Acne vulgaris- how to manage?
Hello, my niece is a 28-year-old woman who has got acne primarily located on her cheeks, chin, and forehead. She had more than 10 papules or pustules on each of these areas, which I consider severe acne. In addition, she experienced painful red cysts on her cheeks and chin. She had pale skin with red undertones. How to manage this ?
@kunal Oral antibiotics are indicated in mainly moderate-to-severe inflammatory acne. Tetracyclines and derivatives still remain the first choice. Macrolides, co-trimoxazole, and trimethoprim are other alternatives for acne. The following agents should not be used in acne due to lack of efficacy and safety consideration such as cephalosporins, sulphonamide, and gyrase inhibitors. Tetracycline (500 mg–1 g/day), doxycycline (50–200 mg/day), minocycline (50–200 mg/day), lymecycline (150–300 mg/day), erythromycin (500 mg–1 g/day), co-trimoxazole, trimethoprim, and recently azithromycin (500 mg thrice weekly) are being used successfully in acne. Minocycline and doxycycline are more effective than tetracycline and erythromycin. Recently, doxycycline in subantimicrobial dose (20 mg twice daily) and an extended-release minocycline tablet (1 mg/kg/day) were used and found to be effective, but further controlled trials are needed. Gastrointestinal upset and vaginal candidiasis are most common side effects. Doxycycline can be associated with photosensitivity. Minocycline may produce pigment deposition in the skin, mucous membrane, and teeth. Autoimmune hepatitis, systemic lupus erythematosus-like syndrome, and serum sickness-like reactions occur rarely with minocycline.