Key concepts:
- Acne vulgaris, simply known as acne, is a common skin disease seen worldwide.
- Commonly, there are three types of acne: mild, moderate, and severe forms of infection.
- For Mild Acne: Topical therapy is suggested with a retinoid with or without benzoyl peroxide.
- For Moderate Acne: Topical treatment with oral antibiotics is suggested.
- For severe acne, oral isotretinoin is recommended only after being suggested by a dermatologist.
- Combination therapy used in acne vulgaris prevents antibiotic resistance.
- Maintenance therapy is very crucial to avoid recurrences of acne.
- For treatment, patient counselling is essential, which will improve adherence, reduce side effects, and help to develop a skin care routine
Worldwide, acne vulgaris is one of the most common skin conditions. Pharmacists being some of the frontline healthcare professionals, it is essential to understand their causes, clinical significance, and treatment plans.
For overseas pharmacists preparing for the OPRA exam, this topic is crucial because it deals with pharmacology, dermatology, and patient counselling skills.
In this guide, we’ll break down the treatment of acne vulgaris, focusing on both pharmacological and non-pharmacological approaches, as well as everything you need to review for the exam.
Understanding Acne Vulgaris
It is an inflammatory skin condition caused by the blockage of pores by dead skin cells or oil (sebum). Common symptoms of acne include:
- Blackheads and whiteheads
- Pimples, which can be pus-filled and sometimes painful
- Oily skin
- In cases, scarring happens
It usually affects the face, chest, and back, and is most common in adolescents but can persist into adulthood.
Key Pathophysiology:
- It can be caused by increased sebum production (especially in puberty, due to hormonal imbalance).
- It can be caused by follicular hyperkeratinisation (clogged pores)
- It can also form due to a bacterial infection, caused by Cutibacterium acnes (formerly Propionibacterium acnes)
What are the types of acne?
Types of Acne
| Type of Acne | Formed By |
|---|---|
| Cystic acne | Causes deep, pus-filled pimples and nodules. They can cause scars. |
| Fungal acne | Due to fungal infection caused by yeast buildup in hair follicles; it can be itchy and inflamed. |
| Hormonal acne | Overproduction of sebum clogs the pores. |
| Nodular acne | Severe form seen on the surface of the skin, with tender nodular lumps under the skin. |
How severe can acne get?
Dermatologists rank acne as:
Acne Grading System
| Grade | Description |
|---|---|
| Grade 1 (Mild) | Mostly whiteheads and blackheads, with a few papules and pustules. |
| Grade 2 (Moderate or pustular acne) | Multiple acne on the face with pus. |
| Grade 3 (Moderately severe or nodulocystic acne) | Occasionally, inflamed nodules are seen on the back or chest. |
| Grade 4 (Severe nodulocystic acne) | Numerous, painful, enlarged, and inflamed pustules and nodules. |
Stepwise Treatment of Acne Vulgaris
1. Common Measures to adapt
- People with sensitive skin should cleanse their faces with a mild soap twice daily.
- Avoid using a scrub or picking the lesions with nails to avoid further infection or scars.
- Use mild moisturizers and sunscreens for protection.
2. First-Line Treatment for Mild to Moderate Acne: Topical Therapy
- Patients can use topical retinoids (e.g., adapalene, tretinoin), which will reduce nodule formation. It also acts as an anti-inflammatory agent.
- Apply topical benzoyl peroxide, which acts as an antibacterial agent that prevents resistance when combined with an antibiotic.
- Using topical antibiotics, such as e.g., clindamycin and erythromycin, will reduce bacterial spread. Doctors suggest using it in combination with benzoyl peroxide.
3. Oral Therapy For Moderate to Severe Acne
- Oral retinoid derivative: Isotretinoin is an oral retinoid used to shrink the size of oil glands, which contribute to acne formation
- Oral antibiotics, such as doxycycline and minocycline, are used to reduce inflammation and further spread.
- Some Hormonal Therapy in females, with
- Combined Oral Contraceptives (anti-androgenic effect)
- Spironolactone (anti-androgen, off-label)
4. Treatment for Severe Acne / Nodulocystic Acne
- Oral Isotretinoin (Retinoid): Highly effective, reduces sebum, comedogenesis, and inflammation
- This medication should be used with caution. It requires strict monitoring of liver function tests and lipid profiles, and it should be wholly avoided in patients who are pregnant, as it causes teratogenicity.
5. Adjunctive Therapies
- Treatment with Intralesional corticosteroids for nodules
- Advanced therapy with a light-based source, such as lasers or photodynamic therapy, for resistant cases
6. Maintenance Therapy
Patients must continue using topical retinoids, either alone or in combination with benzoyl peroxide, for several months to prevent recurrence.
Conclusion
For pharmacy aspirants preparing for competitive exams like OPRA, it is crucial to understand the topics commonly discussed in the community. Some common skin conditions, like acne vulgaris, are a high-weightage topic for such exams. Pharmacists are the first line of healthcare service providers whom patients rely on for common, mild diseases.
Always consider that patient education and knowledge about standard therapies are essential for a pharmacist. The OPRA exam evaluates a pharmacist's knowledge required to practice safely and effectively in Australia.