Acne: Current Concepts

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Abstract
At the patient's initial visit an assessment of general medical health and degree, type, and extent of acne is made. A careful history is obtained to determine possible aggravating factors, such as the ingestion of hormones or drugs, or the use of moisturizing or corticosteroid creams. If the patient has a few comedones and papules, benzoyl peroxide alone may be adequate. If comedones are large and numerous, retinoic acid plus benzoyl peroxide is useful. If there are a significant number of deep pustules and nodules, tetracycline or erythromycin orally can be prescribed. The dosage of antibiotic should be tapered and the drug discontinued as soon as the inflamniatory lesions subside. The patient should be informed that topical medications must be used indefinitely even when the eruption improves because the medications will prevent formation of new lesions. The patient should also be told that acne responds over a period of weeks, not days, and that improvement may not be noticed for four to eight weeks. Provision of a realistic time frame helps the adolescent to maintain confidence in the peeling medications which, at times, will cause irritation and redness of the face. Frequency of cleansing and appropriate cleansing agents and shampoos should be discussed. Dietary facts and fictions should also be mentioned, and, in some instances, parents should be included to preveiit confrontations at home. Girls who feel the need to cover blemishes should be advised to avoid greasy foundations and substitute one of the many cosmetically acceptable water-based formulations now available. Patient compliance will increase if a brief explanation of the pathogenesis of acne lesions and the effects of therapeutic agents is provided. Above all, the teenager should be told that the outlook for improvement is good, that acne can be treated successfully, and that for most patients, excellent control can be achieved if there is cooperation and interest on the part of both physician and patient.

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