canada Inc.
Publication of THE LATEST IN ACNE CARE supplement was made possible by an unrestricted educational grant from Galderma Canada Inc.
Maha Theresa Dutil, MD, M.Ed, FRCPC, Assistant Professor of Medicine, Division of Dermatology, University of Toronto, Toronto, ON.
One of the marked changes in the practice of dermatology over the past thirty years has been the increased focus on acne. What was once considered a universal rite of passage that occasionally caused deeply disturbing scars is now considered—by patients and doctors alike—an insufferable condition that must be treated. Perhaps as a sign that available treatments are increasingly successful, acne is showing signs of affecting popular culture. Kid Acne, a British artist (not his real name!), decided to make his affliction his signature so as to stand out in the crowded hip-hop scene. The Uruguayan movie Acné (as you would have guessed, about a thirteen-year-old boy coming of age while enduring acne outbreaks) was a hit of Spanish-speaking cinema in 2008. Acne for Dummies by Dr. Herbert P. Goodheart (a remarkably good book!) ranks a respectable 76th in skin care/ beauty books on Amazon.ca.
Success has bred the desire for even more success. This supplemental publication to Dermatology Times on "Innovations in Acne Care: The Latest Guidelines and Treatment Options" sheds light on new approaches that will be helpful to specialists and GPs alike. Dr. Neil Shear's "Newest Guidelines for the Treatment of Acne" discusses the acne guidelines...
Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON.
Abstract: This article summarizes key statements from the 2009 Global Alliance to Improve Outcomes in Acne Group's therapeutic guidelines, published as a supplement in the Journal of the American Academy of Dermatology (JAAD). It offers an algorithm for acne treatment, as well as addresses important statements from the committee on acne pathophysiology, epidemiology, and the latest research findings, as they pertain to the guidelines.
Dermatologists should be actively contributing to educating other clinicians that acne is a chronic disease.
Despite many extensive educational programs, the committee sees an ongoing need to urgently reduce the use of antimicrobial therapies, especially as single agents.
A combination of a topical retinoid plus an antimicrobial agent is first-line therapy for most patients with acne (a finding based on clinical trials with over 16,000 total subject participants in studies of Level I evidence quality), as it targets multiple pathogenic features and both inflammatory and noninflammatory acne lesions.
The Global Alliance 2009 update affirms that topical retinoids should be fundamentally a core component of an acne therapy regimen for stages I to III. The committee's consensus is that early and appropriate treatment, continued for as long as necessary, is the best approach to mitigating scarring for acne patients.
Implement strategies to improve adherence to therapy (e.g., medication reminders, self-monitoring with diaries, support groups, telephone follow-up) to ensure success.
Treat acne as quickly and as efficiently as possible to achieve the best therapeutic outcomes, and to improve patient satisfaction, limit treatment expenses, and mitigate scarring.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
1Clinical Instructor, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC. 2Family Physician in private practice, Woodstock, ON. 3Medical Director, Health Plexus and the Journal of Current Clinical Care, Toronto, ON.
Abstract: Do dermatologists and GPs approach acne care differently? How do these two groups of clinicians approach acne treatment, keep abreast of the latest guidelines, and manage maintenance therapy? How will the availability of a new retinoid combination product in Canada for acne change the way acne is currently treated?
To address these questions, a roundtable discussion was convened, featuring clinicians with a significant number of acne patients in their practices. Dr. Shannon Humphrey, a dermatologist, and Dr. Joseph Brioux, a family physician, and moderator Dr. D'Arcy Little, himself a family physician and radiologist, offered a candid take on guideline-based acne treatment and the effort to improve treatment outcomes among patients.
The discussants addressed how each professional has tended to view acne, pursues acne care differently, and why. They also discussed the latest acne treatment guidelines as well as the depth of the gap between the generalist's versus the specialist's treatment approach.
Antiobiotic resistance is a key factor to consider when establishing maintenance and treatment regimens.
Combination retinoid-based therapies are first-line treatments for acne; evidence suggests that such regimens achieve faster and more complete clearance, while addressing multiple pathogenic factors simultaneously.
Patients are often prescribed legitimate, evidence-based therapies but may abandon them after a short trial because of lack of perceived, efficacy or side effects. Address patient expectations and advise on the necessity of pursuing a sufficient course of topical therapy (e.g., 12 weeks) before drawing conclusions.
It is advisable to see patients on maintenance therapy for follow-up—attempt at least two office visits per year, and more if there is an increase in flares.
Convey to patients that acne is a chronic condition and that a sound treatment maintenance regimen is essential.
Do not give samples to patients unless supply is sufficient to pursue a 12-week trial of medication.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Abstract: Adapalene 0.1%/BPO 2.5% (adapalene/BPO) gel is a novel agent for acne therapy that has recently become available in Canada. This fixed-dose combination of a topical retinoid and benzoyl peroxide is efficacious in mild-moderate inflammatory acne and as an adjunct to oral antibiotics for severe acne. Adapalene 0.1%/BPO 2.5% (adapalene/BPO) gel provides synergistic efficacy, whereby efficacy of the combination exceeds the summed efficacy of individual components. Furthermore, adapalene/BPO with oral doxycycline for severe acne increases the rate of global treatment success four-fold beyond that with doxycycline alone. Practical means to abrogate the development of local intolerability have been shown to be effective.
Three of five pathogenic factors involved in acne can be addressed by topical medications: follicular hyperkeratinization, Proprionibacterium acnes proliferation, and inflammation.
The combination of retinoid and BPO in the form of adapalene 0.1%/BPO 2.5% has recently been approved in Canada, and has been advocated by an international acne expert group as a rational standard for treating mild-moderate acne as it offers complementary mechanisms of action.
An adapalene/BPO formulation provides greater proportions of global success and reduction in acne lesion counts compared to the vehicle or either agent alone.
As topical retinoids and benzoyl peroxide can be irritating, their combination may potentiate this factor. Measures to minimize intolerability include every other night application and daily moisturizer use.
For the treatment of mild-moderate acne, the fixed-dose adapalene and BPO gel combination may enhance treatment efficacy and adherence through improved ease of use.
Benzoyl peroxide does not induce bacterial resistance.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
One of the marked changes in the practice of dermatology over the past thirty years has been the increased focus on acne. What was once considered a universal rite of passage that occasionally caused deeply disturbing scars is now considered—by patients and doctors alike—an insufferable condition that must be treated. Perhaps as a sign that available treatments are increasingly successful, acne is showing signs of affecting popular culture. Kid Acne, a British artist (not his real name!), decided to make his affliction his signature so as to stand out in the crowded hip-hop scene. The Uruguayan movie Acné (as you would have guessed, about a thirteen-year-old boy coming of age while enduring acne outbreaks) was a hit of Spanish-speaking cinema in 2008. Acne for Dummies by Dr. Herbert P. Goodheart (a remarkably good book!) ranks a respectable 76th in skin care/ beauty books on Amazon.ca.
